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Alternative, complementary and traditional medicine in Malaysia

Talib N

Med Law, 2006 Sep;25(3):445-62.
PMID: 17078519

This paper sets out the practice of traditional, alternative and/or complementary medicine in Malaysia. It gives an overview of the types of alternative medicine available, and the legal regulation, or lack of it within the current setting. The relevant policies and governmental action in this area are highlighted. Relevant case law decisions in this area are also included. The practice of spiritual healing as one form of traditional medicine, and its role within the spectrum of alternative medicine is dealt with briefly. The significant question of integration of alternative medicine within the existing allopathic system is addressed. The paper concludes that as interest in, and usage of alternative medicine is not likely to decrease, certain measures must be taken by the relevant authorities to ensure among others, the safety and efficacy of these medicines.
Legal values as tools for promoting harmony

Talib N

Med Law, 2010 Sep;29(3):433-42.
PMID: 22145562

The doctrine of informed consent has the effect of allowing the mentally competent adult patient to exercise individual choice in any proposed medical treatment. The ethical principles primarily inherent in this doctrine would be the principles of autonomy and beneficence. However, it is argued in this essay that the concept and meaning of autonomy might be vastly different between western and eastern communities. Consequently the doctrine of informed consent will lead to a different meaning in these different societies. The essay also raises the implication of transplanting legal doctrines into societies which might not be fully prepared to implement the ideal contained in the doctrine of informed consent.
Dilemmas surrounding passive euthanasia--a Malaysian perspective

Talib N

Med Law, 2005 Sep;24(3):605-13.
PMID: 16229394

In western societies where the principle of autonomy is jealously guarded, perhaps active euthanasia is more often the focus of public concern and debates rather than any other forms of euthanasia. However due to the advance in technology and its corresponding ability in prolonging life, in Malaysia passive euthanasia presents more of a dilemma. For those concerned and involved with end of life decision-making, it is generally agreed that this is an area fraught with not only medical but legal and ethical issues. In Malaysia where the society is not homogenous but is multi-cultural and multi-religious, in addition to medical, legal and ethical issues, religious principles and cultural norms further impact and play significant roles in end of life decision-making. This paper seeks to identify the issues surrounding the practice of passive euthanasia in Malaysia. It will be shown that despite applicable legal provisions, current practice of the medical profession combined with religious and cultural values together affect decision-making which involves the withholding and/or withdrawing of life-saving treatment.
Fulltext Integrating technological pedagogical and content knowledge in computer programming courses: Issues and challenges

Talib, N., Yassin, S.F.M, Bunyamin, M.A.H.

Journal of Advanced Research Design, 2016;27(1):1-13.
MyJurnal

The purpose of this study is to explore the issues and challenges in integrating
technological pedagogical content knowledge (TPACK) for computer programming
courses. This study employed the triangulation method of the case studies and
Grounded Theory (GT). Twenty-five computer programming educators were
interviewed via online such as e-mail, media social’s chatting and messaging
application like WhatsApp and Telegram. The main issue discovered in this study is the
misconception in using technology for teaching and learning computer programming.
Besides that, there were two major challenges found in this study. The challenges are
the instructors were not able to explore the rapid development of technology and this
may cause the lack of technological pedagogical knowledge among them. They also
showed the lack of knowledge about pedagogy and assessment for teaching and
learning computer programming that relevant to the programming content. The
research that has been done showed that TPACK model is very suitable to guide
exploration about how educators make use of technology appropriate to the pedagogy
and content. However, the exploration that has been done has limitation on how
educators integrate student’s assessment on affective and instructional design
implementation with TPACK. Therefore, this paper suggesting for the future study, in
order that more exploration should be doing about how assessment on student’s
affective and instructional design would be integrate with technology, pedagogy and
content knowledge via TPACK model.
The impact of immigration on health systems: a legal analysis from a three-country perspective

Blum J, Carstens P, Talib N

Med Law, 2005 Jun;24(2):323-36.
PMID: 16082868

The focus of this paper will be on how health care systems in three countries, Malaysia, South Africa and the United States, are responding to the health needs of immigrants with a strong focus on the legal aspects of the respective national responses. The Malaysia portion emphasizes legal immigration and analyses as to how the country's Ministry of Health and the delivery system itself is responding to the demands of immigrant's health. In the context of South Africa, the paper explores implications of the South African Constitution, which establishes a right to access health care, and explores whether such a right can be extended to non-citizens, or can be tempered by economic constraints. In the American discussion the focus is on whether publicly supported health care programs can be accessed to provide coverage for undocumented residents, and highlights recent constraints in using government monies in this area.
Fulltext Pyrosequencing-based quantitative evaluation of P16 methylation in diffuse large b-cell lymphoma

Mohd. Ridah L.J., Ismail A., A. Talib N., Muhammad N., Hussain F.A., Zainuddin N.

Journal of Biomedical and Clinical Sciences, 2016;1(1):12-17.
MyJurnal

Introduction: Methylation of promoter region of p16 leading to gene silencing has been implicated ina wide range of malignancies including lymphomas. In diffuse large B cell lymphoma (DLBCL) particularly, a varying percentage of epigenetic inactivation of p16 promoter region was observed ranging from 16 -54%. However, quantitative analysis of p16 promoter methylation in DLBCL has not been extensively studied in Malaysia. Objective: This study aims to quantitatively analyse p16 methylation in DLBCL samples using pyrosequencing technique. Methods: Genomic DNA was extracted from 16 formalin-fixed paraffin-embedded lymphoma tissue blocks from patients diagnosed with DLBCL. Samples were retrieved from Hospital Tengku Ampuan Afzan, Pahang and Hospital Universiti Sains Malaysia, Kelantan. Primers were designed to amplify bisulfite-treated DNA targeting p16 promoter region. Methylation status of 7 CpG sites was determined by pyrosequencing. Results: All the 16 samples studied showed promoter methylation of p16. The range of mean methylation percentage was between 18 to 81%. Conclusion: The present study has successfully measured the level of methylation of p16 in all 7 CpG sites despite the limitation in sample size. Since p16 methylation is a common event in our series of DLBCL cases, it is worth including a larger sample size in future studies to increase the chance of finding a significant correlation with clinical parameters.
Government public health policy: three cautionary tales from Malaysia, South Africa and the United States

Blum J, Carstens P, Talib N

Med Law, 2007 Dec;26(4):615-42.
PMID: 18284107

Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.
Fulltext Haplotypes frequencies of CYP2B6 in Malaysia

Musa N, Zulkafli MI, Talib N, Mohamad N, Fauzi H, Ismail R

J Postgrad Med, 2012 Oct-Dec;58(4):235-41.
PMID: 23298916 DOI: 10.4103/0022-3859.105439

Drugs with complex pharmacology are used in the management of drug use disorder (DUD) and HIV/AIDS in Malaysia and in parts of South-East Asia. Their multiethnic populations suggest complexity due to the genetic polymorphism, such as CYP2B6 that metabolizes methadone and anti-retroviral.
Fulltext Eyelid Juvenile Xanthogranuloma: A Case Report and Literature Review

Hassan A, Talib N, Adzman S, Hussein A

Cureus, 2019 Jun 26;11(6):e5008.
PMID: 31497438 DOI: 10.7759/cureus.5008

Juvenile xanthogranuloma (JXG) is an uncommon condition affecting the eye. We herein report a rare case of eyelid swelling in paediatric age group. A three-year-old Malay boy presented with chronic painless left upper eyelid mass which did not resolve with topical steroid. Clinically, the mass was a non-tender and firm nodular swelling which located at the lateral 1/3 of the left upper lid. Total excisional biopsy of the swelling was done and histopathological findings were consistent with JXG. The systemic associations and the treatment options for ocular JXG are discussed.
Fulltext Proteomic profiles of young adults with acute myocardial infarction.

Mohamed Bakrim N, Mohd Shah AS, Mohd. Shah ANS, A. Talib N, A.Rahman J, Muhamad Bunnori N, et al.

IIUM Medical Journal Malaysia, 2019;18(3):112-119.
MyJurnal

Proteomic profiling is essential in understanding the pathophysiological process of multifactorial diseases such as acute myocardial infarction (AMI). Despite the increasing incidence of AMI in young adults, proteomic-based study focusing on young AMI remains limited. This study aimed to examine the plasma proteomic profiles of young adults with AMI compared to control subjects. We also hope to identify disease-specific protein biomarkers that contribute to the development of AMI in the young. Methods:Pooled plasma protein from 10 AMI patients aged 18 to 45 years and 10 age, gender and race-matched volunteers were separated using two-dimensional electrophoresis (2-DE). The spots proteins were analysed using the PD Quest analysis software. The spots proteins that were found to have been expressed differently between the two groups were identified by Matrix Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) Mass Spectrometry. Results:There were three differently expressed proteins namely Apolipoprotein AI (Apo AI), Apolipoprotein AIV (Apo AIV) and Haptoglobin (p < 0.05). The expressions of these proteins were found to be increased in young patients with AMI compared to control subjects. Conclusion: The up regulation of Apo AI, Apo AIV and Haptoglobin in AMI patients indicate their important roles in the development of atherosclerotic disease. Thus, Apo AI, Apo AIV and Haptoglobin are potential disease biomarkers for young AMI.
Fulltext Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Mohamad N, Bakar NH, Musa N, Talib N, Ismail R

Harm Reduct J, 2010;7:30.
PMID: 21167035 DOI: 10.1186/1477-7517-7-30

BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.
Invasive Klebsiella syndrome with coexisting fungal endophthalmitis

Sugantheran J, Zunaina E, Md Kasim WM, Talib N

Malays Fam Physician, 2021 Jul 22;16(2):94-97.
PMID: 34386173 DOI: 10.51866/cr1100

Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. Key messages: A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.
Beating the odds: a rare case of supracardiac total anomalous pulmonary venous return (TAPVR) in an adult patient

Talib N, Sayuti KA, Abdullah MS, Mohd Zain MR

BMJ Case Rep, 2018 Mar 05;2018.
PMID: 29507009 DOI: 10.1136/bcr-2017-221074

Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect, and patients are usually symptomatic at a very young age. Survival to adulthood without surgical correction is extremely rare. We report a 33-year-old woman with a heart murmur and a history of a successful pregnancy. Echocardiogram revealed a large atrial septal defect with suspicious pulmonary vein anomaly. Chest radiograph demonstrated classical 'snowman' configuration. Cardiac catheterisation was consistent with anomalous pulmonary venous drainage. Cardiac CT confirmed supracardiac TAPVR, whereby all the pulmonary veins drain into the anomalous vein and finally to the superior vena cava. She remained asymptomatic and underwent a successful surgical repair.
Preliminary studies on the effect of excretory secretory (ES) Ascaris lumbricoides antigens on colorectal cell line viability

Ab Talib NN, Nisha M, Ramasamy R, Pang JC

Trop Biomed, 2024 Jun 01;41(2):160-165.
PMID: 39154268 DOI: 10.47665/tb.41.2.005

Helminth parasites are a group of complex metazoans from various taxonomic families. Excretory secretory (ES) by-products, secreted by living parasites from the surface, appeared to modulate the host immunological response towards helminth infection. This study aims to investigate the effect of ES antigen from helminth parasite on colorectal cell viability. Worm were cultured in phosphate-buffered saline (PBS x1) at 37°C for 24 hours after being rinsed in sterile PBS. Using a mortar and pestle, the worm was crushed vigorously using PBS. The obtained excretory secretory (ES) antigens were extracted and filtered using a 0.22 µM filter and stored at -20°C for further assay. For LCMS, 100 µl of the extract was analysed using Agilent ZORBAX Eclipse Plus C18 Rapid Resolution HT. The extraction of ES antigen (10 µg/ml and 20 µg/ml) was used for cell viability studies using CRC cell line HCT 116. Cell viability and MTT assay were conducted as per the protocol mentioned in the MTT kit. The liquid chromatography and mass spectrometry (LCMS) data indicated that the ES antigen contained metabolic compounds, namely fatty acid, amino alcohol, indoles, sterols, glycosides, and sphingoids. For the Ascaris lumbricoides LCMS analyses, around 405 metabolic peaks were detected. Out of which, 58 were detected via the database were identified, while several compounds detected have anticancer properties. The MTT assay indicated that after 24 hours and 48 hours of exposure, all treated cells showed a decrease in cell viability compared to the control group. The preliminary studies demonstrated that the ES antigen from Ascaris lumbricoides has some ability to decrease the cell viability of the HCT116 CRC cell line. Further studies are needed to examine the cell cycle arrest and apoptosis effect of the ES antigen towards the CRC cell line.
Rights of patients: comparative perspectives from five countries

Blum JD, Talib N, Carstens P, Nasser M, Tomkin D, McAuley A

Med Law, 2003;22(3):451-71.
PMID: 14626880

Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.
The association between the reflux symptoms index and nasal symptoms among patients with non-allergic rhinitis

Hamizan AW, Choo YY, Loh PV, Abd Talib NF, Mohd Ramli MF, Zahedi FD, et al.

J Laryngol Otol, 2021 Feb;135(2):142-146.
PMID: 33494850 DOI: 10.1017/S0022215120002492

BACKGROUND: Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients.
METHODS: A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0-3), moderate (4-7) or severe (8-12)) were assessed.
RESULTS: The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16-13.87); p < 0.01).
CONCLUSION: Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.
Fulltext The identification of copy number variation of CNV ESV27061 among young adults with hypertension: preliminary findings. [Abstract]

Shaik Alaudeen SR, Mohd Shah AS, Abdul Talib N, Abdullah A

International Medical Journal Malaysia, 2017;16(11):31.
MyJurnal

Introduction: Hypertension related morbidities and mortalities around the world show a gradual increase and early detection and prevention are advocated. The Database of Genomic Variants (DGV) has associated variation in DNA sequences called copy number variation (CNV) with susceptibility to common diseases. However, little is known about CNV role in essential hypertension. Thus, this study aimed to characterize the CNV esv27061 among prehypertensive and hypertensive young adults in Malaysia. Materials and method: In this comparative cross-sectional study, 104 subjects living in Kuantan who gave voluntary consent to participate are recruited and divided into three groups; control (43 subjects), prehypertensive (38 subjects) and mild hypertensive (23 subjects). An optimized droplet digital polymerase chain reaction (ddPCR) was used in the determination of CNV esv27061 in this study. Results: All subjects in the control (n=38; 88.4% gain), prehypertensive (n=33; 86.8% gain) and mild hypertensive (n=21; 91.3% gain) groups had CNV gain (copy number > 2) while 11.6% of control, 13.2% of prehypertensive and 8.7% of mild hypertensive subjects exhibited normal copies (copy number = 2). Conclusion: The present preliminary finding was consistent with the Database of Genomic Variants (DGV) which stated that CNV esv27061 showed more gain than loss.
Fulltext Inconclusive relationship between rheumatoid arthritis and schizophrenia: How to move forward?

Nur Shafawati AR, Sulong S, Wan Ghazali WS, Abdul Talib N, Wan Taib WR

Buletin Persatuan Genetik Malaysia, 2015;21(1):15-19.
MyJurnal

Rheumatoid Arthritis (RA) is a chronic inflammatory polyarthritis disease predominantly involving synovial tissue of the joints and characterized by destructive and debilitating arthritis (Choy et al., 2012; Weyand, 2000; reviewed by Worthington, 2005; Gabriel et al., 1999). It can cause progressive and irreversible destruction of tendons, cartilage and bone, which leads to lack of ability to perform daily activities (Singh et al., 2015). Although the aetiology of RA remains unsolved, the strength of the genetic component in RA is estimated based on familial aggregation and information about epidemiology and population prevalence (reviewed by Gregersen, 1999, Choy et al., 2012). (Copied from article).
Fulltext The effect of frying on browning, acrylamide and 5-hydroxymethylfurfural formation on Malaysian curry puff skin treated with l-asparaginase

Mohd Hashim MN, Abd-Talib N, Yaji ELA, Kelly YTL, Razali N, Pa'ee KF

Food Sci Biotechnol, 2021 Jan;30(1):149-158.
PMID: 33552626 DOI: 10.1007/s10068-020-00849-w

Acrylamide and 5-hydroxymethylfurfural (HMF) is the product of the Maillard reaction and its accumulation may lead to adverse health effects. Hence, this paper aims to study the effect of l-asparaginase treatment (E100 U/kg and E500 U/kg), frying temperatures (180 °C, 190 °C, 200 °C) and times (2 min, 3 min, 5 min, 7 min) on acrylamide and HMF content after the frying process of curry puff skin. Colour development, moisture content, water activity analysis and sensory evaluation were also carried out. Frying condition at 190 °C for 5 min produced desirable attributes through sensory evaluation. Furthermore, the enzyme reduced the acrylamide and HMF level to 2500 μg/kg and 230 μg/kg respectively. Frying temperature plays a crucial role in acrylamide decomposition leading to the reduction of acrylamide content. Therefore, the use of this enzyme is plausible for the reduction of acrylamide and HMF in puff skin without altering the original quality.
p16 Tumor Suppressor Gene Methylation in Diffuse Large B Cell Lymphoma: A Study of 88 Cases at Two Hospitals in the East Coast of Malaysia

Mohd Ridah LJ, A Talib N, Muhammad N, Hussain FA, Zainuddin N

Asian Pac J Cancer Prev, 2017 10 26;18(10):2781-2785.
PMID: 29072413

Introduction: p16 gene plays an important role in the normal cell cycle regulation. Methylation of p16 has been reported to be one of the epigenetic events contributing to the pathogenesis of diffuse large B-cell lymphoma (DLBCL) which occurring at varying frequency. DLBCL is an aggressive and high-grade malignancy which accounts for approximately 30% of all non-Hodgkin lymphoma cases. However, little is known regarding the epigenetic alterations of p16 gene in DLBCL cases in Malaysia. Therefore, the objective of this study was to examine the status of p16 methylation in DLBCL. Methods: A total of 88 formalin-fixed paraffin-embedded DLBCL tissues retrieved from two hospitals located in the east coast of Malaysia, namely Hospital Tengku Ampuan Afzan (HTAA) Pahang and Hospital Universiti Sains Malaysia (HUSM) Kelantan, were chosen for this study. DNA specimens were isolated and subsequently subjected to bisulfite treatment prior to methylation specific-PCR. Two pairs of primers were used to amplify methylated and unmethylated regions of p16 gene. The PCR products were then separated using agarose gel electrophoresis and visualised under UV illumination. SPSS version 12.0 was utilised to perform all statistical analysis. Result: p16 methylation was detected in 65 of 88 (74%) samples. There was a significant association between p16 methylation status and patients aged >50 years old (p=0.04). Conclusion: Our study demonstrated that methylation of p16 tumor suppressor gene in our DLBCL cases is common and significantly increased among patients aged 50 years and above. Aging is known to be an important risk factor in the development of cancers and we speculate that this might be due to the increased transformation of malignant cells in aging cell population. However, this has yet to be confirmed with further research and correlate the findings with clinicopathological parameters.

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