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Fulltext Patterns of initial opioid prescription and its association with short-term and long-term use among opioid-naïve patients in Malaysia: a retrospective cohort study

Zin CS, Nazar NI, Rahman NSA, Ahmad WR, Rani NS, Ng KS

BMJ Open, 2019 07 02;9(7):e027203.
PMID: 31270113 DOI: 10.1136/bmjopen-2018-027203

OBJECTIVE: This study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients.
DESIGN: This study was designed as a retrospective cohort study.
SETTING AND PARTICIPANTS: In this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.
MAIN OUTCOME MEASURES: The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.
RESULTS: There were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.
CONCLUSIONS: The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.
Fulltext Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used

Zin CS, Nazar NI, Rahman NS, Alias NE, Ahmad WR, Rani NS, et al.

J Pain Res, 2018;11:1959-1966.
PMID: 30288090 DOI: 10.2147/JPR.S164774

Purpose: To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients.
Patients and methods: This cross-sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid, and naproxen), tramadol, and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13.
Results: A total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (<4.5%). All the analgesics were increased over time except meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n=4,021) and oxycodone (0.5%, n=1,049), were prescribed the least, but the rate of increase was the highest.
Conclusion: Tramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.
Data source: Prescription databases of two public tertiary hospitals in Malaysia

Study site: two public tertiary hospitals in Malaysia
Fulltext Emotion brain network topology in healthy subjects following passive listening to different auditory stimuli

Mohd Rashid MH, Ab Rani NS, Kannan M, Abdullah MW, Ab Ghani MA, Kamel N, et al.

PeerJ, 2024;12:e17721.
PMID: 39040935 DOI: 10.7717/peerj.17721

A large body of research establishes the efficacy of musical intervention in many aspects of physical, cognitive, communication, social, and emotional rehabilitation. However, the underlying neural mechanisms for musical therapy remain elusive. This study aimed to investigate the potential neural correlates of musical therapy, focusing on the changes in the topology of emotion brain network. To this end, a Bayesian statistical approach and a cross-over experimental design were employed together with two resting-state magnetoencephalography (MEG) as controls. MEG recordings of 30 healthy subjects were acquired while listening to five auditory stimuli in random order. Two resting-state MEG recordings of each subject were obtained, one prior to the first stimulus (pre) and one after the final stimulus (post). Time series at the level of brain regions were estimated using depth-weighted minimum norm estimation (wMNE) source reconstruction method and the functional connectivity between these regions were computed. The resultant connectivity matrices were used to derive two topological network measures: transitivity and global efficiency which are important in gauging the functional segregation and integration of brain network respectively. The differences in these measures between pre- and post-stimuli resting MEG were set as the equivalence regions. We found that the network measures under all auditory stimuli were equivalent to the resting state network measures in all frequency bands, indicating that the topology of the functional brain network associated with emotional regulation in healthy subjects remains unchanged following these auditory stimuli. This suggests that changes in the emotion network topology may not be the underlying neural mechanism of musical therapy. Nonetheless, further studies are required to explore the neural mechanisms of musical interventions especially in the populations with neuropsychiatric disorders.
Fulltext Prediction of mortality in severe dengue cases

Md-Sani SS, Md-Noor J, Han WH, Gan SP, Rani NS, Tan HL, et al.

BMC Infect Dis, 2018 05 21;18(1):232.
PMID: 29783955 DOI: 10.1186/s12879-018-3141-6

BACKGROUND: Increasing incidence of dengue cases in Malaysia over the last few years has been paralleled by increased deaths. Mortality prediction models will therefore be useful in clinical management. The aim of this study is to identify factors at diagnosis of severe dengue that predicts mortality and assess predictive models based on these identified factors.
METHOD: This is a retrospective cohort study of confirmed severe dengue patients that were admitted in 2014 to Hospital Kuala Lumpur. Data on baseline characteristics, clinical parameters, and laboratory findings at diagnosis of severe dengue were collected. The outcome of interest is death among patients diagnosed with severe dengue.
RESULTS: There were 199 patients with severe dengue included in the study. Multivariate analysis found lethargy, OR 3.84 (95% CI 1.23-12.03); bleeding, OR 8.88 (95% CI 2.91-27.15); pulse rate, OR 1.04 (95% CI 1.01-1.07); serum bicarbonate, OR 0.79 (95% CI 0.70-0.89) and serum lactate OR 1.27 (95% CI 1.09-1.47), to be statistically significant predictors of death. The regression equation to our model with the highest AUROC, 83.5 (95% CI 72.4-94.6), is: Log odds of death amongst severe dengue cases = - 1.021 - 0.220(Serum bicarbonate) + 0.001(ALT) + 0.067(Age) - 0.190(Gender).
CONCLUSION: This study showed that a large proportion of severe dengue occurred early, whilst patients were still febrile. The best prediction model to predict death at recognition of severe dengue is a model that incorporates serum bicarbonate and ALT levels.
Fulltext A review of the holy Quran listening and its neural correlation for its potential as a psycho-spiritual therapy

Kannan MA, Ab Aziz NA, Ab Rani NS, Abdullah MW, Mohd Rashid MH, Shab MS, et al.

Heliyon, 2022 Dec;8(12):e12308.
PMID: 36578419 DOI: 10.1016/j.heliyon.2022.e12308

Since its revelation over 14 centuries ago, the Holy Quran is considered as scriptural divine words of Islam, and it is believed to promote psycho-spiritual therapeutic benefits to its reciter and/or listener. In this context, the listening of rhythmic Quranic verses among Muslims is often viewed as a form of unconventional melodic vocals, with accompanied anecdotal claims of the 'Quranic chills' pleasing effect. However, compared to music, rhythm, and meditation therapy, information on the neural basis of the anecdotal healing effects of the Quran remain largely unexplored. Current studies in this area took the leads from the low-frequency neuronal oscillations (i.e., alpha and theta) as the neural correlates, mainly using electroencephalography (EEG) and/or magnetoencephalography (MEG). In this narrative review, we present and discuss recent work related to these neural correlates and highlight several methodical issues and propose recommendations to progress this emerging transdisciplinary research. Collectively, evidence suggests that listening to rhythmic Quranic verses activates similar brain regions and elicits comparable therapeutic effects reported in music and rhythmic therapy. Notwithstanding, further research are warranted with more concise and standardized study designs to substantiate these findings, and opens avenue for the listening to Quranic verses as an effective complementary psycho-spiritual therapy.
Fulltext Diversity of global rice markets and the science required for consumer-targeted rice breeding

Calingacion M, Laborte A, Nelson A, Resurreccion A, Concepcion JC, Daygon VD, et al.

PLoS One, 2014;9(1):e85106.
PMID: 24454799 DOI: 10.1371/journal.pone.0085106

With the ever-increasing global demand for high quality rice in both local production regions and with Western consumers, we have a strong desire to understand better the importance of the different traits that make up the quality of the rice grain and obtain a full picture of rice quality demographics. Rice is by no means a 'one size fits all' crop. Regional preferences are not only striking, they drive the market and hence are of major economic importance in any rice breeding / improvement strategy. In this analysis, we have engaged local experts across the world to perform a full assessment of all the major rice quality trait characteristics and importantly, to determine how these are combined in the most preferred varieties for each of their regions. Physical as well as biochemical characteristics have been monitored and this has resulted in the identification of no less than 18 quality trait combinations. This complexity immediately reveals the extent of the specificity of consumer preference. Nevertheless, further assessment of these combinations at the variety level reveals that several groups still comprise varieties which consumers can readily identify as being different. This emphasises the shortcomings in the current tools we have available to assess rice quality and raises the issue of how we might correct for this in the future. Only with additional tools and research will we be able to define directed strategies for rice breeding which are able to combine important agronomic features with the demands of local consumers for specific quality attributes and hence, design new, improved crop varieties which will be awarded success in the global market.