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  1. Zamora-Ros R, Rinaldi S, Tsilidis KK, Weiderpass E, Boutron-Ruault MC, Rostgaard-Hansen AL, et al.
    Int J Cancer, 2016 Jan 01;138(1):65-73.
    PMID: 26190646 DOI: 10.1002/ijc.29693
    Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HRQ4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HRQ4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI ≥ 25 and with sugar intake in those with BMI 
    Matched MeSH terms: Aged; Middle Aged
  2. Zamora-Ros R, Barupal DK, Rothwell JA, Jenab M, Fedirko V, Romieu I, et al.
    Int J Cancer, 2017 Apr 15;140(8):1836-1844.
    PMID: 28006847 DOI: 10.1002/ijc.30582
    Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93-1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.
    Matched MeSH terms: Aged; Middle Aged
  3. Zamora-Ros R, Alghamdi MA, Cayssials V, Franceschi S, Almquist M, Hennings J, et al.
    Eur J Nutr, 2019 Dec;58(8):3303-3312.
    PMID: 30535794 DOI: 10.1007/s00394-018-1874-z
    PURPOSE: Coffee and tea constituents have shown several anti-carcinogenic activities in cellular and animal studies, including against thyroid cancer (TC). However, epidemiological evidence is still limited and inconsistent. Therefore, we aimed to investigate this association in a large prospective study.

    METHODS: The study was conducted in the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort, which included 476,108 adult men and women. Coffee and tea intakes were assessed through validated country-specific dietary questionnaires.

    RESULTS: During a mean follow-up of 14 years, 748 first incident differentiated TC cases (including 601 papillary and 109 follicular TC) were identified. Coffee consumption (per 100 mL/day) was not associated either with total differentiated TC risk (HRcalibrated 1.00, 95% CI 0.97-1.04) or with the risk of TC subtypes. Tea consumption (per 100 mL/day) was not associated with the risk of total differentiated TC (HRcalibrated 0.98, 95% CI 0.95-1.02) and papillary tumor (HRcalibrated 0.99, 95% CI 0.95-1.03), whereas an inverse association was found with follicular tumor risk (HRcalibrated 0.90, 95% CI 0.81-0.99), but this association was based on a sub-analysis with a small number of cancer cases.

    CONCLUSIONS: In this large prospective study, coffee and tea consumptions were not associated with TC risk.

    Matched MeSH terms: Aged; Middle Aged
  4. Zamora-Ros R, Cayssials V, Franceschi S, Kyrø C, Weiderpass E, Hennings J, et al.
    Int J Cancer, 2020 Apr 01;146(7):1841-1850.
    PMID: 31342519 DOI: 10.1002/ijc.32589
    Polyphenols are bioactive compounds with several anticarcinogenic activities; however, human data regarding associations with thyroid cancer (TC) is still negligible. Our aim was to evaluate the association between intakes of total, classes and subclasses of polyphenols and risk of differentiated TC and its main subtypes, papillary and follicular, in a European population. The European Prospective Investigation into Cancer and Nutrition cohort included 476,108 men and women from 10 European countries. During a mean follow-up of 14 years, there were 748 incident differentiated TC cases, including 601 papillary and 109 follicular tumors. Polyphenol intake was estimated at baseline using validated center/country-specific dietary questionnaires and the Phenol-Explorer database. In multivariable-adjusted Cox regression models, no association between total polyphenol and the risks of overall differentiated TC (HRQ4 vs. Q1 = 0.99, 95% confidence interval [CI] 0.77-1.29), papillary (HRQ4 vs. Q1 = 1.06, 95% CI 0.80-1.41) or follicular TC (HRQ4 vs. Q1 = 1.10, 95% CI 0.55-2.22) were found. No associations were observed either for flavonoids, phenolic acids or the rest of classes and subclasses of polyphenols. After stratification by body mass index (BMI), an inverse association between the intake of polyphenols (p-trend = 0.019) and phenolic acids (p-trend = 0.007) and differentiated TC risk in subjects with BMI ≥ 25 was observed. In conclusion, our study showed no associations between dietary polyphenol intake and differentiated TC risk; although further studies are warranted to investigate the potential protective associations in overweight and obese individuals.
    Matched MeSH terms: Middle Aged
  5. Zamora-Ros R, Castañeda J, Rinaldi S, Cayssials V, Slimani N, Weiderpass E, et al.
    J Nutr, 2017 Jul;147(7):1366-1373.
    PMID: 28592517 DOI: 10.3945/jn.117.247874
    Background: Differentiated thyroid cancer (TC) is the most common endocrine cancer. Fish can be an important source of iodine and other micronutrients and contaminants that may affect the thyroid gland and TC risk.Objective: We prospectively evaluated the relations between the consumption of total fish and different fish types and shellfish and TC risk in the EPIC (European Prospective Investigation into Cancer and Nutrition) study.Methods: EPIC is a cohort of >500,000 men and women, mostly aged 35-70 y, who were recruited in 10 European countries. After a mean follow-up of 14 y, 748 primary differentiated TC cases were diagnosed; 666 were in women and 601 were papillary TC. Data on intakes of lean fish, fatty fish, fish products, and shellfish were collected by using country-specific validated dietary questionnaires at recruitment. Multivariable Cox regression was used to calculate HRs and 95% CIs adjusted for many potential confounders, including dietary and nondietary factors.Results: No significant association was observed between total fish consumption and differentiated TC risk for the highest compared with the lowest quartile (HR: 1.03; 95% CI: 0.81, 1.32; P-trend = 0.67). Likewise, no significant association was observed with the intake of any specific type of fish, fish product, or shellfish. No significant heterogeneity was found by TC subtype (papillary or follicular tumors), by sex, or between countries with low and high TC incidence.Conclusion: This large study shows that the intake of fish and shellfish was not associated with differentiated TC risk in Europe, a region in which iodine deficiency or excess is rare.
    Matched MeSH terms: Aged; Middle Aged
  6. Zamiah SAKS, Draman CR, Seman MR, Safhan AF, Rozalina R, Nik Ruzni NI
    Saudi J Kidney Dis Transpl, 2018 2 20;29(1):114-119.
    PMID: 29456216 DOI: 10.4103/1319-2442.225185
    Cardiovascular (CV) event is the most common cause of death in dialysis patients. Both traditional and nontraditional CV risk factors related to malnutrition, inflammation, and anemia are commonly found in this population. This study was conducted to evaluate the burden factors of CV risk factors and its management in our regularly dialyzed patients. It was a single-center, cross-sectional analysis of prevalent intermittent hemodialysis (IHD) and continuous ambulatory peritoneal dialysis (CAPD) patients followed up in our hospital. Both the traditional and non-traditional CV risk factors were recorded and compared between the two groups. Eighty-eight patients were recruited. Forty-five were treated with CAPD and 43 patients were treated with IHD. The mean age was 49.5 ± 15.17 years old and 54.5% were females. Eighty percent were Malay followed by Chinese (14.7%) and Indian (5.7%). Thirty-eight percent were hypertensive and 17% were diabetic. The mean age of CAPD patients was 48.9 ± 16.9 compared to 50 ± 13.5 years old for IHD patients (P > 0.05). The body mass index (BMI) of CAPD patients was 23.9 kg/m2 versus 21.7 kg/m2 of the IHD (P = 0.04). The systolic and diastolic blood pressure of CAPD patients were 158 and 89 mm Hg in comparison to 141 and 72 mm Hg in IHD patients (P <0.001) and their total and low-density lipoprotein cholesterol level were 5.93 mmol/L and 3.84 mmol/L versus 4.79 mmol/L and 2.52 mmol/L, respectively (P≤0.001). The CAPD patients were hyperglycemic more than IHD patients, although it was not statistically significant. All the nontraditional CV risk factors except serum albumin were comparable between the two groups. Serum albumin in CAPD patients was 35.5 g/L compared to 40.8 g/L in the IHD patients (P <0.001). In our prevalent dialysis-dependent patients, both traditional and non-traditional CV risk factors are common. Due to the prolonged and continuous glucose exposure from the peritoneal dialysis fluid, the CAPD patients had highly atherogenic serum, higher BMI, and intensified inflammation which pre-disposed them to higher CV events.
    Matched MeSH terms: Aged; Middle Aged
  7. Zambahari R, Kwok OH, Javier S, Mak KH, Piyamitr S, Tri Ho HQ, et al.
    Int J Clin Pract, 2007 Mar;61(3):473-81.
    PMID: 17313616
    Several therapeutic approaches have been developed to improve the outcome among patients with acute coronary syndrome (ACS). However, treatment with antithrombotic therapies such as oral glycoprotein IIb/IIIa inhibitors has been limited by the lack of efficacy and excess bleeding complications. As the publication of the landmark study Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), the clinical benefit of early and intermediate-term use of combined antiplatelet agents--clopidogrel plus aspirin--in non-ST-segment elevation myocardial infarction (NSTEMI) patients became evident. Pretreatment and intermediate-term therapy with clopidogrel in NSTEMI ACS patients undergoing percutaneous coronary intervention (PCI) was further supported by the PCI-CURE trial. Recently, the results of two major trials Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28, Clopidogrel and Metoprolol in Myocardial Infarction Trial established the pivotal role of clopidogrel in the other spectrum of ACS-STEMI. Coupled with the results from previous multicentre trials, these two studies provide a guide for the early and long-term use of clopidogrel in the whole spectrum of ACS. A review summarising the results of the recent clinical trials and a discussion on its implications for the clinical management of ACS is presented.
    Matched MeSH terms: Aged; Middle Aged
  8. Zamaniah WI, Mastura MY, Phua CE, Adlinda A, Marniza S, Rozita AM
    Asian Pac J Cancer Prev, 2014;15(20):8987-92.
    PMID: 25374241
    BACKGROUND: The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre.

    MATERIALS AND METHODS: A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin (40 mg/m2) concurrent with daily EBRT to pelvis of 45-50 Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated.

    RESULTS: The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients.

    CONCLUSIONS: The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.

    Matched MeSH terms: Aged; Middle Aged
  9. Zaman Huri H, Permalu V, Vethakkan SR
    PLoS One, 2014;9(9):e106505.
    PMID: 25181406 DOI: 10.1371/journal.pone.0106505
    Sliding-scale and basal-bolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Although its use is not recommended, sliding-scale insulin therapy is still being used widely. The aims of the study were to compare the glycemic control achieved by using sliding-scale or basal-bolus regimens for the management of severe or acute hyperglycemia in patients with type 2 diabetes and to analyze factors associated with the types of insulin therapy used in the management of severe or acute hyperglycemia. This retrospective study was conducted using the medical records of patients with acute or severe hyperglycemia admitted to a hospital in Malaysia from January 2008 to December 2012. A total of 202 patients and 247 admissions were included. Patients treated with the basal-bolus insulin regimen attained lower fasting blood glucose (10.8 ± 2.3 versus 11.6 ± 3.5 mmol/L; p = 0.028) and mean glucose levels throughout severe/acute hyperglycemia (12.3 ± 1.9 versus 12.8 ± 2.2; p = 0.021) compared with sliding-scale insulin regimens. Diabetic ketoacidosis (p = 0.043), cardiovascular diseases (p = 0.005), acute exacerbation of bronchial asthma (p = 0.010), and the use of corticosteroids (p = 0.037) and loop diuretics (p = 0.016) were significantly associated with the type of insulin regimen used. In conclusion, type 2 diabetes patients with severe and acute hyperglycemia achieved better glycemic control with the basal-bolus regimen than with sliding-scale insulin, and factors associated with the insulin regimen used could be identified.
    Matched MeSH terms: Middle Aged
  10. Zaman Huri H, Chai Ling L
    BMC Public Health, 2013;13:1192.
    PMID: 24341672 DOI: 10.1186/1471-2458-13-1192
    Drug-Related Problems (DRPs) commonly occur among type 2 diabetes mellitus (T2DM) patients. However, few studies have been performed on T2DM patients with dyslipidemia. This purpose of this study was to assess drug-related problems (DRPs) and factors associated with its occurrence.
    Matched MeSH terms: Aged; Aged, 80 and over; Middle Aged
  11. Zaman Huri H, Lian Choo T, Sulaiman CZ, Mark R, Abdul Razack AH
    BMJ Open, 2014 Jul 07;4(7):e005381.
    PMID: 25001396 DOI: 10.1136/bmjopen-2014-005381
    OBJECTIVE: To investigate factors associated with demographic/clinical characteristics and drug selection in patients with erectile dysfunction (ED). The prevalence of ED is increasing worldwide. Studies have shown that ED is associated with age, lifestyle and comorbidities. However, the factors associated with patient characteristics as well as drug selection are incompletely understood.

    SETTING: A tertiary medical centre in Kuala Lumpur, Malaysia.

    PARTICIPANTS: A total of 219 patients (range 23-80 years) who had received phosphodiesterase type-5 (PDE-5) inhibitors as ED treatment were evaluated.

    INCLUSION CRITERIA: Adult patients aged ≥18 years, diagnosed with ED, and prescribed with sildenafil, tadalafil or vardenafil.

    EXCLUSION CRITERIA: Patients diagnosed with ED but who did not receive any PDE-5 inhibitor, or those with missing data.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Factors associated with demographic and clinical characteristics as well as drug selection were assessed.

    RESULTS: Ischaemic heart disease (p=0.025), benign prostatic hyperplasia (p<0.001), obesity (p=0.005), lower urinary tract symptoms (LUTS) (p=0.006) and α-blockers (p<0.001) were significantly associated with elderly patients with ED. Additionally, LUTS (p=0.038) and α-blockers (p=0.008) were significantly associated with the selection of PDE-5 inhibitor.

    CONCLUSIONS: These data showed that elderly patients with ED were significantly associated with comorbidities and α-blockers, whereas LUTS and α blockers were associated with drug selection.

    Matched MeSH terms: Aged; Aged, 80 and over; Middle Aged
  12. Zalina, N., Aruku, N., Azura, N., Shahida, N., Akhmarina, N., Dian, F.
    MyJurnal
    Introduction: Frequency of lower urinary tract symptoms (LUTS) in young age women is not well studied. It is said to be common among female elderly and multiparous population. The aim of this study is to obtain the prevalence of LUTS among nulliparous students in relation to their personal hygiene. Materials and methods: This is a prospective cross-sectional study conducted among 200 nulliparous medical and nursing students aged between 18-28 years using standardized questionnaires. Urine samples were also collected from students to detect urinary tract infections. Results: The complete data sets of 146 students were analyzed. All of them were nulliparous, single and not sexually active. The prevalence of LUTS was 52.7% consist of over-active bladder, urinary incontinence (UI) and voiding difficulty respectively (51.3%, 34.9% and 45.2%). The most common type of UI was stress urinary incontinence which was 21.9% followed by 11.6% of urgency incontinence. Conclusion: The prevalence of LUTS among young age population is high at 52.7%. Public awareness regarding LUTS and availability of treatment is needed.
    Matched MeSH terms: Aged
  13. Zalina AZ, Lee VC, Kandiah M
    Malays J Nutr, 2012 Aug;18(2):255-64.
    PMID: 24575671 MyJurnal
    The objective of this study was to determine the relationship between nutritional status, physical activity and quality of life among gastrointestinal cancer survivors.
    Matched MeSH terms: Aged; Middle Aged
  14. Zaki R, Roffeei SN, Hii YL, Yahya A, Appannan M, Said MA, et al.
    PLoS One, 2019;14(2):e0212497.
    PMID: 30818394 DOI: 10.1371/journal.pone.0212497
    An early warning system for dengue is meant to predict outbreaks and prevent dengue cases by aiding timely decision making and deployment of interventions. However, only a system which is accepted and utilised by the public would be sustainable in the long run. This study aimed to explore the perception and attitude of the Malaysian public towards a dengue early warning system. The sample consisted of 847 individuals who were 18 years and above and living/working in the Petaling District, an area adjacent to Kuala Lumpur, Malaysia. A questionnaire consisting of personal information and three sub-measures of; i) perception, ii) attitude towards dengue early warning and iii) response towards early warning; was distributed to participants. We found that most of the respondents know about dengue fever (97.1%) and its association with climate factors (90.6%). Most of them wanted to help reduce the number of dengue cases in their area (91.5%). A small percentage of the respondents admitted that they were not willing to be involved in public activities, and 64% of them admitted that they did not check dengue situations or hotspots around their area regularly. Despite the high awareness on the relationship between climate and dengue, about 45% of respondents do not know or are not sure how this can be used to predict dengue. Respondents would like to know more about how climate data can be used to predict a dengue outbreak (92.7%). Providing more information on how climate can influence dengue cases would increase public acceptability and improve response towards climate-based warning system. The most preferred way of communicating early warning was through the television (66.4%). This study shows that the public in Petaling District considers it necessary to have a dengue warning system to be necessary, but more education is required.
    Matched MeSH terms: Aged; Middle Aged
  15. Zaki NAM, Ambak R, Othman F, Wong NI, Man CS, Morad MFA, et al.
    J Health Popul Nutr, 2021 05 31;40(Suppl 1):8.
    PMID: 34059165 DOI: 10.1186/s41043-021-00237-y
    BACKGROUND: Hypertension is one of the most common risk factors for cardiovascular disease and leading cause of mortality globally. The aims of this study were to assess the prevalence of hypertension and its associated risk factors among Malaysian population using data from the Malaysian Community Salt Study (MyCoSS).

    METHODS: This study was a cross-sectional study using multi-stage stratified sampling method. Data collection was carried out via face-to-face interview at the respondent's home from October 2017 until March 2018. A total of 1047 respondents aged 18 years and above completed the questionnaires and blood pressure measurement. A person who reported diagnosis of hypertension by a physician and had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on three readings was categorised as hypertensive. Risk factors of hypertension were analysed using multiple logistic regression.

    RESULTS: The prevalence of hypertension in the present study was 49.39% (95% CI 44.27-54.51). There was no statistically significant difference in gender. Age, household income, BMI, and diabetes were significantly associated with hypertension. Hypertension found had inverse association with the level of education. Age was the strongest predictor of hypertension (35-44 years old; OR=2.39, 95% CI=1.39-4.09, 45-54 years old; OR=5.50, 95% CI=3.23-9.38, 55-64 years old OR=13.56, 95% CI=7.77-23.64 and 65 years old and above; OR=25.28, 95% CI=13.33-48.66). Those who had higher BMI more likely to be hypertensive as compared to respondents with normal weight (overweight, OR=1.84; 95% CI=1.18-2.86; obese, OR=4.29% CI=2.56-7.29).

    CONCLUSION: The findings showed that hypertension is prevalent among adults in Malaysia. Those with older age, higher BMI, and diabetes are more likely to have hypertension. Efforts regarding lifestyle modification and education could be important in hypertension management and prevention.

    Matched MeSH terms: Aged; Middle Aged
  16. Zaki M, Robaayah Z, Chan SP, Vadivale M, Lim TO
    Med J Malaysia, 2010 Jun;65 Suppl A:143-9.
    PMID: 21488476
    Abdominal obesity (AO), measured by waist circumference (WC), is a stronger predictor of subsequent development of cardiovascular disease (CVD) than generalised obesity, which is measured by body mass index (BMI). This study aimed to measure WC and prevalence of AO in Malaysians visiting primary care physicians. 1893 patients between the ages of 18 and 80 attending primary care clinics in Malaysia were recruited over two days for this multi-centre cross-sectional study. Pregnant women were excluded, their medical history, weight, height and WC were examined. The prevalence of co-morbidities were as follows: (1) CVD-4%, lipid disorder-17%, hypertension-26%, diabetes-14% and any of the clinical characteristics of CVD/lipid disorder/hypertension/diabetes-38%. The mean BMI for men and women was 25.62 +/- 4.73 kg/m2 and 26.63 +/- 5.72 kg/m2, respectively. Based on WHO criteria for BMI (overweight, 25-29.9 kg/m2; obese, > 30 kg/m2), 34.2% were overweight and 20.4% were obese. The mean WC for men and women was 89.03 +/- 13.45 cm and 84.26 +/- 12.78 cm, respectively. Overall, 55.6% had AO and there was higher prevalence among women (based on International Diabetes Federation criteria: WC > or = 90 cm for men and > or = 80 cm for women). AO was present in approximately 71% patients with lipid disorder, in 76% with hypertension and in 75% with diabetes. Patients with AO were also at a higher risk of developing co-morbidities. Malaysia has a high prevalence of AO and associated cardiovascular risk factors. This needs to be addressed by public health programs, which should also include routine measurement of WC.
    Matched MeSH terms: Aged; Middle Aged
  17. Zakaria Z, Zainordin NA, Sim BL, Zaid M, Haridan US, Aziz AT, et al.
    J Infect Dev Ctries, 2014 Jul;8(7):869-75.
    PMID: 25022297 DOI: 10.3855/jidc.4283
    INTRODUCTION: The latest revised version of the World Health Organization's dengue classification was released in 2009. A handful of studies have taken initiatives to evaluate the old and revised guidelines to determine early signs and symptoms of severe dengue. This retrospective study aimed to compare the classification of dengue using both the 1997 and 2009 guidelines in a selected cohort of dengue patients from Peninsular Malaysia between 2008 and 2012.
    METHODOLOGY: Adult dengue patients were recruited from tertiary hospitals in two different states, Selangor and Kelantan, in Peninsular Malaysia. Their clinical manifestations were assessed.
    RESULTS: A total of 281 confirmed dengue patients were enrolled; the mean duration of illness at admission was five days. Of these, 88.6%, 10.7%, and 0.7% were classified according to the 1997 guidelines as having dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), respectively. When the WHO 2009 guidelines were applied, 17.1%, 78.3%, and 4.6% were classified as dengue without warning signs, dengue with warning signs, and severe dengue, respectively.
    CONCLUSIONS: Our data suggests that the revised WHO 2009 guidelines stratify a much larger proportion of patients into a category that requires a higher level of medical and nursing care.
    Matched MeSH terms: Aged; Aged, 80 and over; Middle Aged
  18. Zakaria Z, Sapiai NA, Ghani ARI
    Acta Neurochir (Wien), 2021 08;163(8):2359-2362.
    PMID: 34101024 DOI: 10.1007/s00701-021-04860-w
    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is a highly transmissible virus and has become pandemic. Part of the prevention of disease spread by the Malaysian government is by getting COVID-19 vaccine. Using the mRNA technology, the Pfizer/BioNTech vaccine is one of the vaccines been approved by the Drug Control Authority in Malaysia. Herein, we report an immediate complication of cerebral VST after the first dose of the Pfizer/BioNTech vaccine.
    Matched MeSH terms: Middle Aged
  19. Zakaria Z, Badhan RKS
    Eur J Pharm Sci, 2018 Jul 01;119:90-101.
    PMID: 29635009 DOI: 10.1016/j.ejps.2018.04.012
    Lumefantrine is a widely used antimalarial in children in sub-Saharan Africa and is predominantly metabolised by CYP3A4. The concomitant use of lumefantrine with the antiretroviral efavirenz, which is metabolised by CYP2B6 and is an inducer of CYP3A4, increases the risk of lumefantrine failure and can result in an increased recrudescence rate in HIV-infected children. This is further confounded by CYP2B6 being highly polymorphic resulting in a 2-3 fold higher efavirenz plasma concentration in polymorphic subjects, which enhances the potential for an efavirenz-lumefantrine drug-drug interaction (DDI). This study developed a population-based PBPK model capable of predicting the impact of efavirenz-mediated DDIs on lumefantrine pharmacokinetics in African paediatric population groups, which also considered the polymorphic nature of CYP2B6. The validated model demonstrated a significant difference in lumefantrine target day 7 concentrations (Cd7) in the presence and absence of efavirenz and confirmed the capability of efavirenz to initiate this DDI. This was more apparent in the *6/*6 compared to *1/*1 population group and resulted in a significantly lower (P 
    Matched MeSH terms: Middle Aged
  20. Zakaria SM, Abdullah N, Md Akhir N, Amin AS, Mohd Shukry ANA, Abdul Rashid MR, et al.
    Int J Environ Res Public Health, 2022 Sep 27;19(19).
    PMID: 36231521 DOI: 10.3390/ijerph191912219
    During the pandemic, the lives of B40 single mothers were severely affected, especially in terms of social, economic, and psychological factors. The reduction of income caused by the crisis has forced single mothers and their children to live frugally and without luxury. They also had to perform more than one job at a time during the pandemic to meet their children's needs. A qualitative study has been conducted to explore the perceptions of quality of life during the pandemic among B40 single mothers. Respondents were selected based on demographic characteristics established before the study. A focus group discussion has been conducted on ten (10) B40 single mothers in Balik Pulau, Penang. Single mothers were selected based on purposive sampling. They had to meet the inclusive criteria required to participate in the study, specifically: aged between 20 and 60 years old, belonged to the B40 income category, had children under 18 years old living together, and became single mothers due to divorce or death of husbands. The focused group discussion explored issues related to qualities of life during the pandemic. B40 single mothers expressed their concern about access to health facilities, security in residence, children's education, and economic stability. These areas of life quality have been significantly affected especially during Movement Control Order (MCO). In short, the quality of life of these single mothers has been significantly affected by the pandemic. Their vulnerability towards stress, anxiety, and depression have worsened due to financial issues. Besides the need for emotional and social support, this study found that these single mothers entail financial support.
    Matched MeSH terms: Middle Aged
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