Displaying publications 1381 - 1400 of 8478 in total

Abstract:
Sort:
  1. Khaing M, Lim KS, Tan CT
    Epileptic Disord, 2014 Sep;16(3):370-4.
    PMID: 25166001 DOI: 10.1684/epd.2014.0672
    We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.
  2. Tan SH, Ong KC, Wong KT
    J. Neuropathol. Exp. Neurol., 2014 Nov;73(11):999-1008.
    PMID: 25289894 DOI: 10.1097/NEN.0000000000000122
    Enterovirus 71 (EV71)-associated hand, foot, and mouth disease may be complicated by encephalomyelitis. We investigated EV71 brainstem infection and whether this infection could be ameliorated by passive immunization in a mouse model. Enterovirus 71 was injected into unilateral jaw/facial muscles of 2-week-old mice, and hyperimmune sera were given before or after infection. Harvested tissues were studied by light microscopy, immunohistochemistry, in situ hybridization, and viral titration. In unimmunized mice, viral antigen and RNA were detected within 24 hours after infection only in ipsilateral cranial nerves, motor trigeminal nucleus, reticular formation, and facial nucleus; viral titers were significantly higher in the brainstem than in the spinal cord samples. Mice given preinfection hyperimmune serum showed a marked reduction of ipsilateral viral antigen/RNA and viral titers in the brainstem in a dose-dependent manner. With optimum hyperimmune serum given after infection, brainstem infection was significantly reduced in a time-dependent manner. A delay in disease onset and a reduction of disease severity and mortality were also observed. Thus, EV71 can directly infect the brainstem, including the medulla, via cranial nerves, most likely by retrograde axonal transport. This may explain the sudden cardiorespiratory collapse in human patients with fatal encephalomyelitis. Moreover, our results suggest that passive immunization may still benefit EV71-infected patients who have neurologic complications.
  3. Azmi AN, Tan SS, Mohamed R
    World J Gastroenterol, 2014 Sep 14;20(34):12045-55.
    PMID: 25232242 DOI: 10.3748/wjg.v20.i34.12045
    The natural history of chronic hepatitis B is characterized by different phases of infection, and patients may evolve from one phase to another or may revert to a previous phase. The hepatitis B e antigen (HBeAg)-negative form is the predominant infection worldwide, which consists of individuals with a range of viral replication and liver disease severity. Although alanine transaminase (ALT) remains the most accessible test available to clinicians for monitoring the liver disease status, further evaluations are required for some patients to assess if treatment is warranted. Guidance from practice guidelines together with thorough investigations and classifications of patients ensure recognition of who needs which level of care. This article aims to assist physicians in the assessment of HBeAg-negative individuals using liver biopsy or non-invasive tools such as hepatitis B s antigen quantification and transient elastography in addition to ALT and hepatitis B virus DNA, to identify who will remain stable, who will reactivate or at risk of disease progression hence will benefit from timely initiation of anti-viral therapy.
  4. Tan WL, Asahar SF, Harun NL
    Singapore Med J, 2015 Apr;56(4):224-7.
    PMID: 25532511 DOI: 10.11622/smedj.2014170
    INTRODUCTION: Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors.
    METHODS: This cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors.
    RESULTS: There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00).
    CONCLUSION: Insulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.
    Study site: Klinik Kesihatan, Kubang Pasu, Kedah, Malaysia
  5. Zia A, Kamaruzzaman SB, Tan MP
    Postgrad Med, 2015 Apr;127(3):330-7.
    PMID: 25539567 DOI: 10.1080/00325481.2014.996112
    The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug-drug or drug-disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.
  6. Tan SC, Matzen P, Khoo SP
    Value Health, 2014 Nov;17(7):A743.
    PMID: 27202681 DOI: 10.1016/j.jval.2014.08.153
    Objectives
    Economic evaluations of BIAsp have been published in the context of different countries. This study aimed to evaluate the financial impact from a perspective of patients treated by public providers of different adoption rates of Biphasic Insulin Aspart (BIAsp; NovoMix 30 FlexPen®) versus Biphasic Human Insulin (BHI; Mixtard Penfill®) in treating T2DM.
    Methods
    An Excel based 5-year budget impact model was built to estimate insulin treated patients by public providers using the local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and medical costs for major hypoglycaemia and other complications were applied with a 3% discount rate to the estimated corresponding incidence rates derived from the UKPDS equations. The projected adoption rates were based on the 2013 utilisation volume data. Other local specific considerations e.g. subsidized selling prices and co-payments were included in the analyses for an assumed size of eligible patients. Sensitivity analyses were conducted.
    Results
    The adoption rates of BIAsp were assumed to increase from 23.6% in 2013 to 30% or 36.5% in 2018 for base case and upside scenario, respectively. In comparison to base case scenario, increases in adoption rate of BIAsp were associated with a cumulative increase up to slightly greater than S$ 2.02M in insulin acquisition cost but a potential cumulative net saving up to approximately S$0.92M in overall total costs over 5 years, attributing to subsidized selling price of BIAsp assuming it is included standard drug list and its significantly lower major hypoglycaemia risk, respectively. Cost savings were predicted for other complications.
    Conclusions
    The wider adoption of BIAsp was predicted to result in net cost savings from patient perspective in Singapore. More cost saving would be estimated in analyses with reduced productivity loss from a societal perspective.
  7. Tan SC, Matzen P, Yeo LN
    Value Health, 2014 Nov;17(7):A743.
    PMID: 27202679 DOI: 10.1016/j.jval.2014.08.151
    Objectives
    Budget impact analysis (BIA) is a useful tool for reimbursement decision-makers in health technology assessments by authorities across different countries. This study aimed to evaluate the financial impact from the Ministry of Health (MOH) perspective of different adoption rates of Biphasic Insulin Aspart (BIAsp) versus Biphasic Human Insulin (BHI) in treating type 2 diabetes mellitus.
    Methods
    An Excel basfed 5-year budget impact model was built to estimate insulin treated patients by public providers using local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and other medical costs for complications e.g. major hypoglycaemia, myocardial infarction, stroke, end-stage renal disease, blindness and amputation were included at a discount rate of 3%. The incidence rates of these complications were derived from the established UKPDS equations. The adoption rates were assumed and projected from the 2013 utilisation volume data of BIAsp and BHI by public providers. Sensitivity analyses were conducted.
    Results
    The adoption rates of BIAsp were assumed to increase from 1.8% in 2013 to 4.5% or 6.9% in 2018 for base case and upside scenario, respectively. Compared to the base case, upside scenario of wider BIAsp adoption was associated with an increased insulin cost up to RM 8.2M which was offset by avoided complication costs resulting in an overall net budget saving of approximately RM 5.5M over 5 years, primarily driven by estimated reduction in major hypoglycaemia events for patients treated with BIAsp.
    Conclusions
    The higher and wider adoption of BIAsp would likely be associated with cost savings in Malaysia from the MOH perspective attributed to its superiority in H1Ac reduction and lower major hypoglycemia risk in comparison to BHI. More cost saving would be concluded if productivity loss is included from a societal perspective.
  8. Lum KY, Lindén M, Tan TS
    Stud Health Technol Inform, 2015;211:225-32.
    PMID: 25980873
    For medical application, the efficiency and transmission distance of the wireless power transfer (WPT) are always the main concern. Research has been showing that the impedance matching is one of the critical factors for dealing with the problem. However, there is not much work performed taking both the source and load sides into consideration. Both sides matching is crucial in achieving an optimum overall performance, and the present work proposes a circuit model analysis for design and implementation. The proposed technique was validated against experiment and software simulation. Result was showing an improvement in transmission distance up to 6 times, and efficiency at this transmission distance had been improved up to 7 times as compared to the impedance mismatch system. The system had demonstrated a near-constant transfer efficiency for an operating range of 2cm-12cm.
  9. Adam F, Ameram N, Tan WM
    Acta Crystallogr E Crystallogr Commun, 2015 Jun 01;71(Pt 6):o425.
    PMID: 26090205 DOI: 10.1107/S2056989015009585
    There are two mol-ecules in the asymmetric unit of the title compound, C9H10N2OS. In one, the dihedral angle between the aromatic ring and the carbamo-thioyl group is 52.31 (7)° and in the other it is 36.16 (6)°. Each mol-ecule features an intra-molecular N-H⋯O hydrogen bond, which generates an S(6) ring and the O and S atoms have an anti disposition. In the crystal, mol-ecules are linked by N-H⋯S and N-H⋯O hydrogen bonds, generating separate [130] and [1-30] infinite chains. Weak C-H⋯O and C-H⋯S inter-actions are also observed.
  10. Chay SY, Tan WK, Saari N
    J Microencapsul, 2015;32(5):488-95.
    PMID: 26079597 DOI: 10.3109/02652048.2015.1057250
    The aim of this study was to produce and characterise nanosize liposomes containing bioactive peptides with antioxidative and ACE-inhibitory properties, derived from winged bean seeds (WBS) protein. WBS powder was papain-proteolysed, at 70 °C and pH 6.5 for six hours, followed by encapsulation via a solvent-free heating method. The results showed that the WBS proteolysate was successfully incorporated into spherical, unilamellar liposomal particles, with particle diameter, polydispersity index, zeta potential and encapsulation efficiency of 193.3 ± 0.12 nm, 0.4 ± 0.02 (unit less), -70.5 ± 0.30 mV and 27.6 ± 1.17%, respectively. It also demonstrated good storage stability over eight weeks at 4 °C, indicated by slight increment (15.1%) in particle size and a zeta potential only weaker by 17.2% at the end of the study period. These results suggested the feasibility of entrapping water soluble peptides in hydrophobic liposomal system that, upon optimisation, has the potential to act as bioactive food ingredient.
  11. Low YS, Tan SL, Wan AS
    J Pediatr Pharmacol Ther, 2015 Mar-Apr;20(2):119-27.
    PMID: 25964729 DOI: 10.5863/1551-6776-20.2.119
    OBJECTIVE: To evaluate the usefulness of extended-interval gentamicin dosing practiced in neonatal intensive care unit (NICU) and special care nursery (SCN) of a Malaysian hospital.
    METHODS: Cross-sectional observational study with pharmacokinetic analysis of all patients aged ≤28 days who received gentamicin treatment in NICU/SCN. Subjects received dosing according to a regimen modified from an Australian-based pediatric guideline. During a study period of 3 months, subjects were evaluated for gestational age, body weight, serum creatinine concentration, gentamicin dose/interval, serum peak and trough concentrations, and pharmacokinetic parameters. Descriptive percentages were used to determine the overall dosing accuracy, while analysis of variance (ANOVA) was conducted to compare the accuracy rates among different gestational ages. Pharmacokinetic profile among different gestational age and body weight groups were compared by using ANOVA.
    RESULTS: Of the 113 subjects included, 82.3% (n = 93) achieved therapeutic concentrations at the first drug-monitoring assessment. There was no significant difference found between the percentage of term neonates who achieved therapeutic concentrations and the premature group (87.1% vs. 74.4%), p = 0.085. A total of 112 subjects (99.1%) achieved desired therapeutic trough concentration of <2 mg/L. Mean gentamicin peak concentration was 8.52 mg/L (95% confidence interval [Cl], 8.13-8.90 mg/L) and trough concentration was 0.54 mg/L (95% CI, 0.48-0.60 mg/L). Mean volume of distribution, half-life, and elimination rate were 0.65 L/kg (95% CI, 0.62-0.68 L/kg), 6.96 hours (95% CI, 6.52-7.40 hours), and 0.11 hour(-1) (95% CI, 0.10-0.11 hour(-1)), respectively.
    CONCLUSION: The larger percentage of subjects attaining therapeutic range with extended-interval gentamicin dosing suggests that this regimen is appropriate and can be safely used among Malaysian neonates.
    KEYWORDS: aminoglycosides; extended-interval; gentamicin; neonate; pharmacokinetics
  12. Tan ST, Sherina MS, Rampal L, Normala I
    Med J Malaysia, 2015 Feb;70(1):1-5.
    PMID: 26032521 MyJurnal
    BACKGROUND: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others.

    OBJECTIVE: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university.

    METHODS: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21).

    RESULTS: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent's lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9).

    CONCLUSION: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.
  13. Balakrishnan SS, Dass AK, Tan YL
    Indian J Urol, 2015 Apr-Jun;31(2):160-1.
    PMID: 25878424 DOI: 10.4103/0970-1591.154223
    This video describes the transobturator outside in suburethral sling surgical procedure for the indication of urodynamic stress urinary incontinence. A total of 170 cases were performed from January 2007 till December 2013. The average follow up was from 6 months till 7 years. The cure rate was 90%. There were no recurrences in our series. There was one patient with tape exposure after 3 years which required excision.
  14. Li H, Teo YY, Tan EK
    Mov Disord, 2015 Sep;30(10):1335-42.
    PMID: 25758099 DOI: 10.1002/mds.26176
    Reproducing genomewide association studies findings in different populations is challenging, because the reproducibility fundamentally relies on the similar patterns of linkage disequilibrium between the unknown causal variants and the genotyped single-nucleotide polymorphisms (SNPs).
  15. Fung SY, Lee ML, Tan NH
    Toxicon, 2015 Mar;96:38-45.
    PMID: 25615711 DOI: 10.1016/j.toxicon.2015.01.012
    Snake venom LAAOs have been reported to exhibit a wide range of pharmacological activities, including cytotoxic, edema-inducing, platelet aggregation-inducing/platelet aggregation-inhibiting, bactericidal and antiviral activities. A heat-stable form of l-amino acid oxidase isolated from king cobra (Ophiophagus hannah) venom (OH-LAAO) has been shown to exhibit very potent cytotoxicity against human tumorigenic cells but not in their non-tumorigenic counterparts, and the cytotoxicity was due to the apoptosis-inducing effect of the enzyme. In this work, the molecular mechanism of cell death induced by OH-LAAO was investigated. The enzyme exerts its apoptosis-inducing effect presumably via both intrinsic and extrinsic pathways as suggested by the increase in caspase-8 and -9 activities. Oligonucleotide microarray analysis showed that the expression of a total of 178 genes was significantly altered as a result of oxidative stress induced by the hydrogen peroxide generated by the enzyme. Of the 178 genes, at least 27 genes are involved in apoptosis and cell death. These alterations of gene expression was presumably caused by the direct cytotoxic effect of H2O2 generated during the enzymatic reaction, as well as the non-specific oxidative modifications of signaling molecules that eventually lead to apoptosis and cell death. The very substantial up-regulation of cytochrome P450 genes may also contribute to the potent cytotoxic action of OH-LAAO by producing excessive reactive oxygen species (ROS). In conclusion, the potent apoptosis inducing activity of OH-LAAO was likely due to the direct cytotoxic effect of H2O2 generated during the enzymatic reaction, as well as the non-specific oxidation of signalling molecules.
  16. Azmi AN, Tan SS, Mohamed R
    World J Hepatol, 2015 Jan 27;7(1):78-92.
    PMID: 25624999 DOI: 10.4254/wjh.v7.i1.78
    Hepatitis C infection and chronic kidney disease are major health burden worldwide. Hepatitis C infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis C and chronic kidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis C infection. Despite much improvement in the care of this group of patients, the prevalence of hepatitis C infection in hemodialysis patients is still higher than the general population. Hepatitis C infection has a negative effect on the survival of hemodialysis and renal transplant patients. Treatment of hepatitis C in end stage renal disease patients using conventional or pegylated interferon with or without ribavirin remains a clinical challenge with low response rate, high dropout rate due to poor tolerability and many unmet needs. The approval of new direct acting antiviral agents for hepatitis C may dramatically change the treatment approach in hepatitis C infected patients with mild to moderate renal impairment. However it remains to be confirmed if the newer Hepatitis C therapies are safe in individuals with severe renal impairment. This review article discusses the relationship between hepatitis C and chronic kidney disease, describe the various types of renal diseases associated with hepatitis C and the newer as well as the existing treatments for hepatitis C in the context of this subpopulation of hepatitis C patients.
  17. Zia A, Kamaruzzaman SB, Tan MP
    Postgrad Med, 2015 Mar;127(2):186-93.
    PMID: 25622817 DOI: 10.1080/00325481.2015.996505
    Hypertension is a highly prevalent condition among older people, but many physicians avoid aggressive treatment in this age group due to concerns about adverse effects such as orthostatic hypotension and falls. Orthostatic hypotension, which also increases in prevalence with increasing age, has been considered to be associated with antihypertensive therapy. Both orthostatic hypotension and antihypertensive medications are considered independent yet closely related predictors for falls among older people. The prescription of antihypertensive therapy among the elderly remains a long-standing controversy in geriatric medicine due to ongoing concerns about potential complications such as falls, despite conclusive evidence supporting the treatment of hypertension even among the very elderly. However, recent evidence suggests a dose-dependent relationship between blood pressure lowering therapy and falls among older individuals with preexisting risk factors for falls. In response to the spate of revisions in hypertension treatment targets for older patients in international guidelines and the recent evidence on antihypertensive therapy and falls, this review article examines the complex relationship between hypertension, antihypertensives, orthostatic hypotension, and falls among older patients.
  18. Jaafar MH, Mahadeva S, Morgan K, Tan MP
    J Nutr Health Aging, 2015 Feb;19(2):190-7.
    PMID: 25651445 DOI: 10.1007/s12603-014-0527-z
    OBJECTIVE: The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia.

    METHODS: We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia.

    RESULTS: 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.

    CONCLUSIONS: Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.

  19. Ting YH, Tan CH, Vu C
    Med J Malaysia, 2014 Oct;69(5):203-9.
    PMID: 25638232
    No abstract available.
  20. Tan WS, Yin WF, Chan KG
    Genome Announc, 2015;3(1).
    PMID: 25555739 DOI: 10.1128/genomeA.01372-14
    Aeromonas hydrophila species can be found in warm climates and can survive in different environments. They possess the ability to communicate within their populations, which is known as quorum sensing. In this work, we present the draft genome sequence of A. hydrophila M013, a bacterium isolated from a Malaysian tropical rainforest waterfall.
Filters
Contact Us

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links