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Medical Tourism in Malaysia: Prospect and Challenges

Sarwar A

Iran J Public Health, 2013 Aug;42(8):795-805.
PMID: 26056632

Tourism, combined with the phrase medical, seems to be a new form of tourism which has gained huge popularity in recent decades. Though, a number of literatures available with regard to the tourism industry and the competitiveness of the destination, however, the major aspects which determine the satisfaction of medical tourists are hardly focused specifically on Malaysia. There is a lack of empirical evidence in this area of study which needs to be bridged. Hence, this study aimed at investigating the various factors contributing towards the development of medical tourism in Malaysia.
Fulltext The study of mindfulness as an intervening factor for enhanced psychological well-being in building the level of resilience

Oh VKS, Sarwar A, Pervez N

Front Psychol, 2022;13:1056834.
PMID: 36619105 DOI: 10.3389/fpsyg.2022.1056834

BACKGROUND: By using a practice like mindfulness, people may become more adaptable and flexible in difficult situations, which lowers the levels of unfavorable experiences. Only a small number of research have examined the connection between mindfulness and resilience, with mindfulness as a source of PWB influencing millennials' resilience when faced with adversity. This study sought to close this gap by exploring the role that mindfulness practice plays in millennials' PWB and subsequent increases in resilience to adversity.
METHODS: In this study, key components linked to mindfulness, PWB, and resilience are combined with a thorough literature assessment. Millennials who are active members of the Ti-Ratana Youth in Malaysia and the Buddhist Missionary Society of Malaysia (BMSM) Youth Section make up the study's sample population. Before completing the online survey form, each participant was instructed to engage in 4 weeks of supervised mindfulness practice. To assure the validity of the data gathered, it was crucial to secure the youth's commitment. Only 231 of the 300 respondents who received the link to the online survey had replies that could be used for further research. To analyze the collected data and conduct hypothesis testing, Smart-PLS was used.
RESULTS: Academic research has shown that factors, such as a heavy workload, time constraints, lengthy workdays, work-related home conflicts, and an unstable and uncertain environment all lead to a drop in PWB. According to the findings, the two most significant variables promoting resilience are mindfulness and positive PWB. The outcomes of this experimental study confirmed earlier findings that millennials' PWB and resilience are enhanced by mindfulness training.
CONCLUSION: The study's findings suggest that, in times of high uncertainty, mindfulness-based intervention programs should be expanded to include all young people. This study offers empirical support for the effectiveness of mindfulness-based interventions in raising PWB and resilience.
Fulltext Antifungal activity of chitosan nanoparticles and correlation with their physical properties

Ing LY, Zin NM, Sarwar A, Katas H

Int J Biomater, 2012;2012:632698.
PMID: 22829829 DOI: 10.1155/2012/632698

The need of natural antimicrobials is paramount to avoid harmful synthetic chemicals. The study aimed to determine the antifungal activity of natural compound chitosan and its nanoparticles forms against Candida albicans, Fusarium solani and Aspergillus niger. Chitosan nanoparticles were prepared from low (LMW), high molecular weight (HMW) chitosan and its derivative, trimethyl chitosan (TMC). Particle size was increased when chitosan/TMC concentration was increased from 1 to 3 mg/mL. Their zeta potential ranged from +22 to +55 mV. Chitosan nanoparticles prepared from different concentrations of LMW and HMW were also found to serve a better inhibitory activity against C. albicans (MIC(LMW) = 0.25-0.86 mg/mL and MIC(HMW) = 0.6-1.0 mg/mL) and F. solani (MIC(LMW) = 0.86-1.2 mg/mL and MIC(HMW) = 0.5-1.2 mg/mL) compared to the solution form (MIC = 3 mg/mL for both MWs and species). This inhibitory effect was also influenced by particle size and zeta potential of chitosan nanoparticles. Besides, Aspergillus niger was found to be resistant to chitosan nanoparticles except for nanoparticles prepared from higher concentrations of HMW. Antifungal activity of nanoparticles prepared from TMC was negligible. The parent compound therefore could be formulated and applied as a natural antifungal agent into nanoparticles form to enhance its antifungal activity.
Relationship between organizational dehumanization and nurses' deviant behaviors: A moderated mediation model

Sarwar A, Khan J, Muhammad L, Mubarak N, Jaafar M

J Nurs Manag, 2021 Jan 04.
PMID: 33394539 DOI: 10.1111/jonm.13241

AIM(S): This paper investigated the impact of organisational dehumanization on nurses' deviant behaviours in the Pakistani health sector directly and indirectly through job stress. The study also examined the moderation role of occupational self-efficacy on the relationship between organisational dehumanization and job stress.
BACKGROUND: While the attitudinal outcomes of organisational dehumanization have been a focus of research, its behavioural outcomes are a relatively ignored research area.
METHOD: Data were collected from 295 nurses working in hospitals across Pakistan via self-administered questionnaires with two measurement points to test the direct and indirect effects of organisational dehumanization.
RESULTS: The hypothesized relationships were tested with SPSS 25 and the Process Macro Model 7. The results showed that organisational dehumanization increased deviant behaviours among nurses directly and indirectly via job stress. Moreover, occupational self-efficacy plays moderation role and weakens the relationship between organisational dehumanization and job stress.
CONCLUSION: This study contributes to the existing literature by concentrating on predictors that trigger deviant behaviour among nurses. It also assessed the mediating impact of job stress, an essential endeavour for researchers and practitioners.
IMPLICATIONS FOR NURSING MANAGEMENT: The study outcomes can help the health sector improve their strategies to address organisational dehumanization and deviant behaviour among nurses.
Fulltext Social Connections and Self-Perceived Depression: An Enhanced Model for Studying Teenagers' Mental Wellbeing

Sarwar A, Islam MA, Mohiuddin M, Tareq MA, Siddika A

Int J Environ Res Public Health, 2022 Nov 27;19(23).
PMID: 36497866 DOI: 10.3390/ijerph192315791

The rising prevalence of depression among teenagers in Malaysia as well as globally makes it a vital issue to study. The purpose of this research is to examine the effects of social connection and self-perceived depression towards the improved mental wellbeing of the teenagers of Malaysia. Moreover, the mediating role of self-perceived depression on the improvement of the mental wellbeing of teenagers is examined in this study. This study followed a questionnaire-based approach. The sample of this study included 289 students aged between 15 and 19 years from Klang Valley, Malaysia. Prior permission was obtained from school authorities as well as from parents to allow their children to participate in the survey. To find out the structural relationship between the variables, PLS-SEM was utilized. This study finds that stronger social connections with family and friends may result in reduced self-perceived depression among Malaysian teenagers. Moreover, self-perceived depression among the teenagers surveyed had a negative effect on their improved mental wellbeing. The findings of this study will significantly affect how depression theories are currently understood and have consequences for social work, services, and policy interventions regarding teenagers in Malaysia.
Fulltext Regioselective Sequential Modification of Chitosan via Azide-Alkyne Click Reaction: Synthesis, Characterization, and Antimicrobial Activity of Chitosan Derivatives and Nanoparticles

Sarwar A, Katas H, Samsudin SN, Zin NM

PLoS One, 2015;10(4):e0123084.
PMID: 25928293 DOI: 10.1371/journal.pone.0123084

Recently, the attention of researchers has been drawn toward the synthesis of chitosan derivatives and their nanoparticles with enhanced antimicrobial activities. In this study, chitosan derivatives with different azides and alkyne groups were synthesized using click chemistry, and these were further transformed into nanoparticles by using the ionotropic gelation method. A series of chitosan derivatives was successfully synthesized by regioselective modification of chitosan via an azide-alkyne click reaction. The amino moieties of chitosan were protected during derivatization by pthaloylation and subsequently unblocked at the end to restore their functionality. Nanoparticles of synthesized derivatives were fabricated by ionic gelation to form complexes of polyanionic penta-sodium tripolyphosphate (TPP) and cationic chitosan derivatives. Particle size analysis showed that nanoparticle size ranged from 181.03 ± 12.73 nm to 236.50 ± 14.32 nm and had narrow polydispersity index and positive surface charge. The derivatives and corresponding nanoparticles were evaluated in vitro for antibacterial and antifungal activities against three gram-positive and gram-negative bacteria and three fungal strains, respectively. The minimum inhibitory concentration (MIC) of all derivatives ranged from 31.3 to 250 µg/mL for bacteria and 188 to1500 µg/mL for fungi and was lower than that of native chitosan. The nanoparticles with MIC ranging from 1.56 to 25 µg/mLfor bacteria and 94 to 750 µg/mL for fungi exhibited higher activity than the chitosan derivatives. Chitosan O-(1-methylbenzene) triazolyl carbamate and chitosan O-(1-methyl phenyl sulfide) triazolyl carbamate were the most active against the tested bacterial and fungal strains. The hemolytic assay on erythrocytes and cell viability test on two different cell lines (Chinese hamster lung fibroblast cells V79 and Human hepatic cell line WRL68) demonstrated the safety; suggesting that these derivatives could be used in future medical applications. Chitosan derivatives with triazole functionality, synthesized by Huisgen 1,3-dipolar cycloaddition, and their nanoparticles showed significant enhancement in antibacterial and antifungal activities in comparison to those associated with native, non-altered chitosan.
On the Ethics of Medical Tourism: An Examination of Patients' Perspectives

Sarwar A, Yong Gun Fie D, Mhd Sarif S, Nikhshemi SR

Iran J Public Health, 2016 May;45(5):688-9.
PMID: 27398342
Fulltext Evaluation of Therapeutic Effectiveness of Prescribed Medications in Patients with Type 2 Diabetes Mellitus: Findings from a Tertiary Care Hospital, Lahore, Pakistan

Rana B, Bukhsh A, Khan TM, Sarwar A, Omer MO, Jamshed SQ

J Pharm Bioallied Sci, 2017 Apr-Jun;9(2):121-125.
PMID: 28717335 DOI: 10.4103/jpbs.JPBS_29_17

AIM: The present study was aimed to highlight the current prescribing pattern of oral hypoglycemia in type 2 diabetes mellitus and to evaluate the therapeutic effectiveness of these therapeutic categories in achieving target glycemic control.

METHODS: This is a prospective, cross-sectional, observational study of 6 months' duration conducted in a tertiary care hospital of Lahore, Pakistan.

RESULTS: The current research recruited 145 patients presented in diabetes management center of a tertiary care hospital in Lahore, Pakistan. Mean age of the participants was 50.2 (± 8.5) years. Out of the 145 patients, 63% were females and 37% were males. Most patients were diagnosed to have diabetes within the past 5 years. Diabetes-induced neuropathy was the most common complication (71.7%) among the patients. A large proportion of these patients (70.3%) were also suffering from other comorbidities among which the most common one is hypertension. The average number of prescribed medications was 1.31. Metformin was prescribed to a majority of patients (64%) as monotherapy while 28.96% received combination therapy. Mean glycated hemoglobin (HBA1c) before and after 3 months of treatment was 8.5 (± 2.3) and 8.04 (± 2.1), respectively. Inferential statistics show a strong association between HBA1c and life style modifications and adherence to medication therapy (P = 0.05). However, the correlation between HBA1c and Morisky score and duration of disease was inverse and weak (P = 0.6, 0.4). The t-test values show a small difference between HBA1c values before and after 3 months (t = 0.440 and 0.466, respectively).

CONCLUSION: Optimization of medication regimen and continuous patient education regarding life style modification and adherence to medication therapy are necessitated to bring HBA1c values near to target.
Fulltext Cephalomannine inhibits hypoxia-induced cellular function via the suppression of APEX1/HIF-1α interaction in lung cancer

Ullah A, Leong SW, Wang J, Wu Q, Ghauri MA, Sarwar A, et al.

Cell Death Dis, 2021 05 14;12(5):490.
PMID: 33990544 DOI: 10.1038/s41419-021-03771-z

Lung cancer (LC) is one of the leading causes of cancer-related death. As one of the key features of tumor microenvironment, hypoxia conditions are associated with poor prognosis in LC patients. Upregulation of hypoxic-induced factor-1α (HIF-1α) leads to the activation of various factors that contribute to the increased drug resistance, proliferation, and migration of tumor cells. Apurinic/apyrimidinic endonuclease-1 (APEX1) is a multi-functional protein that regulates several transcription factors, including HIF-1α, that contribute to tumor growth, oxidative stress responses, and DNA damage. In this study, we explored the mechanisms underlying cell responses to hypoxia and modulation of APEX1, which regulate HIF-1α and downstream pathways. We found that hypoxia-induced APEX1/HIF-1α pathways regulate several key cellular functions, including reactive oxygen species (ROS) production, carbonic anhydrase 9 (CA9)-mediated intracellular pH, migration, and angiogenesis. Cephalomannine (CPM), a natural compound, exerted inhibitory effects in hypoxic LC cells via the inhibition of APEX1/HIF-1α interaction in vitro and in vivo. CPM can significantly inhibit cell viability, ROS production, intracellular pH, and migration in hypoxic LC cells as well as angiogenesis of HUVECs under hypoxia through the inhibition of APEX1/HIF-1α interaction. Taken together, CPM could be considered as a promising compound for LC treatment.
Fulltext Prevalence of type-2 diabetes and prediabetes in Malaysia: A systematic review and meta-analysis

Akhtar S, Nasir JA, Ali A, Asghar M, Majeed R, Sarwar A

PLoS One, 2022;17(1):e0263139.
PMID: 35085366 DOI: 10.1371/journal.pone.0263139

OBJECTIVE: The main purpose of this study was to investigate the pooled prevalence of prediabetes and type-2 diabetes in the general population of Malaysia.
METHOD: We systematically searched Medline (PubMed), Embase, Web of Science, Google Scholar and Malaysian Journals Online to identify relevant studies published between January 1, 1995, and November 30, 2021, on the prevalence of type-2 diabetes in Malaysia. Random-effects meta-analyses were used to obtain the pooled prevalence of diabetes and prediabetes. Subgroup analyses also used to analyze to the potential sources of heterogeneity. Meta- regression was carried to assess associations between study characteristics and diabetes prevalence. Three independent authors selected studies and conducted the quality assessment. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Of 2689 potentially relevant studies, 786 titles and abstract were screened. Fifteen studies with 103063 individuals were eligible to be included in the meta-analyses. The pooled prevalence of diabetes was 14.39% (95% CI, 12.51%-16.38%; I2 = 98.4%, 103063 participants from 15 studies). The pooled prevalence of prediabetes was 11.62% (95% CI, 7.17%-16.97%; I2 = 99.8, 88702 participants from 9 studies). The subgroup analysis showed statistically significant differences in diabetes prevalence by the ethical sub-populations with highest in Indians (25.10%; 95% CI, 20.19%-30.35%), followed by Malays (15.25%; 95% CI, 11.59%-19.29%), Chinese (12.87%; 95% CI, 9.73%-16.37%), Bumiputeras (8.62%; 95% CI, 5.41%-12.47%) and others (6.91%; 95% CI, 5.71%-8.19%). There was no evidence of publication bias, although heterogeneity was high (I2 ranged from 0.00% to 99·8%). The quality of evidence based on GRADE was low.
CONCLUSIONS: Results of this study suggest that a high prevalence of prediabetes and diabetes in Malaysia. The diabetes prevalence is associated with time period and increasing age. The Malaysian government should develop a comprehensive approach and strategy to enhance diabetes awareness, control, prevention, and treatment.
TRIAL REGISTRATION: Trial registration no. PROSPERO CRD42021255894; https://clinicaltrials.gov/.
Parkin deficiency promotes liver cancer metastasis by TMEFF1 transcription activation via TGF-β/Smad2/3 pathway

Su Q, Wang JJ, Ren JY, Wu Q, Chen K, Tu KH, et al.

Acta Pharmacol Sin, 2024 Mar 22.
PMID: 38519646 DOI: 10.1038/s41401-024-01254-3

Parkin (PARK2) deficiency is frequently observed in various cancers and potentially promotes tumor progression. Here, we showed that Parkin expression is downregulated in liver cancer tissues, which correlates with poor patient survival. Parkin deficiency in liver cancer cells promotes migration and metastasis as well as changes in EMT and metastasis markers. A negative correlation exists between TMEFF1 and Parkin expression in liver cancer cells and tumor tissues. Parkin deficiency leads to upregulation of TMEFF1 which promotes migration and metastasis. TMEFF1 transcription is activated by Parkin-induced endogenous TGF-β production and subsequent phosphorylation of Smad2/3 and its binding to TMEFF1 promotor. TGF-β inhibitor and TMEFF1 knockdown can reverse shParkin-induced cell migration and changes of EMT markers. Parkin interacts with and promotes the ubiquitin-dependent degradation of HIF-1α/HIF-1β and p53, which accounts for the suppression of TGF-β production. Our data have revealed that Parkin deficiency in cancer leads to the activation of the TGF-β/Smad2/3 pathway, resulting in the expression of TMEFF1 which promotes cell migration, EMT, and metastasis in liver cancer cells.

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