Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psycho... more Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psychometrically sound measurements are urgently needed to assess anxiety symptoms. The extensively used Generalized Anxiety Disorder 7-item (GAD-7) is a promising candidate. However, studies on its factorial validity show mixed findings. While the one-factor solution has been replicated in different cultural contexts, some studies found different factorial structures instead. This study aimed to clarify the factorial validity of the English version of the GAD-7 in the Malaysian context. The responses collected from 1272 emerging to older adults in Malaysia were randomly divided into two halves and submitted to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) respectively. Four acceptable models were explored in EFA ranging from unidimensional factor with 7 items to 3-factor models with 6 items. The four models revealed in EFA and the other competing models found in past studies were then examined and compared using CFA. The 6-item secondorder model with a general factor of anxiety and three first-order factors with two items respectively (i.e., GAD-6) showed a more harmonic result and hence, is preferable. Moreover, the GAD-6 and its three subscales also showed satisfactory internal consistency and construct validity. This study uncovers a new and unique factorial structure of the GAD screening tool that fits in the Malaysian context. The scale may reveal GAD symptomatic dimensions that guide clinical interventions.
Biochemical and Biophysical Research Communications, Nov 1, 2012
The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely use... more The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely used in veterinary medicine and as food additives and growth promoters in animal husbandry including poultry farming. Their effects on human health, however, are not fully understood. Recent studies showed that salinomycin is a cancer stem cell inhibitor. Since poultry consumption has risen sharply in the last three decades, we asked whether the consumption of meat tainted with growth promoting antibiotics might have effects on adipose cells. We showed in this report that the ionophoric antibiotics inhibit the differentiation of preadipocytes into adipocytes. The block of differentiation is not due to the induction of apoptosis nor the inhibition of cell proliferation. In addition, salinomycin also suppresses the transcriptional activity of the CCAAT/enhancer binding proteins and the peroxisome proliferator-activated receptor γ. These results suggest that the ionophoric antibiotics can be exploited as novel anti-obesity therapeutics and as pharmacological probes for the study of adipose biology. Further, the pharmacological effects of salinomycin could be a harbinger of its toxicity on the adipose tissue and other susceptible target cells in cancer therapy.
This research was conducted in privately-run assisted living facilities for the elderly in the Kl... more This research was conducted in privately-run assisted living facilities for the elderly in the Klang Valley, Malaysia to screen for cognitive disorder and affective disorder using the Mini-Cog assessment and Patient Health Questionnaire-2, respectively. Besides finding the incidences of these disorders as well as the gender and race distribution among the sample, this research also aimed to find the association between cognitive and affective disorder with two factors; highest level of education and frequency of visits from family and/or friends in the past 2 years. This crosssectional study managed to obtain consent to interview a total of 591 residents out of which 43 (7.2%) are found to be positive for cognitive impairment and 188 (31.8%) are found to have depressive disorder. Among the 43 residents with cognitive disorder, a majority of 16 (37.2%) did not receive any formal education and the same number also did not receive any visits from family and/or friends. Among the 188 residents with depressive disorder, a majority of 64 (34%) received secondary education and a majority of 65 (34.6%) received monthly visits from family and/or friends. There are positive associations between cognitive disorder and level of education as well as frequency of visits from family and/or friends. But interestingly, there are no associations between depressive disorder and level of education as well as frequency of visits. The reasons behind these figures will be further explored in this paper along with possible intervention methods
Candida albicans is an important opportunistic fungal pathogen capable of causing fatal systemic ... more Candida albicans is an important opportunistic fungal pathogen capable of causing fatal systemic infections in humans. Presently in Malaysia, there is little information available on the genetic diversity of this organism and trends in behavioural characteristics. In this project, three genotyping methods: 25S rDNA genotyping, Alternative Lengthening of Telomerase (ALT) sequence typing and Multi-Locus Sequence Typing (MLST) were applied to study the genetic diversity of strains from infected hospital in-patients and asymptomatic individuals in the community. The results showed that, with the 25S rDNA genotyping, as in other parts of the world, the most common genotype was type A which accounted for approximately 70% of the 111 isolates tested. Further typing with the ALT sequence showed type 3 to be the most common in the isolates tested. MLST analysis revealed many possibly novel sequence types, as well as a statistically significant association between pathogenicity and a group of...
A simplified assay for the detection of Thyroid-binding Inhibiting Immunoglobulin (TBII) using un... more A simplified assay for the detection of Thyroid-binding Inhibiting Immunoglobulin (TBII) using unextracted serum was set up. A total of 176 patients with Graves' disease were tested for the presence of TBII in their serum. Using the t3SD limit for normal controls as the cut off value for a positive result, 124 patients (70.5%) were positive for TBII. A further 18 patients (10.2%) who had TB11 values between t2SD and t3SD limits were considered borderline positives. The intraand inter-assay variability, determined by replicate analysis of samples from patients with Graves' disease were both good at 5.8% and 5.6% respectively. Assay results obtained were comparable to that of standard procedure using extracted gamma-globulins as samples. Performance characteristics of the assay were acceptable.
The molecular basis of variable phenotypes in P-thalassaemia patients with identical genotypes ha... more The molecular basis of variable phenotypes in P-thalassaemia patients with identical genotypes has been associated with co-inheritance of alpha-thalassaemia and persistence of HbF production in adult life. The Xmn I restriction site at -158 position of the Ggamma-gene is associated with increased expression of the Ggamma-globin gene and higher production of HbF This study aims to determine the frequency of the digammaferent genotypes of the Ggamma Xmn I polymorphism in P-thalassaemia patients in two ethnic groups in Malaysia. Molecular characterisation and frequency of the Ggamma Xmn I polymorphism were studied in fifty-eight Chinese and forty-nine beta-thalassaemia Malay patients by Xmn I digestion after DNA amplification of a 650 bp sequence. The in-house developed technique did not require further purification or concentration of amplified DNA before restriction enzyme digestion. The cheaper Seakem LE agarose was used instead of Nusieve agarose and distinct well separated bands w...
Hepatitis B virus (HBV) and high liver iron deposits have both been associated with the developme... more Hepatitis B virus (HBV) and high liver iron deposits have both been associated with the development of cirrhosis. Among HBV factors, genotype and mutations in the basal core promoter (BCP) and precore regions have been most frequently studied but the evidence for a positive association with cirrhosis has been inconsistent. In this study, sera from persons with chronic HBV infection with and without cirrhosis were used for whole HBV genome analysis and for the estimation of serum iron marker (serum iron or ferritin) levels. Single codon analysis showed that the precore wild-type, TGG (nt 1,895-1,897), gave the highest accuracy (77.5%) for the identification of cirrhosis compared to other codons. When TGG was analyzed together with the precore start codon wild-type, ATG (nt 1,814-1,816), the accuracy was improved to 80.0% (odds ratio ¼ 35.29; 95% confidence interval ¼ 3.87-321.93; Phi ¼ 0.629; P < 0.001). When the serum iron marker was included for analysis, it was clear that a combination of a precore wild-type and high serum iron marker gave a better accuracy (90.0%) (odds ratio ¼ 107.67; 95% confidence interval ¼ 10.21-1,135.59; Phi ¼ 0.804; P < 0.001) for the identification of cirrhosis than either biomarker alone. It appeared that a combined use of both these biomarkers might help to predict the development of cirrhosis in a person with chronic HBV infection, but longitudinal studies are required to test this hypothesis.
Aims-To determine (1) the detection rate of primary carcinoma of the lung by serological assay of... more Aims-To determine (1) the detection rate of primary carcinoma of the lung by serological assay of CEA (carcinoembryonic antigen); and (2) whether addition of seroassay of squamous cell carcinoma related antigen before treatment improves detection sensitivity. Methods-A prospective study spanning 27 months was conducted at the University Hospital, Kuala Lumpur. Serum CEA (Abbott IMx) and serum squamous cell carcinoma antigen (Abbott IMx) from patients clinically suspected of hav- ing primary carcinoma of the lung, were assayed using the microparticle enzyme immunoassay method. Results-Thirty seven cases of histo- logically confirmed primary lung carci- noma were studied. Of these, 17 were squamous cell carcinomas, 10 adeno- carcinomas, nine small cell carcinomas, and one large cell carcinoma. The patients' ages ranged from 34-82 years. The male:female ratio was 3-6: 1. Squamous cell carcinoma antigen was raised above the cutoff value of 1.5 ngiml in 94-1% of squamous cell carcinomas, 20-0% of adenocarcinomas, and 11*1% of small cell carcinomas. By comparison, CEA was raised above the cutoff value of 3-0 nglml in 70-6% of squamous cell car- cinomas, 77*8% of small cell carcinomas,
Biochemical and Biophysical Research Communications, 2012
The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely use... more The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely used in veterinary medicine and as food additives and growth promoters in animal husbandry including poultry farming. Their effects on human health, however, are not fully understood. Recent studies showed that salinomycin is a cancer stem cell inhibitor. Since poultry consumption has risen sharply in the last three decades, we asked whether the consumption of meat tainted with growth promoting antibiotics might have effects on adipose cells. We showed in this report that the ionophoric antibiotics inhibit the differentiation of preadipocytes into adipocytes. The block of differentiation is not due to the induction of apoptosis nor the inhibition of cell proliferation. In addition, salinomycin also suppresses the transcriptional activity of the CCAAT/enhancer binding proteins and the peroxisome proliferator-activated receptor γ. These results suggest that the ionophoric antibiotics can be exploited as novel anti-obesity therapeutics and as pharmacological probes for the study of adipose biology. Further, the pharmacological effects of salinomycin could be a harbinger of its toxicity on the adipose tissue and other susceptible target cells in cancer therapy.
Vaccination is a key public health strategy that is known to be effective in mitigating the risk ... more Vaccination is a key public health strategy that is known to be effective in mitigating the risk of infection and severe disease. However, in the context of the COVID-19 pandemic, the percentage (<50%) of Malaysians who have received a booster for the COVID-19 vaccine has remained stagnant over a year. This study aimed to determine the prevalence of and the factors associated with hesitancy toward the second dose of booster for the COVID-19 vaccine. A web-based cross-sectional study was conducted from August to November 2022. The Oxford Vaccine Hesitancy Scale was used to assess the hesitancy toward the second dose of booster for the COVID-19 vaccine. Simple and multiple factors logistic regressions were used to determine the predictors of hesitancy. A p-value less than 0.05 was considered to be statistically significant. Data from 798 respondents were included in the analysis. The prevalence of hesitancy toward the second booster of the COVID-19 vaccine was 26.7%. The predictors of second-booster hesitancy were older age (AOR = 1.040, 95 CI = 1.022, 1.058), having received the third dose (first booster) because of instruction by the government (AOR = 2.125, 95% CI = 1.380, 3.274), concern about serious long term side effects of the vaccine (AOR = 4.010, 95% CI = 2.218, 7.250), and opinions of close friends and immediate family members that the booster is harmful (AOR = 2.201, 95% CI = 1.280, 3.785). Conversely, factors that appear to reduce vaccine booster hesitancy were acceptance of the third dose due to the high number of cases and the increasing rate of infection (AOR = 0.548, 95% CI = 0.317, 0.947), the belief that the vaccine will decrease the risk of getting the infection (AOR = 0.491, 95% CI = 0.277, 0.870), and opinions of close friends and immediate family members that the booster is helpful (AOR = 0.479, 95% CI = 0.273, 0.840). In conclusion, more than one-fifth of Malaysians were hesitant to take the second booster of the COVID-19 vaccine. This suggests that appropriate steps that increase vaccine acceptance, taking into consideration the findings of the present study, are needed to address this issue and to foster more positive attitudes toward vaccination. The survey was available in three main languages but limited to people with internet access; hence, it would likely be biased toward younger adults and social media users and exclude those with limited or no internet access, in particular older people. Therefore, the results are not representative of the Malaysian population at large and caution should be exercised when interpreting the findings.
AimWe examined the anxiety levels and coping strategies among staff and students of a tertiary ed... more AimWe examined the anxiety levels and coping strategies among staff and students of a tertiary educational institution during the COVID-19 pandemic and determined the association between anxiety level and coping strategies.MethodThrough an online survey, we used Coronavirus Anxiety Scale (CAS) to measure the level of anxiety associated with the COVID-19 crisis and Brief Coping Orientation to Problems Experienced (COPE) to assess the coping responses adopted to handle stressful life events. Coping strategies were classified as adaptive and maladaptive, for which the aggregate sores were calculated. Multiple linear regression was used to determine the predictors of anxiety adjusted for potentially confounding variables. Results from 434 participants were available for analysis.ResultsThe mean score (SD) of the CAS was 1.1 (1.8). The mean scores of adaptive and maladaptive coping strategies were 35.69 and 19.28, respectively. Multiple linear regression revealed that maladaptive coping ...
The human oral microbiome has been known to show strong association with various oral diseases in... more The human oral microbiome has been known to show strong association with various oral diseases including oral cancer. This study attempts to characterize the community variations between normal, oral potentially malignant disorders (OPMD) and cancer associated microbiota using 16S rDNA sequencing. Swab samples were collected from three groups (normal, OPMD and oral cancer) with nine subjects from each group. Bacteria genomic DNA was isolated in which full length 16S rDNA were amplified and used for cloned library sequencing. 16S rDNA sequences were processed and analysed with MOTHUR. A core oral microbiome was identified consisting of Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes and Actinobacteria at the phylum level while Streptococcus, Veillonella, Gemella, Granulicatella, Neisseria, Haemophilus, Selenomonas, Fusobacterium, Leptotrichia, Prevotella, Porphyromonas and Lachnoanaerobaculum were detected at the genus level. Firmicutes and Streptococcus were the predominant ...
The relationship between serum Hepatitis B virus DNA (HBV-DNA) and the Hepatitis B e-antigen/ ant... more The relationship between serum Hepatitis B virus DNA (HBV-DNA) and the Hepatitis B e-antigen/ anti-Hepatitis Be (HBeAg/anti-HBe) serological status in Malaysians was studied. 212 cases of asymptomatic HBV carriers were recruited for this study. 92 cases were positive for the HBeAg at the point of recruitment. 85 (92.4%) of these patients tested positive for HBV-DNA, of whom 55 (64.7%) had levels over 100pg/ml of serum. Three of the remaining 7 HBeAg positive cases who were negative for HBV-DNA subsequently seroconverted. The other 4 cases remained negative for HBV-DNA for periods of 6-12 months. Out of 113 cases who were anti-HBe positive, 12 (10.6%) gave a positive HBV-DNA result. 2 of these 12 patients were recent seroconverters; the remaining cases had transiently increased viral replicative activity which later subsided. 7 out of the 212 carriers were in the e-window period; all 7 tested negative for HBV-DNA. Our data confirm a high frequency of HBV-DNA in HBeAg positive carrier...
Background: Studies on sarcopenia among Malaysian older people (OP ≥ 60 years of age) living in t... more Background: Studies on sarcopenia among Malaysian older people (OP ≥ 60 years of age) living in the community but not in long-term care (LTC) homes have been reported previously. This study aimed to determine the prevalence of sarcopenia and its risk factors in OP in Malaysian LTC homes. Methods: This cross-sectional study was conducted with 202 independently mobile OP (males 32%) in seven LTC homes in the Klang Valley of Malaysia. Trained personnel measured their anthropometrics, body composition, gait speed, hand grip strength and timed up-andgo (TUG) duration. Criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Asian Working Group for Sarcopenia were used to identify the presence of sarcopenia. The mini-nutritional assessment (MNA) was used to determine their nutritional status. Additionally, logistic regression analysis was performed to identify significant risk factors associated with pre-sarcopenia/sarcopenia. Results: Pre-sarcopenia/sarcopenia was detected in 103 (51%) OP. The significant risk factors were body mass index (BMI, weight/height 2 ; adjusted odds ratio [AOR] = 0.44, P < 0.001), percentage of body fat (PBF; AOR = 1.26, P < 0.001), age group (≥ 80 years; AOR = 3.63, P = 0.025) and 'at risk of malnutrition' status (AOR = 2.63, P = 0.049). Conclusion: Sarcopenia is common among OP in LCT homes. The risk increases with decreasing BMI, increasing PBF, age ≥ 80 years and suboptimal nutrition status.
Introduction. This study aimed to determine the nutritional status of elderly residents of long-t... more Introduction. This study aimed to determine the nutritional status of elderly residents of long-term care homes in Klang Valley, Malaysia, and to identify risk factors associated with malnutrition. Methods: A total of 506 participants were assessed by trained healthcare personnel, using the Mini Nutritional Assessment (MNA) for the nutritional status, the Mini-Cog for the cognition status, and the Katz Index of Independence in Activities of Daily Living for the level of dependency. Results: Of 506 participants, 200 (39.5%) were well nourished (MNA score ≥24), 250 (49.4%) were at risk of malnutrition (MNA score 17-23.5), and 56 (11.1%) were malnourished (MNA score <17). Risk factors independently associated with those malnourished or at risk of malnutrition were age ≥80 years (adjusted odds ratio [AOR]=2.04), Malay ethnicity (AOR=2.91), no schooling (AOR=2.14), primary schooling (AOR=1.69), cognitive impairment (AOR=3.06), Katz score of 2-3 (AOR=2.86), and Katz score of 0-1 (AOR=16.87). Those who were divorced (AOR=0.34) or widowed (AOR=0.44) had significantly lower risk than those who were married. Sex and number of comorbidities were not risk factors. Conclusion: Among residents of long-term care homes in Klang Valley, those aged ≥80 years, of Malay ethnicity, with little or no schooling, with cognitive impairments, and with Katz score of ≤3 were more likely to develop malnutrition.
We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolesc... more We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents. This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor State, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of last palpable rib and the top of iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. The participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire. Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of...
The objective of the study is to determine the level of agreement between measured total carbon d... more The objective of the study is to determine the level of agreement between measured total carbon dioxide (TCO2) and calculated bicarbonate (HCO3-) in our laboratory. TCO2 and HCO3- values of 1820 samples drawn at the same time from the patient were compared. TCO2 from venous samples was measured on Dimension RxL while HCO3- was obtained from arterial blood gas samples analyzed on Radiometer ABL 700. The TCO2 and HCO3- values correlated well (r = 0.977, p < 0.001), with the correlation given by the equation, y = 0.986x - 0.5335. Using Bland-Altman analysis, the bias was 0.87 mmol/L (SD 1.42 mmol/L), and the limits of agreement (LOA) were -1.92 to 3.67 mmol/L. Story and Poustie's criteria were applied to study the agreement between these two methods. Based on the first criterion that the bias between TCO2 and HCO3- should be less than +/- 1 mmol/L, the results for the two methods appear to be in good agreement. The second criterion requires that the LOA between the two methods s...
Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and co... more Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and contributes to a majority of the hydropic foetuses in the Malaysian Chinese alpha-thalassaemia carriers who possess the 2-alpha-gene deletion in cis (--SEA/alphaalpha). A duplex-PCR which simultaneously amplifies a normal 136 bp sequence between the psialpha-alpha2-globin genes and a 730 bp Southeast Asian deletion-specific sequence (--SEA) between the psialpha2-theta1-globin genes was established. The duplex-PCR which detects the --SEA deletion in both chromosomes serves as a rapid and cost-effective confirmatory test in the antenatal diagnosis of Haemoglobin Bart's hydrops foetalis syndrome in Malaysia. In addition, the duplex-PCR is simple to perform as both the normal and deletion-specific alpha-globin gene sequences are amplified in the same PCR reaction.
Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psycho... more Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psychometrically sound measurements are urgently needed to assess anxiety symptoms. The extensively used Generalized Anxiety Disorder 7-item (GAD-7) is a promising candidate. However, studies on its factorial validity show mixed findings. While the one-factor solution has been replicated in different cultural contexts, some studies found different factorial structures instead. This study aimed to clarify the factorial validity of the English version of the GAD-7 in the Malaysian context. The responses collected from 1272 emerging to older adults in Malaysia were randomly divided into two halves and submitted to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) respectively. Four acceptable models were explored in EFA ranging from unidimensional factor with 7 items to 3-factor models with 6 items. The four models revealed in EFA and the other competing models found in past studies were then examined and compared using CFA. The 6-item secondorder model with a general factor of anxiety and three first-order factors with two items respectively (i.e., GAD-6) showed a more harmonic result and hence, is preferable. Moreover, the GAD-6 and its three subscales also showed satisfactory internal consistency and construct validity. This study uncovers a new and unique factorial structure of the GAD screening tool that fits in the Malaysian context. The scale may reveal GAD symptomatic dimensions that guide clinical interventions.
Biochemical and Biophysical Research Communications, Nov 1, 2012
The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely use... more The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely used in veterinary medicine and as food additives and growth promoters in animal husbandry including poultry farming. Their effects on human health, however, are not fully understood. Recent studies showed that salinomycin is a cancer stem cell inhibitor. Since poultry consumption has risen sharply in the last three decades, we asked whether the consumption of meat tainted with growth promoting antibiotics might have effects on adipose cells. We showed in this report that the ionophoric antibiotics inhibit the differentiation of preadipocytes into adipocytes. The block of differentiation is not due to the induction of apoptosis nor the inhibition of cell proliferation. In addition, salinomycin also suppresses the transcriptional activity of the CCAAT/enhancer binding proteins and the peroxisome proliferator-activated receptor γ. These results suggest that the ionophoric antibiotics can be exploited as novel anti-obesity therapeutics and as pharmacological probes for the study of adipose biology. Further, the pharmacological effects of salinomycin could be a harbinger of its toxicity on the adipose tissue and other susceptible target cells in cancer therapy.
This research was conducted in privately-run assisted living facilities for the elderly in the Kl... more This research was conducted in privately-run assisted living facilities for the elderly in the Klang Valley, Malaysia to screen for cognitive disorder and affective disorder using the Mini-Cog assessment and Patient Health Questionnaire-2, respectively. Besides finding the incidences of these disorders as well as the gender and race distribution among the sample, this research also aimed to find the association between cognitive and affective disorder with two factors; highest level of education and frequency of visits from family and/or friends in the past 2 years. This crosssectional study managed to obtain consent to interview a total of 591 residents out of which 43 (7.2%) are found to be positive for cognitive impairment and 188 (31.8%) are found to have depressive disorder. Among the 43 residents with cognitive disorder, a majority of 16 (37.2%) did not receive any formal education and the same number also did not receive any visits from family and/or friends. Among the 188 residents with depressive disorder, a majority of 64 (34%) received secondary education and a majority of 65 (34.6%) received monthly visits from family and/or friends. There are positive associations between cognitive disorder and level of education as well as frequency of visits from family and/or friends. But interestingly, there are no associations between depressive disorder and level of education as well as frequency of visits. The reasons behind these figures will be further explored in this paper along with possible intervention methods
Candida albicans is an important opportunistic fungal pathogen capable of causing fatal systemic ... more Candida albicans is an important opportunistic fungal pathogen capable of causing fatal systemic infections in humans. Presently in Malaysia, there is little information available on the genetic diversity of this organism and trends in behavioural characteristics. In this project, three genotyping methods: 25S rDNA genotyping, Alternative Lengthening of Telomerase (ALT) sequence typing and Multi-Locus Sequence Typing (MLST) were applied to study the genetic diversity of strains from infected hospital in-patients and asymptomatic individuals in the community. The results showed that, with the 25S rDNA genotyping, as in other parts of the world, the most common genotype was type A which accounted for approximately 70% of the 111 isolates tested. Further typing with the ALT sequence showed type 3 to be the most common in the isolates tested. MLST analysis revealed many possibly novel sequence types, as well as a statistically significant association between pathogenicity and a group of...
A simplified assay for the detection of Thyroid-binding Inhibiting Immunoglobulin (TBII) using un... more A simplified assay for the detection of Thyroid-binding Inhibiting Immunoglobulin (TBII) using unextracted serum was set up. A total of 176 patients with Graves' disease were tested for the presence of TBII in their serum. Using the t3SD limit for normal controls as the cut off value for a positive result, 124 patients (70.5%) were positive for TBII. A further 18 patients (10.2%) who had TB11 values between t2SD and t3SD limits were considered borderline positives. The intraand inter-assay variability, determined by replicate analysis of samples from patients with Graves' disease were both good at 5.8% and 5.6% respectively. Assay results obtained were comparable to that of standard procedure using extracted gamma-globulins as samples. Performance characteristics of the assay were acceptable.
The molecular basis of variable phenotypes in P-thalassaemia patients with identical genotypes ha... more The molecular basis of variable phenotypes in P-thalassaemia patients with identical genotypes has been associated with co-inheritance of alpha-thalassaemia and persistence of HbF production in adult life. The Xmn I restriction site at -158 position of the Ggamma-gene is associated with increased expression of the Ggamma-globin gene and higher production of HbF This study aims to determine the frequency of the digammaferent genotypes of the Ggamma Xmn I polymorphism in P-thalassaemia patients in two ethnic groups in Malaysia. Molecular characterisation and frequency of the Ggamma Xmn I polymorphism were studied in fifty-eight Chinese and forty-nine beta-thalassaemia Malay patients by Xmn I digestion after DNA amplification of a 650 bp sequence. The in-house developed technique did not require further purification or concentration of amplified DNA before restriction enzyme digestion. The cheaper Seakem LE agarose was used instead of Nusieve agarose and distinct well separated bands w...
Hepatitis B virus (HBV) and high liver iron deposits have both been associated with the developme... more Hepatitis B virus (HBV) and high liver iron deposits have both been associated with the development of cirrhosis. Among HBV factors, genotype and mutations in the basal core promoter (BCP) and precore regions have been most frequently studied but the evidence for a positive association with cirrhosis has been inconsistent. In this study, sera from persons with chronic HBV infection with and without cirrhosis were used for whole HBV genome analysis and for the estimation of serum iron marker (serum iron or ferritin) levels. Single codon analysis showed that the precore wild-type, TGG (nt 1,895-1,897), gave the highest accuracy (77.5%) for the identification of cirrhosis compared to other codons. When TGG was analyzed together with the precore start codon wild-type, ATG (nt 1,814-1,816), the accuracy was improved to 80.0% (odds ratio ¼ 35.29; 95% confidence interval ¼ 3.87-321.93; Phi ¼ 0.629; P < 0.001). When the serum iron marker was included for analysis, it was clear that a combination of a precore wild-type and high serum iron marker gave a better accuracy (90.0%) (odds ratio ¼ 107.67; 95% confidence interval ¼ 10.21-1,135.59; Phi ¼ 0.804; P < 0.001) for the identification of cirrhosis than either biomarker alone. It appeared that a combined use of both these biomarkers might help to predict the development of cirrhosis in a person with chronic HBV infection, but longitudinal studies are required to test this hypothesis.
Aims-To determine (1) the detection rate of primary carcinoma of the lung by serological assay of... more Aims-To determine (1) the detection rate of primary carcinoma of the lung by serological assay of CEA (carcinoembryonic antigen); and (2) whether addition of seroassay of squamous cell carcinoma related antigen before treatment improves detection sensitivity. Methods-A prospective study spanning 27 months was conducted at the University Hospital, Kuala Lumpur. Serum CEA (Abbott IMx) and serum squamous cell carcinoma antigen (Abbott IMx) from patients clinically suspected of hav- ing primary carcinoma of the lung, were assayed using the microparticle enzyme immunoassay method. Results-Thirty seven cases of histo- logically confirmed primary lung carci- noma were studied. Of these, 17 were squamous cell carcinomas, 10 adeno- carcinomas, nine small cell carcinomas, and one large cell carcinoma. The patients' ages ranged from 34-82 years. The male:female ratio was 3-6: 1. Squamous cell carcinoma antigen was raised above the cutoff value of 1.5 ngiml in 94-1% of squamous cell carcinomas, 20-0% of adenocarcinomas, and 11*1% of small cell carcinomas. By comparison, CEA was raised above the cutoff value of 3-0 nglml in 70-6% of squamous cell car- cinomas, 77*8% of small cell carcinomas,
Biochemical and Biophysical Research Communications, 2012
The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely use... more The polyether ionophoric antibiotics including monensin, salinomycin, and narasin, are widely used in veterinary medicine and as food additives and growth promoters in animal husbandry including poultry farming. Their effects on human health, however, are not fully understood. Recent studies showed that salinomycin is a cancer stem cell inhibitor. Since poultry consumption has risen sharply in the last three decades, we asked whether the consumption of meat tainted with growth promoting antibiotics might have effects on adipose cells. We showed in this report that the ionophoric antibiotics inhibit the differentiation of preadipocytes into adipocytes. The block of differentiation is not due to the induction of apoptosis nor the inhibition of cell proliferation. In addition, salinomycin also suppresses the transcriptional activity of the CCAAT/enhancer binding proteins and the peroxisome proliferator-activated receptor γ. These results suggest that the ionophoric antibiotics can be exploited as novel anti-obesity therapeutics and as pharmacological probes for the study of adipose biology. Further, the pharmacological effects of salinomycin could be a harbinger of its toxicity on the adipose tissue and other susceptible target cells in cancer therapy.
Vaccination is a key public health strategy that is known to be effective in mitigating the risk ... more Vaccination is a key public health strategy that is known to be effective in mitigating the risk of infection and severe disease. However, in the context of the COVID-19 pandemic, the percentage (<50%) of Malaysians who have received a booster for the COVID-19 vaccine has remained stagnant over a year. This study aimed to determine the prevalence of and the factors associated with hesitancy toward the second dose of booster for the COVID-19 vaccine. A web-based cross-sectional study was conducted from August to November 2022. The Oxford Vaccine Hesitancy Scale was used to assess the hesitancy toward the second dose of booster for the COVID-19 vaccine. Simple and multiple factors logistic regressions were used to determine the predictors of hesitancy. A p-value less than 0.05 was considered to be statistically significant. Data from 798 respondents were included in the analysis. The prevalence of hesitancy toward the second booster of the COVID-19 vaccine was 26.7%. The predictors of second-booster hesitancy were older age (AOR = 1.040, 95 CI = 1.022, 1.058), having received the third dose (first booster) because of instruction by the government (AOR = 2.125, 95% CI = 1.380, 3.274), concern about serious long term side effects of the vaccine (AOR = 4.010, 95% CI = 2.218, 7.250), and opinions of close friends and immediate family members that the booster is harmful (AOR = 2.201, 95% CI = 1.280, 3.785). Conversely, factors that appear to reduce vaccine booster hesitancy were acceptance of the third dose due to the high number of cases and the increasing rate of infection (AOR = 0.548, 95% CI = 0.317, 0.947), the belief that the vaccine will decrease the risk of getting the infection (AOR = 0.491, 95% CI = 0.277, 0.870), and opinions of close friends and immediate family members that the booster is helpful (AOR = 0.479, 95% CI = 0.273, 0.840). In conclusion, more than one-fifth of Malaysians were hesitant to take the second booster of the COVID-19 vaccine. This suggests that appropriate steps that increase vaccine acceptance, taking into consideration the findings of the present study, are needed to address this issue and to foster more positive attitudes toward vaccination. The survey was available in three main languages but limited to people with internet access; hence, it would likely be biased toward younger adults and social media users and exclude those with limited or no internet access, in particular older people. Therefore, the results are not representative of the Malaysian population at large and caution should be exercised when interpreting the findings.
AimWe examined the anxiety levels and coping strategies among staff and students of a tertiary ed... more AimWe examined the anxiety levels and coping strategies among staff and students of a tertiary educational institution during the COVID-19 pandemic and determined the association between anxiety level and coping strategies.MethodThrough an online survey, we used Coronavirus Anxiety Scale (CAS) to measure the level of anxiety associated with the COVID-19 crisis and Brief Coping Orientation to Problems Experienced (COPE) to assess the coping responses adopted to handle stressful life events. Coping strategies were classified as adaptive and maladaptive, for which the aggregate sores were calculated. Multiple linear regression was used to determine the predictors of anxiety adjusted for potentially confounding variables. Results from 434 participants were available for analysis.ResultsThe mean score (SD) of the CAS was 1.1 (1.8). The mean scores of adaptive and maladaptive coping strategies were 35.69 and 19.28, respectively. Multiple linear regression revealed that maladaptive coping ...
The human oral microbiome has been known to show strong association with various oral diseases in... more The human oral microbiome has been known to show strong association with various oral diseases including oral cancer. This study attempts to characterize the community variations between normal, oral potentially malignant disorders (OPMD) and cancer associated microbiota using 16S rDNA sequencing. Swab samples were collected from three groups (normal, OPMD and oral cancer) with nine subjects from each group. Bacteria genomic DNA was isolated in which full length 16S rDNA were amplified and used for cloned library sequencing. 16S rDNA sequences were processed and analysed with MOTHUR. A core oral microbiome was identified consisting of Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes and Actinobacteria at the phylum level while Streptococcus, Veillonella, Gemella, Granulicatella, Neisseria, Haemophilus, Selenomonas, Fusobacterium, Leptotrichia, Prevotella, Porphyromonas and Lachnoanaerobaculum were detected at the genus level. Firmicutes and Streptococcus were the predominant ...
The relationship between serum Hepatitis B virus DNA (HBV-DNA) and the Hepatitis B e-antigen/ ant... more The relationship between serum Hepatitis B virus DNA (HBV-DNA) and the Hepatitis B e-antigen/ anti-Hepatitis Be (HBeAg/anti-HBe) serological status in Malaysians was studied. 212 cases of asymptomatic HBV carriers were recruited for this study. 92 cases were positive for the HBeAg at the point of recruitment. 85 (92.4%) of these patients tested positive for HBV-DNA, of whom 55 (64.7%) had levels over 100pg/ml of serum. Three of the remaining 7 HBeAg positive cases who were negative for HBV-DNA subsequently seroconverted. The other 4 cases remained negative for HBV-DNA for periods of 6-12 months. Out of 113 cases who were anti-HBe positive, 12 (10.6%) gave a positive HBV-DNA result. 2 of these 12 patients were recent seroconverters; the remaining cases had transiently increased viral replicative activity which later subsided. 7 out of the 212 carriers were in the e-window period; all 7 tested negative for HBV-DNA. Our data confirm a high frequency of HBV-DNA in HBeAg positive carrier...
Background: Studies on sarcopenia among Malaysian older people (OP ≥ 60 years of age) living in t... more Background: Studies on sarcopenia among Malaysian older people (OP ≥ 60 years of age) living in the community but not in long-term care (LTC) homes have been reported previously. This study aimed to determine the prevalence of sarcopenia and its risk factors in OP in Malaysian LTC homes. Methods: This cross-sectional study was conducted with 202 independently mobile OP (males 32%) in seven LTC homes in the Klang Valley of Malaysia. Trained personnel measured their anthropometrics, body composition, gait speed, hand grip strength and timed up-andgo (TUG) duration. Criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Asian Working Group for Sarcopenia were used to identify the presence of sarcopenia. The mini-nutritional assessment (MNA) was used to determine their nutritional status. Additionally, logistic regression analysis was performed to identify significant risk factors associated with pre-sarcopenia/sarcopenia. Results: Pre-sarcopenia/sarcopenia was detected in 103 (51%) OP. The significant risk factors were body mass index (BMI, weight/height 2 ; adjusted odds ratio [AOR] = 0.44, P < 0.001), percentage of body fat (PBF; AOR = 1.26, P < 0.001), age group (≥ 80 years; AOR = 3.63, P = 0.025) and 'at risk of malnutrition' status (AOR = 2.63, P = 0.049). Conclusion: Sarcopenia is common among OP in LCT homes. The risk increases with decreasing BMI, increasing PBF, age ≥ 80 years and suboptimal nutrition status.
Introduction. This study aimed to determine the nutritional status of elderly residents of long-t... more Introduction. This study aimed to determine the nutritional status of elderly residents of long-term care homes in Klang Valley, Malaysia, and to identify risk factors associated with malnutrition. Methods: A total of 506 participants were assessed by trained healthcare personnel, using the Mini Nutritional Assessment (MNA) for the nutritional status, the Mini-Cog for the cognition status, and the Katz Index of Independence in Activities of Daily Living for the level of dependency. Results: Of 506 participants, 200 (39.5%) were well nourished (MNA score ≥24), 250 (49.4%) were at risk of malnutrition (MNA score 17-23.5), and 56 (11.1%) were malnourished (MNA score <17). Risk factors independently associated with those malnourished or at risk of malnutrition were age ≥80 years (adjusted odds ratio [AOR]=2.04), Malay ethnicity (AOR=2.91), no schooling (AOR=2.14), primary schooling (AOR=1.69), cognitive impairment (AOR=3.06), Katz score of 2-3 (AOR=2.86), and Katz score of 0-1 (AOR=16.87). Those who were divorced (AOR=0.34) or widowed (AOR=0.44) had significantly lower risk than those who were married. Sex and number of comorbidities were not risk factors. Conclusion: Among residents of long-term care homes in Klang Valley, those aged ≥80 years, of Malay ethnicity, with little or no schooling, with cognitive impairments, and with Katz score of ≤3 were more likely to develop malnutrition.
We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolesc... more We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents. This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor State, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of last palpable rib and the top of iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. The participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire. Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of...
The objective of the study is to determine the level of agreement between measured total carbon d... more The objective of the study is to determine the level of agreement between measured total carbon dioxide (TCO2) and calculated bicarbonate (HCO3-) in our laboratory. TCO2 and HCO3- values of 1820 samples drawn at the same time from the patient were compared. TCO2 from venous samples was measured on Dimension RxL while HCO3- was obtained from arterial blood gas samples analyzed on Radiometer ABL 700. The TCO2 and HCO3- values correlated well (r = 0.977, p < 0.001), with the correlation given by the equation, y = 0.986x - 0.5335. Using Bland-Altman analysis, the bias was 0.87 mmol/L (SD 1.42 mmol/L), and the limits of agreement (LOA) were -1.92 to 3.67 mmol/L. Story and Poustie's criteria were applied to study the agreement between these two methods. Based on the first criterion that the bias between TCO2 and HCO3- should be less than +/- 1 mmol/L, the results for the two methods appear to be in good agreement. The second criterion requires that the LOA between the two methods s...
Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and co... more Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and contributes to a majority of the hydropic foetuses in the Malaysian Chinese alpha-thalassaemia carriers who possess the 2-alpha-gene deletion in cis (--SEA/alphaalpha). A duplex-PCR which simultaneously amplifies a normal 136 bp sequence between the psialpha-alpha2-globin genes and a 730 bp Southeast Asian deletion-specific sequence (--SEA) between the psialpha2-theta1-globin genes was established. The duplex-PCR which detects the --SEA deletion in both chromosomes serves as a rapid and cost-effective confirmatory test in the antenatal diagnosis of Haemoglobin Bart's hydrops foetalis syndrome in Malaysia. In addition, the duplex-PCR is simple to perform as both the normal and deletion-specific alpha-globin gene sequences are amplified in the same PCR reaction.
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