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Fulltext Recent Progress of Chitosan and Chitosan Derivatives-Based Nanoparticles: Pharmaceutical Perspectives of Oral Insulin Delivery

Seyam S, Nordin NA, Alfatama M

Pharmaceuticals (Basel), 2020 Oct 14;13(10).
PMID: 33066443 DOI: 10.3390/ph13100307

Diabetes mellitus is a chronic endocrine disease, affecting more than 400 million people around the world. Patients with poorly controlled blood glucose levels are liable to suffer from life-threatening complications, such as cardiovascular, neuropathy, retinopathy and even premature death. Today, subcutaneous parenteral is still the most common route for insulin therapy. Oral insulin administration is favourable and convenient to the patients. In contrast to injection route, oral insulin delivery mimics the physiological pathway of endogenous insulin secretion. However, oral insulin has poor bioavailability (less than 2%) due to the harsh physiological environment through the gastrointestinal tract (GIT). Over the last few decades, many attempts have been made to achieve an effective oral insulin formulation with high bioavailability using insulin encapsulation into nanoparticles as advanced technology. Various natural polymers have been employed to fabricate nanoparticles as a delivery vehicle for insulin oral administration. Chitosan, a natural polymer, is extensively studied due to the attractive properties, such as biodegradability, biocompatibility, bioactivity, nontoxicity and polycationic nature. Numerous studies were conducted to evaluate chitosan and chitosan derivatives-based nanoparticles capabilities for oral insulin delivery. This review highlights strategies that have been applied in the recent five years to fabricate chitosan/chitosan derivatives-based nanoparticles for oral insulin delivery. A summary of the barriers hurdle insulin absorption rendering its low bioavailability such as physical, chemical and enzymatic barriers are highlighted with an emphasis on the most common methods of chitosan nanoparticles preparation. Nanocarriers are able to improve the absorption of insulin through GIT, deliver insulin to the blood circulation and lower blood glucose levels. In spite of some drawbacks encountered in this technology, chitosan and chitosan derivatives-based nanoparticles are greatly promising entities for oral insulin delivery.
Fulltext Effective Removal of Pb(II) Ions by Electrospun PAN/Sago Lignin-based Activated Carbon Nanofibers

Nordin NA, Abdul Rahman N, Abdullah AH

Molecules, 2020 Jul 06;25(13).
PMID: 32640766 DOI: 10.3390/molecules25133081

Heavy metal pollution, such as lead, can cause contamination of water resources and harm human life. Many techniques have been explored and utilized to overcome this problem, with adsorption technology being the most common strategies for water treatment. In this study, carbon nanofibers, polyacrylonitrile (PAN)/sago lignin (SL) carbon nanofibers (PAN/SL CNF) and PAN/SL activated carbon nanofibers (PAN/SL ACNF), with a diameter approximately 300 nm, were produced by electrospinning blends of polyacrylonitrile and sago lignin followed by thermal and acid treatments and used as adsorbents for the removal of Pb(II) ions from aqueous solutions. The incorporation of biodegradable and renewable SL in PAN/SL blends fibers produces the CNF with a smaller diameter than PAN only but preserves the structure of CNF. The adsorption of Pb(II) ions on PAN/SL ACNF was three times higher than that of PAN/SL CNF. The enhanced removal was due to the nitric acid treatment that resulted in the formation of surface oxygenated functional groups that promoted the Pb(II) ions adsorption. The best-suited adsorption conditions that gave the highest percentage removal of 67%, with an adsorption capacity of 524 mg/g, were 40 mg of adsorbent dosage, 125 ppm of Pb(II) solution, pH 5, and a contact time of 240 min. The adsorption data fitted the Langmuir isotherm and the pseudo-second-order kinetic models, indicating that the adsorption is a monolayer, and is governed by the availability of the adsorption sites. With the adsorption capacity of 588 mg/g, determined via the Langmuir isotherm model, the study demonstrated the potential of PAN/SL ACNFs as the adsorbent for the removal of Pb(II) ions from aqueous solution.
Fulltext Urban Green Space and Subjective Well-Being of Older People: A Systematic Literature Review

Xu T, Nordin NA, Aini AM

Int J Environ Res Public Health, 2022 Oct 31;19(21).
PMID: 36361106 DOI: 10.3390/ijerph192114227

A growing number of articles have identified and reported the benefits and importance of urban green spaces for improving human well-being, but there is a significant knowledge gap regarding the impact of urban green spaces on the subjective well-being of older adults. The literature search (August 2015-August 2022) was derived from two major scientific databases, Google Scholar, and Web of Science. As a result, 2558 articles were found, 1527 of which were retrieved from WOS and the rest from Google Scholar. Bibliometric methods and VOSviewer software were used to screen and organize the articles in the relevant fields. Finally, 65 articles met the review criteria. The included studies aim to capture the benefits of various features of urban green spaces in meeting or enhancing the subjective well-being needs of older adults. The results of our review further support the existence of a strong link between older adults' subjective well-being and various features of urban green spaces, providing new insights for future in-depth reexamination and policy development. Furthermore, the relationship between urban green spaces and older adults' subjective well-being depends not only on the urban green spaces themselves but also on the characteristics of the older adult population that uses them.
Fulltext Connectedness among Urban Parks from the Users' Perspective: A Systematic Literature Review

Li J, Md Dali M, Nordin NA

Int J Environ Res Public Health, 2023 Feb 18;20(4).
PMID: 36834348 DOI: 10.3390/ijerph20043652

Although many benefits of urban green space networks have been consistently demonstrated, most of the discussion on space connectivity has concentrated on ecological aspects, such as patch-corridor-matrix connectivity. There are limited systematic studies that have investigated the connectedness between urban parks and people. This study aimed to explore the connectedness among urban parks from the users' perspective by using a systematic literature review. By following the PRISMA protocol and analyzing 54 studies from Scopus and Web of Science between 2017 and 2022, we proposed the concepts of physical connectedness and perceived connectedness. The "physical connectedness" contained the dimensions of road attributes and park attributes, as well as six categories including physical accessibility, street connectivity, the street environment, spatial scale, facilities and amenities, and natural elements. The "perceived connectedness" mainly referred to people's perception of the physical environment. The four categories were perceived accessibility, perceived safety, aesthetics, and Kaplan's perceptual model. Finally, in terms of individual attributes, the impact of sociodemographic factors (age, gender, income, education, and occupation) and the motivation for activity on park connectedness were also taken into account. On the basis of our findings, this study suggested that park connectedness should not only focus on physical connectedness but also perceived connectedness.
Fulltext Piper sarmentosum inhibits ICAM-1 and Nox4 gene expression in oxidative stress-induced human umbilical vein endothelial cells

Ugusman A, Zakaria Z, Hui CK, Nordin NA

BMC Complement Altern Med, 2011;11:31.
PMID: 21496279 DOI: 10.1186/1472-6882-11-31

Aqueous extract of Piper sarmentosum (AEPS) is known to possess antioxidant and anti-atherosclerotic activities but the mechanism responsible for it remains unclear. In early part of atherosclerosis, nuclear factor-kappa B (NF-κB) induces the expression of cellular adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1) and E-selectin. NADPH oxidase 4 (Nox4) is the predominant source of superoxide in the endothelial cells whereas superoxide dismutase 1 (SOD1), catalase (CAT) and glutathione peroxidase (GPx) are the antioxidant enzymes responsible for inactivating reactive oxygen species. The present study aimed to investigate the effects of AEPS on the gene expression of NF-κB, VCAM-1, ICAM-1, E-selectin, Nox4, SOD1, CAT and GPx in cultured human umbilical vein endothelial cells (HUVECs).
Fulltext The use of Piper sarmentosum leaves aqueous extract (Kadukmy™) as antihypertensive agent in spontaneous hypertensive rats

Mohd Zainudin M, Zakaria Z, Megat Mohd Nordin NA

BMC Complement Altern Med, 2015 Mar 10;15:54.
PMID: 25887182 DOI: 10.1186/s12906-015-0565-z

BACKGROUND: The National Health and Morbidity Survey in 2011 estimated that 35.1% (5.7 million) of Malaysian adults aged 18 and older suffer from hypertension. Hypertension is still treated by conventional medicine despite its exact aetiology being unknown. Studies showed that oxidative stress and low availability of nitric oxide (NO) causes an increase in vascular wall tension and increase blood pressure. Piper sarmentosum (PS) a traditional Malay herbal plant is well known for its high antioxidant content. Antioxidant is useful in improving cardiovascular diseases particularly hypertension. Thus, it is beneficial to determine the effect of PS leaves aqueous extract (Kadukmy™) on the blood pressure, NO level, oxidative stress markers and serum cholesterol level of the Spontaneous Hypertensive Rats (SHR).
METHODS: Rats were devided into five groups consisting of three treatment groups and two control groups. Baseline blood investigations were done before and following commencement of treatment. Spontaneous hypertensive rats were treated for 28 consecutive days and the blood pressure was measured weekly.
RESULTS: Kadukmy™ administration showed a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) (P
Fulltext The effectiveness of home-based therapy on functional outcome, self-efficacy and anxiety among discharged stroke survivors

Pui Kei C, Mohd Nordin NA, Abdul Aziz AF

Medicine (Baltimore), 2020 Nov 20;99(47):e23296.
PMID: 33217861 DOI: 10.1097/MD.0000000000023296

INTRODUCTION: Stroke survivors are commonly at risk of functional decline following discharge from rehabilitation, which increase their susceptibility to falls, dependency in activities of daily living and emotional disturbances. To combat these, continued therapy is important. Home-based therapy (HBT) has been shown to be useful in maintaining functional performance and quality of life of chronic stroke survivors. However, evidence on its effectiveness remains limited, while no studies are available to date which report the benefit of HBT on stroke survivors self-efficacy and emotional status. Therefore, this study aims to assess the effectiveness of post-discharge HBT in comparison to usual practice on functional outcome (mobility and gait speed), self-efficacy and anxiety level among stroke survivors.
METHODS: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are HBT (experimental group) and usual practice (UP) (control group). Based on sample size calculation using GPower, a total number of 42 participants will be recruited and allocated into either the HBT or the UP group. Participants in HBT group will receive a set of structured exercise therapy consisting of progressive strengthening, balance and task-related exercises. While participants in UP group will receive a usual "intervention" practised by rehabilitation professional prior to discharging stroke patients from their care. Both groups are advised to perform the given interventions for 3 times per week for 12 weeks under the supervision of their caregiver. Outcomes of interventions will be measured using timed up and go test (for mobility), ten-meter walk test (for gait speed), stroke self-efficacy questionnaire (for self-efficacy) and hospital anxiety and depression scale (for anxiety level). All data will be analyzed using descriptive and inferential statistics.
DISCUSSION: This study will provide the information on the effectiveness of HBT in comparison to UP among stroke population who are discharged from rehabilitation. Findings from the study will enable rehabilitation professionals to design effective discharge care plan for stroke survivors in combating functional decline when no longer receiving hospital-based therapy.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001182189 (last updated 22/11/2019).
Fulltext Low back pain and associated risk factors among health science undergraduates

Mohd Nordin NA, Ajit Singh DK, Lim K

Sains Malaysiana, 2014;43:423-428.

Identification of associated risk factors is important to enable successful implementation of low back pain prevention strategies. To date, there is limited research data on back pain among young adults in Malaysia despite an increasing incidence of this disabling condition worldwide. A cross-sectional survey was conducted to determine the incidence of low back pain (LBP) and associated factors among health science undergraduates. A self-administered questionnaire was distributed to full time students of a main public university. One hundred and forty undergraduates; mean age 21.4±1.3 years, 70% female, 60% in year 3 of study, participated in the survey. The results showed that 31% spent between 6 and 8 h and another 31% spent more than 9 h sitting in a day. Twelve percent of the undergraduates rated their fitness level as ‘poor’. The incidence of LBP was 40.3% among the undergraduates. LBP incidence was associated with age (X2=12.1, p=0.007), years of study (X2=8.7, p=0.03), self-rated physical fitness (X2=7.0, p=0.02) and hours spent sitting (X2 =8.7, p=0.03). Gender, body mass index and hours spent in sports and physical activity were not associated with LBP. The findings from this study demonstrate that physical fitness and sitting duration is associated with low back pain among health science undergraduates. Health science undergraduates should improve their physical fitness, practice frequent breaks and stretching during sitting. This will help to minimize LBP related to decreased fitness levels and prolonged sitting.
Fulltext The effect of game-based in comparison to conventional circuit exercise on functions, motivation level, self-efficacy and quality of life among stroke survivors

Johar MN, Mohd Nordin NA, Abdul Aziz AF

Medicine (Baltimore), 2022 Jan 14;101(2):e28580.
PMID: 35029235 DOI: 10.1097/MD.0000000000028580

INTRODUCTION: Stroke survivors are commonly at risk of functional decline, which increase their dependency in activities of daily living and eventually affects their motivation level, self-efficacy, and quality of life. Circuit exercise has been shown to be useful in enhancing functional performance and quality of life of chronic stroke survivors. There is a need to review the existing "usual circuit exercise" and develop a better approach, such as game-based circuit exercise. Training in enriched and fun environment may possibly further promote neuroplasticity. However, evidence on inducing fun element in the existing circuit exercise among stroke survivors is limited. Also, no studies are available to date which report the benefit of circuit exercise on stroke survivors' self-efficacy and motivation level. Therefore, this study aims to assess the effectiveness of game-based circuit exercise in comparison to conventional circuit exercise on functional outcome (lower limb strength, postural stability and aerobic endurance), motivation level, self-efficacy and quality of life among stroke survivors. This study also aims to assess whether the outcomes gained from the 2 interventions could be sustained at week 12 and 24 post-trial.
METHODS: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are game-based circuit exercise (experimental group) and conventional circuit exercise (control group). Based on sample size calculation using GPower, a total number of 82 participants will be recruited and allocated into either the experimental or the control group. Participants in the experimental group will receive a set of structured game-based exercise therapy which has the components of resistance, dynamic balance and aerobic exercises. While participants in the control group will receive a conventional circuit exercise as usually conducted by physiotherapists consisting of 6 exercise stations; cycling, repeated sit to stand, upper limb exercise, lower limb exercise, stepping up/down and walking over obstacles. Both groups will perform the given interventions for 2 times per week for 12 weeks under the supervision of 2 physiotherapists. Outcomes of the interventions will be measured using 30-second chair rise test (for lower limb strength), Dynamic Gait Index (for postural stability), 6-minute walk test (aerobic capacity), Intrinsic Motivation Inventory questionnaire (for motivation level), stroke self-efficacy questionnaire (for self-efficacy) and Short Form-36 quality of life questionnaire (for quality of life). All data will be analyzed using descriptive and inferential statistics.
DISCUSSION: This study will provide the information regarding the effectiveness of including game elements into circuit exercise training. Findings from this study will enable physiotherapists to design more innovative exercise therapy sessions to promote neuroplasticity and enhance functionality and quality of life among stroke survivors under their care.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN 12621001489886 (last updated 1/11/2021).
Fulltext Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors

Vasu DT, Mohd Nordin NA, Ghazali SE

Medicine (Baltimore), 2021 Aug 20;100(33):e26924.
PMID: 34414949 DOI: 10.1097/MD.0000000000026924

INTRODUCTION: The occurrence of post-stroke emotional problems is significant during the early post-stroke stage and affects the recovery of functionality among the survivors. Because stroke survivors require active engagement in rehabilitation to optimize the process of neuroplasticity in the initial stage of stroke, there is a need to integrate an intervention, preferably therapists-mediated during rehabilitation, which reduce emotional problems thus improve motivation level among the survivors. One such technique is autogenic relaxation training (ART). ART has been found to reduce anxiety and depression among patients with several medical conditions. However, its usage in stroke survivors during rehabilitation has been limited to date. Therefore, this study is intended to evaluate the effectiveness of ART in addition to usual physiotherapy in improving emotional state and functional level of stroke survivors during rehabilitation.
METHODS: This is an assessor blinded randomized controlled trial comparing 2 intervention approaches namely ART-added physiotherapy (experimental group) and usual physiotherapy (control group). A total of 70 post-stroke patients will be recruited and allocated into either the ART-added physiotherapy or the usual physiotherapy group. The ART-added physiotherapy group will undergo a 20-minute ART session followed by 40 minutes of usual physiotherapy. While the usual physiotherapy group will receive usual physiotherapy alone for 60 minutes. All participants will be treated once a week and are required to carry out a set of home exercises for 2 times per week during the 12-week intervention. Assessment of emotional status and functional independence will be carried out at pre-intervention and week 13 of the intervention with the use of Hospital anxiety and depression scale, Barthel index, and EuroQol-5 dimensions-5 levels. All data will be analyzed using descriptive and inferential statistics.
DISCUSSION: The expected main study outcome is an enhanced evidence-based physiotherapy program that may be used by physiotherapists in the rehabilitation of stroke patients with emotional disturbances.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001664134 (last updated on 28/11/2019).
'Eat Right, Future Bright: Nutrition Education Program' (ERFB-NEP) module for aboriginal primary school children in Malaysia

Nordin NA, Haris SN, Hamid SBA

J Educ Health Promot, 2023;12:11.
PMID: 37034863 DOI: 10.4103/jehp.jehp_744_22

BACKGROUND: Nutrition is essential for schoolchildren to reach their full potential psychologically and cognitively. Malnutrition, which is prevalent among aboriginal schoolchildren in Malaysia, can interfere their learning and academic performance. Developing a module to be used during a school-based nutritional intervention program is essential to ensuring that students develop healthy eating habits and lifestyles. Thus, this study aims to develop and validate nutrition education module focusing on aboriginal schoolchildren for the eat right future bright (ERFB) nutrition education program.
MATERIALS AND METHODS: This cross-sectional study was conducted in three steps: Step 1: development of module based on literature reviews, Step 2: content and face validation of the module by the expert panels, and Step 3: face validation of the module by target users. This study has used the validation form proposed by de Castro. This form consists of seven aspects, two aspects related to content validity and another four aspects related to face validity. A content validity index (CVI) was used to analyze the content validity. Two formulas were used to calculate CVI, which were I-CVI and S-CVI. Meanwhile, the data for module's face used the level of agreement.
RESULTS: Both I-CVI and S-CVI obtained more than 0.78 and 0.80, respectively, which indicate that the module has good content validity. Moreover, for face validity, the total of agreement from expert panels and target users was more than 75%, which is considered face validated.
CONCLUSIONS: In conclusion, the module that has been developed has good content validity and can be used by teachers in teaching appropriate nutrition knowledge to aboriginal primary schoolchildren.
Fulltext Facilitating Exercise Engagement among Community Dwelling Stroke Survivors: Is a once Per Week Group Session Sufficient?

Mohd Nordin NA, Yusoff NAH, Ajit Singh DK

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783575 DOI: 10.3390/ijerph16234746

Although exercise is proven as an effective strategy to combat post-stroke complications and the risk of stroke recurrence, many stroke survivors fail to engage in this activity following rehabilitation. In this study, we assessed the feasibility and usefulness of a low-frequency group exercise to determine its suitability as an approach to facilitate exercise engagement among stroke survivors. Forty-one stroke survivors, mean (SD) age 59.34 (10.02) years, mean time post-stroke 17.13 (17.58) months, completed a 90 minute, once per week, group exercise supervised by therapists for 12 weeks. The exercise outcomes were measured using standardized clinical tests. We observed improvement in the group's physical performance; balance score by 3 units (Z = -3.88, p < 0.001), speed of repetitive sit to stand by 3.4 s (Z = -4.69, p < 0.001), and walking speed by 8.22 m/min (Z = -3.25, p < 0.001). Scores of seven out of 14 Berg's balance scale items increased significantly, indicating better balance ability among the survivors. In conclusion, a 12-week, once per week group exercise session seems feasible and sufficient to improve the physical performance of community dwelling stroke survivors. This exercise arrangement may be offered to stroke survivors to facilitate exercise practice following rehabilitation.
Fulltext Effects of low-intensity pulsed ultrasound on recovery of physical impairments, functional performance and quality of life after total knee arthroplasty: Protocol for a quasi-experimental study

Munajat M, Mohd Nordin NA, Mohamad Yahya NH, Zulkifly AH

Medicine (Baltimore), 2019 Sep;98(36):e17045.
PMID: 31490397 DOI: 10.1097/MD.0000000000017045

INTRODUCTION: The presence of significant pain and swelling during the acute stage following total knee arthroplasty (TKA) may limit the patients' ability to cooperate in intensive physiotherapy interventions. Low-intensity pulsed ultrasound is one of the modalities that can be used for acute pain and swelling management. However, only one study investigated the effect of this modality in patients with TKA. There is limited documentation of the effects of combining low-intensity pulsed ultrasound in TKA rehabilitation in the recovery of physical impairments and how these influence the recovery of function after TKA. Therefore, this study is proposed with the aim to evaluate the effects of low-intensity pulsed ultrasound as an adjunct to conventional physiotherapy on the recovery of physical impairments, functional performance and quality of life after TKA surgery.
METHODS: This is an assessor-blinded quasi-experimental study comparing two approaches of physiotherapy, namely pulsed ultrasound-added physiotherapy and conventional physiotherapy. Total number of participants with TKA required for this study will be calculated based on the result of a pilot study. Participants will be alternately allocated into either pulsed ultrasound-added physiotherapy group (low-intensity pulsed ultrasound and conventional physiotherapy) or control group (conventional physiotherapy). Pulsed ultrasound-added physiotherapy group will receive low-intensity pulsed ultrasound starting at post-operative day 2 (4-5 times for the first-week after surgery and 2-3 times a week for a further 2 weeks). Both groups will receive conventional physiotherapy 4 to 5 times for the first-week after surgery and 2 to 3 times a week for a further 11 weeks. This procedure and process will be tested and established in a pilot study. Primary outcomes of interest are pain level, swelling, active range of knee motion, and quadriceps strength. The secondary outcomes are functional performance and quality of life.
DISCUSSION: This study will fill the gaps in knowledge relating the benefits of including low-intensity pulsed ultrasound into conventional physiotherapy for patients with TKA.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618001226291.
Fulltext Effect of constraint-induced movement therapy combined with neuromuscular electrical stimulation on upper extremity function in stroke survivors: A protocol for systematic review

Dboba MM, Mohd Nordin NA, Manaf H, Mohd Rasdi HF

Medicine (Baltimore), 2023 Jul 14;102(28):e34249.
PMID: 37443502 DOI: 10.1097/MD.0000000000034249

BACKGROUND: Motor impairment is common after a stroke and directly affects the function and quality of life of stroke survivors. Constraint-induced movement therapy and neuromuscular electrical stimulation are interventions that facilitate functional recovery of the upper extremities of a particular subgroup of stroke survivors. The objective of this study was to summarize the available evidence on the effects of neuromuscular electrical stimulation combined with constraint-induced movement therapy in patients with stroke.
METHODS: We conducted a comprehensive search of published articles in electronic databases, including PubMed, Scopus, PEDro, Medline (via Ovid), EMBASE, Cochrane Library, and Web of Science, using the following search terms: "stroke"; "upper extremity"; "Constraint-Induced Movement Therapy"; and "Neuromuscular Electrical Stimulation." The search included published studies, conferences, and presentations. The article selection, data extraction, and quality evaluation will be conducted independently by 2 reviewers. The 3rd and 4th reviewers will assist in resolving any disagreements that may arise between the 2 reviewers. The risk of bias in the included studies will be assessed using the PEDro scale and Cochrane risk of bias assessment tool. Narrative synthesis and meta-analysis will be performed based on the characteristics of the included articles, including the risk of bias (if sufficient information is available).
RESULTS: This review summarizes the available evidence and could assist therapists in choosing the best treatment for poststroke upper extremity dysfunction.
CONCLUSION: This study will provide the available evidence on the effectiveness of CIMT and NMES on upper extremity function in patients with stroke.
ETHICS AND DISSEMINATION: Ethical approval is not required because the review will be based on publicly available literature. The findings of this study will be published in a peer-reviewed journal, and updates will be made depending on whether sufficient additional evidence modifies the conclusions of the review. Any changes made to the methods throughout the review will be stated in the article.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023415645.
Fulltext The multifaceted impact of structured training program on persons with Parkinson disease and their adult caregiver: A protocol for a systematic review

Gopala Krishna Pillai S, Mohd Nordin NA, Mohamed Ibrahim N

Medicine (Baltimore), 2023 Jul 14;102(28):e33966.
PMID: 37443466 DOI: 10.1097/MD.0000000000033966

BACKGROUND: Training caregivers and persons with Parkinson Disease (PwPD) is crucial to provide them with adequate knowledge and care skills in preparation for the Parkinson disease (PD) progression. This review will systematically evaluate the effect of structured training programs on the mobility and quality of life (QoL) of PwPD. In addition, the effect of such training programs on the QoL, burden of caregiving, and knowledge of PD among adult caregivers of PwPD will also be evaluated.
METHODS: Systematic and comprehensive search of relevant studies will be conducted using electronic databases such as Cochrane Library, EBSCOhost, PubMed, SCOPUS, and Web of Science. The title, abstract, keywords, and full texts will be screened for eligibility. Studies to be selected are randomized controlled trials (RCT) from inception until April 2023. Studies based on structured PD training either in the form of training, education, program, multidisciplinary approach, or self-management targeted at both PwPD and their adult caregivers will be selected. Only full-text articles available in the English language will be included. Full-text articles will be inspected by 2 independent reviewers to produce the final set of articles that meet the eligibility criteria. A third reviewer will be engaged if no consensus is achieved between the first and second reviewers. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) will be used to evaluate the quality of papers and inform the risk of bias.
RESULTS: This review will provide an outlook on the effects of structured PD training programs on mobility and QoL of PwPD. In addition, it will provide insight into the effects of such training on the caregivers' burden, knowledge of PD, and QoL.
CONCLUSION: This review findings may help clinicians and researchers to understand the effect of structured and comprehensive PD training programs for PwPD and their adult caregiver.
Fulltext Piper sarmentosum increases nitric oxide production in oxidative stress: a study on human umbilical vein endothelial cells

Ugusman A, Zakaria Z, Hui CK, Nordin NA

Clinics (Sao Paulo), 2010 Jul;65(7):709-14.
PMID: 20668629 DOI: 10.1590/S1807-59322010000700010

Nitric oxide produced by endothelial nitric oxide synthase (eNOS) possesses multiple anti-atherosclerotic properties. Hence, enhanced expression of eNOS and increased Nitric oxide levels may protect against the development of atherosclerosis. Piper sarmentosum is a tropical plant with antioxidant and anti-inflammatory activities. This study aimed to investigate the effects of Piper sarmentosum on the eNOS and Nitric oxide pathway in cultured human umbilical vein endothelial cells (HUVECs).
Work-related injuries among physiotherapists in public hospitals: a Southeast Asian picture

Nordin NA, Leonard JH, Thye NC

Clinics (Sao Paulo), 2011;66(3):373-8.
PMID: 21552658

OBJECTIVES: A cross-sectional study was conducted to measure the prevalence of work-related injuries among physiotherapists in Malaysia and to explore the influence of factors such as gender, body mass index, years of work experience and clinical placement areas on the occurrence of work-related musculoskeletal disorders.
METHODS: Self-administered questionnaires adapted from the Nordic Musculoskeletal Questionnaire were sent to 105 physiotherapists at three main public hospitals in Kuala Lumpur, Malaysia. The questionnaire had 12 items that covered demographic information, areas of musculoskeletal problems and physiotherapy techniques that could contribute to work-related musculoskeletal disorders. The data obtained were analyzed using the Statistical Package for Social Science version 14 software.
RESULTS: The overall prevalence of work-related injuries during the past 12 months was 71.6%. Female therapists reported a significantly higher prevalence of work-related musculoskeletal disorders than the male therapists (73.0%, p,0.001). Significant differences were observed between the proportion of therapists who had work-related musculoskeletal disorders and those who did not for the group with a body mass index (BMI) .25 (x² = 9.0, p = 0.003) and the group with a BMI of 18-25 (x² = 7.8, p = 0.006). Manual therapy (58.6%) and lifting/transfer tasks (41.3%) were the two physiotherapy techniques that most often contributed to work-related musculoskeletal disorders.
CONCLUSION: Work-related injuries are significantly higher among the physiotherapists in Malaysia compared with many other countries. Female therapists reported a higher incidence of work-related musculoskeletal disorders in this study, and work-related musculoskeletal disorders were more common among therapists working in the pediatric specialty. This study contributes to the understanding of work-related disorders among physiotherapists from a southeast Asian perspective where the profession is in its development stage.
Fulltext The Unmet Needs of Parents of Highly Dependent Children with Cerebral Palsy

Mohd Nordin NA, Hui Shan E, Zanudin A

Int J Environ Res Public Health, 2019 12 16;16(24).
PMID: 31888294 DOI: 10.3390/ijerph16245145

The overall care for children with cerebral palsy (CP) is challenging to the family which causes significant impacts to their livelihood. There is limited qualitative research that reports the unmet needs of parents with physically disabled children, especially highly dependent CP. The aim of this study was to explore the unmet needs of parents of highly dependent children with CP. A qualitative study using semi-structured face to face interviews was carried out among nine parents of children with CP with gross motor classification function score (GMFCS) levels III, IV, and V. The interviews were tape-recorded and transcribed verbatim. Transcribed data was analysed using thematic analysis method. Several unmet needs were highlighted by the parents; namely the needs in receiving information regarding CP conditions, getting psychological and financial support and explaining the child's condition to strangers. In addition, parents expressed the need for better support from the social welfare department, as well as in effectively organising family functioning. The findings of this study indicate that there is a need for the healthcare professionals to develop suitable strategies to assist the parents of highly dependent children with CP in fulfilling their specific needs. The role of relevant agencies should be optimised in addressing this area of concern.
Fulltext Does Oral Ingestion of Piper sarmentosum Cause Toxicity in Experimental Animals?

Mohd Zainudin M, Zakaria Z, Megat Mohd Nordin NA, Othman F

Evid Based Complement Alternat Med, 2013;2013:705950.
PMID: 24228062 DOI: 10.1155/2013/705950

The prevalence of diabetes mellitus has reached epidemic proportion in Malaysia and worldwide. Scientific studies have shown that herbal plant Piper sarmentosum exhibits an antidiabetic property. Despite the extensive usage and studies of this herb as alternative medicine, there is paucity of the literature on the safety information of this plant. Thus, the present study aimed to observe the subacute toxic effects of Piper sarmentosum aqueous extract (PSAE) on the haematological profile, liver, and kidney in rats. The extract was administered by oral gavage to 6 male and female Sprague Dawley rats in daily dose of 50 mg/kg, 300 mg/kg, and 2000 mg/kg for 28 consecutive days. The control group received normal saline. General behavior of the rats, adverse effects, and mortality were observed for 28 days. The haematological and biochemical parameters were determined at baseline and after the treatment. PSAE did not show abnormality on the body weight and gross observation of internal organs. The haematological, biochemical and histopathological profiles showed minimal changes and variation within normal clinical range except for significant increase in serum potassium level that suggests the need of regular monitoring. Nevertheless, these findings suggested that PSAE up to 2000 mg/kg/day did not show subacute toxicity in Sprague Dawley rats.
Fulltext Role of rutin on nitric oxide synthesis in human umbilical vein endothelial cells

Ugusman A, Zakaria Z, Chua KH, Nordin NA, Abdullah Mahdy Z

ScientificWorldJournal, 2014;2014:169370.
PMID: 25093198 DOI: 10.1155/2014/169370

Nitric oxide (NO), produced by endothelial nitric oxide synthase (eNOS), is a major antiatherogenic factor in the blood vessel. Oxidative stress plays an important role in the pathogenesis of various cardiovascular diseases, including atherosclerosis. Decreased availability of endothelial NO promotes the progression of endothelial dysfunction and atherosclerosis. Rutin is a flavonoid with multiple cardiovascular protective effects. This study aimed to investigate the effects of rutin on eNOS and NO production in cultured human umbilical vein endothelial cells (HUVEC). HUVEC were divided into four groups: control; oxidative stress induction with 180 μM H₂O₂; treatment with 300 μM rutin; and concomitant induction with rutin and H₂O₂ for 24 hours. HUVEC treated with rutin produced higher amount of NO compared to control (P < 0.01). In the oxidative stress-induced HUVEC, rutin successfully induced cells' NO production (P < 0.01). Rutin promoted NO production in HUVEC by inducing eNOS gene expression (P < 0.05), eNOS protein synthesis (P < 0.01), and eNOS activity (P < 0.05). Treatment with rutin also led to increased gene and protein expression of basic fibroblast growth factor (bFGF) in HUVEC. Therefore, upregulation of eNOS expression by rutin may be mediated by bFGF. The results showed that rutin may improve endothelial function by augmenting NO production in human endothelial cells.

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