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Abstract: Background: Buprenorphine maintenance is efficacious for treating opioid dependence, but problems with diversion and misuse of buprenorphine (BUP) may limit its acceptability and dissemination. The buprenorphine/naloxone combination tablet (BNX) was developed to reduce potential problems with diversion and abuse. This paper provides data regarding the characteristics of BUP injection drug users in Malaysia and preliminary data regarding the impact of withdrawing BUP and introducing BNX. BUP was introduced in 2002 and subsequently withdrawn from the Malaysian market in 2006. BNX was introduced in 2007. Methods: A two wave survey of BUP IDUs was conducted shortly prior to BUP withdrawal from the Malaysian market (n =276) and six months after BNX was introduced (n =204). Six focus groups with BUP and/or BNX IDUs were also conducted shortly before the second wave. Results: In addition to current BUP or BNX IDU, 96% of first wave participants and 97% second wave participants reported lifetime heroin IDU preceding the onset of their BUP/BNX IDU. Additionally, 58% of first and 64% of second wave survey participants reported current heroin IDU. Benzodiazepine abuse, often injected with BUP, was reported in both the surveys. Focus group participants reported that BNX was not as desirable as BUP, nonetheless, the results of the second wave survey suggest a continuing widespread BNX IDU, at least in Kuala Lumpur. Conclusions: In Malaysia, BUP and BNX IDU occur among heroin IDUs. The introduction of BNX and withdrawal of BUP may have helped to reduce, but did not eliminate the problems with diversion and abuse. [ABSTRACT FROM AUTHOR]

Abstract: This pilot randomized clinical trial evaluated whether the efficacy of office-based buprenorphine maintenance treatment (BMT), provided with limited counseling or oversight of medication adherence is improved by the addition of individual drug counseling and abstinence-contingent take-home doses of buprenorphine. After a 2-week buprenorphine and stabilization period, heroin dependent individuals (n =24) in Muar, Malaysia were randomly assigned to Standard Services BMT (physician administered advice and support, and weekly, non-contingent medication pick-up) or Enhanced Services (nurse-delivered manual-guided behavioral drug and HIV risk reduction counseling (BDRC) and abstinence-contingent take-home buprenorphine (ACB), 7 day supply maximum). Outcomes included retention, proportion of opioid-negative urine tests, self-reported drug use, and self-reported HIV risk behaviors. 12/12 (100%) of Enhanced Services and 11/12 (92%) of Standard Services participants completed the entire protocol. The proportion of opioid-negative urine tests increased significantly over time for both groups (p <0.001), and the reductions were significantly greater in the Enhanced Services group (p <0.05); Enhanced Services group achieved higher overall proportions of opiate negative urine toxicology tests (87% vs. 69%, p =0.04) and longer periods of consecutive abstinence from opiates (10.3 weeks vs. 7.8 weeks, p =0.154). Both groups significantly reduced HIV risk behaviors during treatment (p <0.05), but the difference between Enhanced and Standard Services (26% vs. 17% reductions from the baseline levels, respectively) was not statistically significant (p =0.9). Manual-guided behavioral drug and HIV risk reduction counseling and abstinence-contingent take-home buprenorphine appear promising for adding to the efficacy of office-based BMT provided with limited drug counseling and medication oversight. [Copyright &y& Elsevier]

In the present study, a micro combined heat and power (micro-CHP) system using compressed natural gas (CNG) and biogas fuels, was developed. The objective of this research study was to investigate the utilization of nanofluids as a working fluid to improve thermal performance of the micro-CHP system. Three different nanofluids based on the CNT, Al 2 O 3 , and SiO 2 have been investigated. The nanofluids was used as the circulating fluid to recover the heating power from the micro-CHP system. Three different concentration of nanoparticles (25, 50 and 100 ppm) have been used. The efficiency of separated heat and power (SHP) system was 27.6% while using combined heat and power, the total efficiency increased up to 65.3%. The results showed that by using CNG gas thermal efficiency of micro-CHP improve compared to the biogas. The result of the present study showed that nanofluids enhances the thermal efficiency of the micro-CHP system. By using the Al 2 O 3 nanofluid the efficiency of micro-CHP efficiency is 73%. While by using the SiO 2 and CNTs nanofluids the efficiency of micro-CHP efficiency is 70% and 66.3% respectively. So, we can coclude that by using the Al 2 O 3 nanofluid thermal performance of micro-CHP systems improves. [ABSTRACT FROM AUTHOR]

Introduction/Background Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in adults and the treatment of choice is by particle repositioning manoeuvres (PRM). This study compares the effects of two home-based exercises, self-Epley manoeuvre (SEM) and Brandt-Daroff exercise (BDE) in patients with posterior canal BPPV. Material and method This is a single-blinded prospective randomized-controlled trial on 50 patients suffering from unilateral posterior canal BPPV with a documented positive Dix-Hallpike test and symptoms of vertigo for at least 1 week. Both groups (25 in SEM and 25 in BDE) performed the home-based exercise for a total of 2-weeks duration. The primary outcome was vertigo resolution at 1 month and 6 months. Secondary outcomes were conversion of a positive to a negative Dix-Hallpike test at 1 month, reduction of vertigo intensity and the Dizziness Handicap Inventory (DHI) scores at 1 month and 6 months. Results Vertigo resolution was achieved in 40% of patients at 1 month and 48% of patients at 6 months for both groups. Conversion rate from positive to negative Dix–Hallpike test at 1 month was 92% in the SEM group and 84% in the BDE group ( P = 0.38). From repeated assessments at 1 and 6 months, significant reduction in vertigo intensity, F(1.6, 78.4) = 84.6, P < 0.001 and improvement in the mean DHI scores, F(1.7, 85.1) = 74.3, P < 0.001 was seen within groups. There were no significant differences in vertigo intensity and mean DHI scores between the two groups. Both SEM and BDE were well-tolerated with few minor complications reported, such as transient dizziness and nausea. Conclusion Both the SEM and BDE are effective in treating posterior canal BPPV. Although there was no significant vertigo resolution, there was a reduction in vertigo intensity, and perceived negative impact on daily life from the improvement in the mean DHI scores [ABSTRACT FROM AUTHOR]

Introduction/Background Traumatic brain injury (TBI) is a leading cause of disability among young adults population in Malaysia. The multi-cultural background and limited post-injury rehabilitation services in Malaysia may play a role in the long-term outcome. This research aimed to describe the functional outcome of moderate to severe TBI patients at one year post-injury. Material and method A prospective cohort study was conducted at University Malaya Medical Centre (UMMC), a tertiary referral center with availability of an early inpatient rehabilitation after TBI. Patients with moderate to severe TBI were selected via a universal sampling method. The functional outcome was assessed at 1 year post-injury using Glasgow Outcome Scale-Extended (GOSE). Factors associated with good outcome (GOSE score of 7&8) were analysed via regression analysis. Results A total of 100 patients were included in this study. The mean age of the study population was 39.4 ( ± 17.6) years old. Majority of participants were male (87%), less than 40 years old (57%) and involved in a motor vehicle accident (77%). 25% of patients have good outcome at 1 year. Factors significantly affecting the functional outcome were age, premorbid marital status, education level, presence of concomitant extremity fractures and early inpatient rehabilitation. After adjusting for the confounders, absence of concomitant extremity fractures was found to be a significant predictor for good functional outcome at one year (OR 9.26, 95% CI 1.86–46.12, P = 0.007) Conclusion Good functional outcome at one year following moderate to severe TBI is slightly lower than other Western studies. However, factors influencing good outcome is comparable to literature worldwide. Early inpatient rehabilitation should be provided as it can improve the functional outcome. Since concomitant extremity fractures significantly influenced outcome post TBI, it is very important to treat the fractures early and aggressively so that patients can start intensive rehabilitation earlier. [ABSTRACT FROM AUTHOR]

Background: Malaysia is experiencing severe problems with heroin dependence and HIV infection. This, study evaluated drug use and other HIV risk behaviors and their association with HIV and other infectious diseases in heroin-dependent subjects enrolled in a clinical trial of drug abuse treatment in Muar, Malaysia.Methods: Baseline assessment of treatment-seeking subjects (n=177) included the Addiction Severity Index; AIDS Risk Inventory; serological tests for HIV, hepatitis B, and hepatitis C; and chest X-ray.Results: All of the subjects were male; 67.8% were Malays, 28.8% Chinese, and 2.3%. Indian. Subjects had a mean (SD) age of 37.2 (9.1) years and 14.4 (8.5) years of using heroin; 76.3% reported lifetime injection drug use (IDU), and 41.5% reported current IDU; 30 of 156 (19.2%) tested HIV positive, 143 of 159 (89.9%) tested hepatitis C positive, and 25 of 159 (15.7%) had radiological evidence of pulmonary tuberbulosis. Malay subjects had a significantly higher prevalence of current IDU, needle sharing (p<0.01), and HIV infection (p<0.05) compared with Chinese subjects. Lifetime IDU, needle sharing, lack of consistent condom use, and Malay ethnicity were significantly associated with HIV infection.Conclusions: The high prevalence of HIV infection among heroin-dependent individuals, in Malaysia supports the important of interventions to reduce the major risk factors for HIV, including IDU, needle sharing, and unprotected sex. [ABSTRACT FROM AUTHOR]

Numerous research studies have been persistently conducted to improve the performance of diesel engines (CI engines) running on alternative fuels. The poor performance of CI engines due to the high viscosity of alternative fuels limits their applications. Several techniques and measures have been introduced, such as preheating the fuel before being supplied to the engine, changing the injection methods, altering the combustion chamber design, and modifying the piston to improve engine performance while running on higher viscosity fuel. These techniques effectively enhanced engine performance and reduced emission, but their performance is still lower than those of petro-diesel engines. Improving the in-cylinder airflow characteristics in the combustion chamber could potentially address the problem of poor performance. Nevertheless, studies investigating the appropriate methods to overcome poor performance are limited. The in-cylinder airflow characteristics are vital for improving the air-fuel mixing process. Changes in the airflow characteristics can generate more turbulence inside the combustion chamber. An increase in the turbulent flow in the combustion chamber will enable the break-up of higher viscosity fuel during injection and mix well with the in-cylinder airflow. From the literature, the commonly used methods to enhance and stimulate the turbulent flow in the combustion chamber are by using a guide vane device, throttling the intake manifold, modifying the combustion chamber, and changing the intake manifold design. This paper briefly reviews various techniques for improving the in-cylinder airflow characteristics in CI engines running on fuel with higher viscosity (FHVs). • The importance of in-cylinder airflow characteristics in improving the performance of alternative fuel-based CI engines is elucidated. • Different methods to improve in-cylinder airflow characteristics are reviewed. • The role of guide vane design parameters towards improving the combustion efficiency of FHVs is established. [ABSTRACT FROM AUTHOR]

Introduction/Background Previous studies have explored the quality of life (QoL) in people with olfactory dysfunction from various aetiologies. However, knowledge on QoL in people with post-traumatic brain injury (TBI) olfactory dysfunction is still limited. This study evaluates the impact of post-TBI olfactory dysfunction on QoL and determine factors influencing resultant QoL. Material and method A case-control study conducted in a single centre on 30 TBI adults with olfactory dysfunction; matched by age and gender with 32 TBI controls having intact olfactory function. All 64 adults self-rated their olfactory function using a Visual Analogue Scale (VAS). Sniffin’ Sticks test was used as an objective olfactory function assessment and results measured as TDI (Threshold, Discrimination and Identification) score. QoL was determined by a self-rated questionnaire; Questionnaire for Olfactory Disorders (QOD). Influential factors evaluated include age, gender, employment, level of education, marital status, smoking habit, TBI-related clinical information and Disability Rating Scale (DRS) score. A correlation test between the VAS and natural log TDI was also conducted. Results Mean QOD score of case group was significantly higher than control group (26.31 ± 14.37 vs 9.44 ± 8.30 respectively; P < 0.001). After removing the effect of employment, smoking habit, co-morbidities, TBI duration and DRS score; there was a significant difference of mean QOD score between the two groups ( F = 16.426, P < 0.001, η 2 = 0.224). Calculated effect size was large with d = 1.07 and odds ratio of 7.02. The most affected QoL domain was “perception of smell changes”. DRS score and olfactory function severity were factors influencing QoL ( P < 0.05). VAS score was positively correlated with natural log TDI score ( r = 0.433, P < 0.05). Conclusion Individuals with post-TBI olfactory dysfunction are at higher risk of developing a lower QoL. One of the factors influencing this is the severity of olfactory dysfunction itself. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The free radical theory of aging (FRTA) suggests that free radicals are the leading cause of deteriorating physiologic function during senescence. Free radicals attack cellular structures or molecules such as DNA resulting in various modifications to the DNA structures. Accumulation of unrepaired DNA contributes to a variety of disorders associated with the aging process. METHODS: A randomized, double-blinded placebo-controlled study was undertaken to evaluate the effect of Tri E Tocotrienol on DNA damage. Sixty four subjects 37-78 y old completed the study. A daily dose of 160 mg of Tri E Tocotrienol was given for 6 months. Blood samples were analyzed for DNA damage using comet assay, frequency of sister chromatid exchange (SCE), and chromosome 4 aberrations. RESULTS: Results showed a significant reduction in DNA damage as measured by comet assay after 3 mo (P < 0.01) and remained low at 6 mo (P < 0.01). The frequency of SCE was also reduced after 6 mo of supplementation (P < 0.05), albeit more markedly in the >50 y-old group (P < 0.01) whereas urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels were significantly reduced (P < 0.05). A strong positive correlation was observed between SCE with age, whereas weak positive correlations were observed in DNA damage and 8-OHdG, which were reduced with supplementation. However, no translocation or a stable insertion was observed in chromosome 4. CONCLUSION: Tri E Tocotrienol supplementation may be beneficial by reducing DNA damage as indicated by a reduction in DNA damage, SCE frequency, and urinary 8-OHdG. [ABSTRACT FROM AUTHOR]

Introduction/Background To quantify clinical and structural white matter tract changes over six months, in patients with mild traumatic brain injury (mTBI) following early structured cognitive therapy. Material and method This was a non-randomized quasi-experimental study design. All patients with mTBI received written information and education on symptom(s) management before being assigned to structured cognitive therapy or conventional cognitive therapy at two weeks post injury. Structured therapy was one hour per week session by using computer-based and metacognitive training for the first three months followed by one hour per month session for the remaining three months. Conventional therapy was patient focused symptom(s) management and coping strategies. Neuropsychological assessment and Diffusion Tensor Imaging (DTI) were performed at baseline and six months post injury. Results Each group consisted of four male participants ( n = 8). Mean cognitive therapy duration was 7 hours (SD ± 1.8). There was no demographic, Glasgow Coma Scale, Post Traumatic Amnesia and loss of consciousness duration statistical difference between groups. Although all cognitive domains tested were not statistically significant, the scores for Attention, Memory, Language, and Executive Function domains were higher than conventional group at six months. We analysed nine white matter tracts. Almost all Fractional Anisotropy mean values were lower (Corpus Callosum genu: P = 0.03; splenium: P = 0.05) whereas Mean Diffusivity and Radial Diffusivity mean values were higher at six months. Conclusion We quantified deficits in various cognitive domains as early as two weeks following mTBI, with higher normal scores in the structured therapy group as compared to conventional group at six months. Abnormal values of DTI parameters may suggest chronic axonal damage of various white matter locations and bundles. We did not yield statistical significance in our analysis due to small sample size caused by high drop-out rate. However, we concluded that early structured cognitive therapy may improve cognitive deficits beyond spontaneous recovery, despite persistent microstructural brain damage. [ABSTRACT FROM AUTHOR]

Introduction/Background Initial muscle tone increase may be apparent within 6 weeks, and even days, post-stroke. Botulinum toxin-A (BoNT-A), an effective and well-tolerated treatment for upper limb spasticity (ULS), improves muscle tone and function, however most studies were conducted > 6 months post-stroke. The ONTIME and ABCDE-S studies assessed efficacy and safety of early use (2–12 weeks post-stroke) of abobotulinumtoxinA (aboBoNT-A) in ULS. Material and method ABCDE-S ( NCT00234546 ; 2008): 24-week, randomised (1:1 aboBoNT-A [ n = 80]: placebo [ n = 83]), study assessing muscle tone changes in patients treated within 2–12 weeks of first stroke, with a Modified Ashworth Scale (MAS) score ≥ 1+. ONTIME ( NCT02321436 ; 2016): 28-week, randomised study (2:1 aboBoNT-A [ n = 28]: placebo [ n = 14]), assessing time to appearance or reappearance of reinjection criteria in patients with MAS score ≥ 2 treated 2–12 weeks post-stroke. All observed or volunteered adverse events (AEs) were recorded. Results MAS score improvements at Week 4 were greater in aboBoNT-A-treated patients than placebo in both studies (ABCDE-S −1.5 vs. −0.5; ONTIME −1.25 vs. −0.25). At 12-weeks post-injection, fewer aboBoNT-A-treated patients versus placebo had MAS scores ≥ 2 in ONTIME (29.6 vs. 69.2%) and ABCDE (21.3 vs. 60.2%) ( Table 1 ). In ONTIME, 11 (39.3%) aboBoNT-A-treated patients did not require reinjection for ≥ 28 weeks versus 2 (14.3%) for placebo. AboBoNT-A was well-tolerated; most AEs were mild–moderate in intensity, with no clinically significant differences in AEs between groups ( Table 2 ). Six patients had treatment-related AEs: two in placebo groups (dysuria and complex regional pain syndrome), and four in aboBoNT-A groups (fatigue [ n = 2], pyrexia, muscular weakness). No serious AEs or deaths were considered treatment-related. Conclusion Early treatment with aboBoNT-A (2–12 weeks) was well-tolerated and had a longer time to reinjection versus placebo. [ABSTRACT FROM AUTHOR]

Introduction/Background This is a randomised controlled study of cognitive rehabilitation for attention deficits following mild traumatic brain injury (mTBI). The study aims at improving patient's cognitive and functional outcomes, measured by Neuropsychological Assessment Battery ® (NAB ® ), Diffusion Tensor Imaging (DTI) and functional parameters. Material and method Participant recruitment is from University Malaya Medical Centre (UMMC), Malaysia. This study was ethically approved by Medical Research Ethics Committee UMMC (MREC ID No.: 2016928-4293) and registered at ClinicalTrial.gov ( NCT03237676 ). Following randomisation, control group receives pre-existing patient-centred cognitive treatment whereas intervention group receives individualised structured cognitive rehabilitation therapy (computer-based and metacognitive approach for 1 hour/week/3 months). The intervention begins at three months post-injury and ends at six months post-injury. Study outcome measurements are applied at pre and post-treatment. Results A total of 125 mTBI patients were screened from March 2017 till now. Forty-three patients fulfilled the study criteria. The male:female gender distribution ratio was 2:1. Within 72 hours post-trauma, participants with Montreal Cognitive Assessment © (MoCA © ) score of < 26/30 ( n = 34, mean score 23; P = 0.03) had persistent cognitive deficits at 2 weeks post-injury. Functionally, 68% of participants ( n = 23) had returned to work within 2 weeks injury time. Deficits of attention was most pronounced ( T -score 70; P < 0.00; Cohen's d 4.31) followed by executive function domain ( T -score 78; P = 0.02; Cohen's d 1.54). At 3 months post-injury, 9 participants continued to have attention ( T -score 70, P < 0.05, Cohen's d 3.33) and language deficits ( T -score 74; P < 0.05; Cohen's d 1.32) but clinically recovered for other cognitive domains assessed. All 9 participants are undergoing cognitive treatment (structured cognitive rehabilitation n = 4; patient-centred therapy is n = 5). Conclusion MoCA © total score < 26/30 performed within 72 hours following injury may predict cognitive deficits at two weeks post-injury. Cognitive deficits persist beyond 3 months post-injury with variable affected domains and severity. [ABSTRACT FROM AUTHOR]