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Illumina RNA-seq analysis was used to characterize the whole transcriptomes of peripheral blood mononuclear cells (PBMCs) from patients with congenital generalized lipodystrophy. RNA-seq information for seven patients with type 2 congenital generalized lipodystrophy (CGL2; Berardinelli-Seip congenital lipodystrophy, BSCL2) was obtained and compared with similar information for seven age- and sex-matched healthy control subjects. All seven CGL2 patients carried biallelic pathogenic mutations affecting the BSCL2 gene and had clinical symptoms of varying severity. The findings provide the whole-transcriptome signatures of PBMCs of CGL2 patients, allowing further exploration of gene expression patterns/signatures associated with the various clinical symptoms of patients with this disease., Measurement(s)RNA-Seq • RNATechnology Type(s)Illumina HiSeq. 2500 • RNA sequencingSample Characteristic - OrganismHomo sapiens Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.15022521

Night eating syndrome (NES) is a disordered eating behaviour characterized by hyperphagia at night and is often accompanied by a sleep disturbance. This study aims to determine the prevalence of NES and its association between sleep quality and body mass index (BMI) among the private university students during the Covid-19. A total of 166 students from a private university participated in this cross-sectional study. Online self-administered questionnaires were used to collect and determine socio-demographic data, BMI, NES, and sleep quality. NES was assessed using Night Eating Diagnostic Questionnaire (NEDQ) while sleep quality was assessed using Pittsburgh Sleep Quality Index Questionnaire (PSQI). The results showed that 38.6% of the participants were engaging with NES, 45.2% were having poor sleep quality and 25.9% were overweight or obese during the Covid-19. There were significant associations between NES with sleep quality and BMI, which students with NES were found to have poorer sleep quality (r=0.306, p

Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is ≥20%; however, it is unknown whether the inclusion of folic acid in weekly IFA supplements reduces anemia.We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone.In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18-45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome).At baseline, 84% of women had low folate status (plasma folate 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) μg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P 0.001) were lower at 16 wk than at baseline.Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.This trial was registered at www.anzctr.org.au as ACTRN12619000818134.

Many factors influence the success of contact lens wear, including lens surface moisture, which is affected by blinking. This study was conducted to determine the eye blinking patterns, corneal staining, and compliance in a group of soft contact lens (CL) wearers. Forty-one soft CL wearers and 41 age-matched control subjects (non-CL wearers) were recruited in this study. Blinking patterns were assessed with a digital camera attached to a slit lamp biomicroscope. Corneal staining was graded using Institute for Eye Research (IER) grading scale with 0.1 increments. The subject’s compliance level was determined using a questionnaire. There was no difference in eye blinking patterns between the CL wearers and control group (Mann-Whitney, p = 0.231). The average grades of corneal staining in CL wearers and control group were 0.38 ± 0.39 and 0.01 ± 0.08 unit, respectively. There was a significant difference in corneal staining between the two groups (Mann-Whitney, p = 0.021). A significant positive correlation was found between blinking patterns and corneal staining (Spearman ρ = 0.378, p = 0.015). Our results also showed that 63.4% of the CL wearers had good compliance towards lens care. In our multiple linear regression analysis, blinking patterns contributed significantly to corneal staining (B = 0.140, p = 0.015), while compliance level did not (B = -0.038, p = 0.471). Overall, eye blinking patterns in CL wearers influenced the risk of corneal staining.

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6–23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.

IntroductionWeekly iron–folic acid (IFA) supplements are recommended for all menstruating women in countries where anaemia prevalence is >20%. Anaemia caused by folate deficiency is low worldwide, and the need to include folic acid is in question. Including folic acid might reduce the risk of a neural tube defect (NTD) should a woman become pregnant. Most weekly supplements contain 0.4 mg folic acid; however, WHO recommends 2.8 mg because it is seven times the daily dose effective in reducing NTDs. There is a reluctance to switch to supplements containing 2.8 mg of folic acid because of a lack of evidence that this dose would prevent NTDs. Our aim was to investigate the effect of two doses of folic acid, compared with placebo, on red blood cell (RBC) folate, a biomarker of NTD risk.MethodsWe conducted a three-arm double-blind efficacy trial in Malaysia. Non-pregnant women (n=331) were randomised to receive 60 mg iron and either 0, 0.4, or 2.8 mg folic acid once weekly for 16 weeks.ResultsAt 16 weeks, women receiving 0.4 mg and 2.8 mg folic acid per week had a higher mean RBC folate than those receiving 0 mg (mean difference (95% CI) 84 (54 to 113) and 355 (316 to 394) nmol/L, respectively). Women receiving 2.8 mg folic acid had a 271 (234 to 309) nmol/L greater mean RBC folate than those receiving 0.4 mg. Moreover, women in the 2.8 mg group were seven times (RR 7.3, 95% CI 3.9 to 13.7; p748 nmol/L, a concentration associated with a low risk of NTD, compared with the 0.4 mg group.ConclusionWeekly IFA supplements containing 2.8 mg folic acid increases RBC folate more than those containing 0.4 mg. Increased availability and access to the 2.8 mg formulation is needed.Trail registration numberThis trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12619000818134).

BackgroundVitamin D deficiency (VDD) has been related to vitamin D binding protein (GC) gene polymorphism, demographics and lifestyle factors in different populations. However, previous studies only focused on demographic and lifestyle factors or genetic factors alone. Therefore, this cross-sectional study aimed to assess the association betweenGCgene polymorphism, demographics and lifestyle factors with VDD among Malaysian pregnant women.MethodInformation on demographic characteristics, dietary vitamin D intake from supplement and food, time spent outdoors, skin type and clothing were collected using a questionnaire. Plasma total 25-hydroxyvitamin D (25OHD) levels were measured using an Ultra-High-Performance Liquid Chromatography (UHPLC). MaternalGCsingle nucleotide polymorphisms (SNPs) (rs4588 and rs7041) were determined using restriction fragment length polymorphism (RFLP) technique.ResultsResults showed that 50.2% of pregnant women were vitamin D deficient (25OHD GCrs7041(andGCdiplotypes). In contrast to previous studies that reported for non-pregnant population, a significant positive association was found between CC genotype for SNPGCrs7041,GC1s–1s andGCIf-2 with risk of VDD (25OHD ConclusionsThe high prevalence of maternal VDD found in this study suggests the need for urgent development and implementation of vitamin D supplementation or fortification strategies to reduce VDD among pregnant women. The discrepancy in the association betweenGCrs7041 gene polymorphism and VDD reflects the variation in the factors associated with VDD in pregnancy compared to non-pregnant state.

Background: Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by scarce adipose tissue. This disease is distributed worldwide, but little is known about these patients in the Chinese population. Here, we delineate the phenotype and prognosis of CGL in our cohort. Methods: Patients diagnosed with CGL from 8 medical centers were reviewed. The initial presentation, laboratory findings, and molecular testing were retrospectively analyzed. Results: A total of 16 patients were analyzed, and the current median age was 3.5 years (range, 9 months-17.5 years). In all patients, molecular results confirmed BSCL2 mutation. c.782dupG (p.Ile262Hisfs*12) was the most common genotype identified. All patients had triangular faces and muscular hypertrophy. In addition, 75% presented with hepatomegaly, 19% had cardiomegaly, and 44% exhibited acanthosis nigricans. Developmental delay was noted in 5 out of 9 patients (56%) with a median developmental quotient (DQ)/intelligence quotient (IQ) of 61. Thirteen patients (81.3%) had high triglyceride levels. Eight patients received leptin analysis, and 7 of them (88%) had low leptin levels. One patient exclusively received a lipid-lowering drug, 4 patients were exclusively placed on a fat-restricted diet, 5 patients were administered combination therapy, and 5 patients received no treatment. Three patients (19%) who developed diabetes mellitus received both oral hypoglycemic agents and insulin. Three patients (19%) experienced loss of ambulation and died prematurely. Conclusion: Our findings highlight the uniqueness of the genotype and phenotype in our cohort. Further long-term surveillance for comorbidities is necessary for early detection and management of these patients. Keywords: Congenital generalized lipodystrophy, Outcome, Morbidity

Objective Enzyme replacement therapy (ERT), the only approved therapy for infantile-onset Pompe disease (IOPD), had heterogeneous clinical effects due to factors such as severity, age at first treatment, dosage, and dosing regimens. We report the clinical and biochemical outcomes of a cohort of IOPD patients identified through newborn screening, and evaluating the dosage effect. Study design A retrospective observational study was designed to describe the long-term clinical and biochemical outcomes of a uniform cohort of IOPD patients who have been treated with high-dosage of ERT. Results Twenty-eight patients received alglucosidase alpha at either the labeled dosage followed by a high dosage (n = 23) or a high dosage exclusively (n = 5). At a median age of 8.3 years (0.8–17.3), 15 patients were walkers, 8 were weak walkers, and 5 were nonwalkers. The three groups exhibited a significant difference in the age of gross motor decline (p, Highlights • CK and uGlc4 levels were correlated with favorable response to ERT in IOPD patients. • Once these biomarkers rose, they never returned to normal. • High-dose ERT instituted immediately at newborn screening seems to give the best outcome.

BACKGROUND/OBJECTIVES Recently, the recommended nutrient intakes (RNI) for vitamin D for Malaysian aged 1-70 yrs has been revised from 5 µg/day to 15 µg/day. This study is aimed to assess the adequacy of vitamin D intake based on revised RNI and to recommend several dietary strategies to increase total vitamin D intake. SUBJECTS/METHODS Vitamin D intake from both food and supplement of 217 pregnant women was assessed using a validated food frequency questionnaire. Hypothetical effect of expanded supplementation and food fortifications strategies were modelled using the consumption data. RESULTS The results revealed that more than half (67.7%) of pregnant women had inadequate vitamin D intake (RNI < 15 µg/day). The modelling results demonstrated the potential of universal provision of 10 µg/day of multivitamins supplements in increasing vitamin D intake. Moreover, mandatory fortification of both milk and malted drink at single level of 5 µg/serving would lead to increase in vitamin D intake of Malaysians, particularly pregnant women. CONCLUSIONS The outcome of this study can be used as a reference for public health professionals to re-evaluate the existing Malaysian food fortification policies and supplementation recommendation for vitamin D for pregnant women.

With possible food crises looming in the near future, urban farming, including small-scale community and home gardens for home consumption, presents a promising option to improve food security in cities. These small-scale farms and gardens often use planter boxes and raised beds filled with lightweight soil or potting mixes. While previous studies on biochar focused on its application on large-scale contiguous farmlands, this study aimed to evaluate the suitability of biochar as a partial soil substitute to produce a durable and lightweight soil-biochar mix for small-scale urban farms. The effects of biochar on the chemical properties of the soil-biochar mix, crop yield and, particularly, crop nutrients and metabolic content were assessed. A germination test using pak choi seeds (Brassica rapa L. cultivar group Pak choi, Green-Petioled Form) showed that the biochar contained phytostimulants. Through a nursery pot experiment over four growth cycles, biochar treatments performed better than pure soil at retaining water-soluble NO3- and K+ ions, but were worse at retaining PO43- ions. Nonetheless, despite its positive effect on soil NO3- retention, biochar application did not improve crop yield significantly when the application rate varied from 0% to 60% (v/v). Untargeted metabolomic analyses showed that biochar application may increase the production of carbohydrates and certain flavonoids and glucosinolates. The results of this study showed that biochar can potentially be used to improve pak choi nutritional values and applied in large quantity to obtain a lightweight soil mix for urban farming.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by degeneration of dopaminergic neurons. Motor features such as tremor, rigidity, bradykinesia and postural instability are common traits of PD. Current treatment options provide symptomatic relief to the condition but are unable to reverse disease progression. The conventional single-target therapeutic approach might not always induce the desired effect owing to the multifactorial nature of PD. Hence, multitarget strategies have been proposed to simultaneously target multiple proteins involved in the development of PD. Herein, we provide an overview of the pathogenesis of PD and the current pharmacotherapies. Furthermore, rationales and examples of multitarget approaches that have been tested in preclinical trials for the treatment of PD are also discussed.

Background: The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients’ first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. Methods: This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient’s first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit. Result: A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%–40.8%). Assessments for a history of TOD were found in only 5.8%–11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%–63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered Conclusion: There was poor assessment of the patients’ CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.

Recombinant human acid β-glucosidase GBA (rhGBA) infusion is an effective therapy for non-neuropathic (type I) Gaucher disease (GD), but its effect on subacute neuropathic (type III) GD is still controversial. The most common genotype for type III GD is homozygous c.1448T>C (p.L444P) mutation, and in this study, we treated seven such patients starting from an early age (median 2.1 years; range 1–2.9 years). Before the start of treatment, all patients presented hepatosplenomegaly, anemia, and thrombocytopenia, but with no neurological signs. Normalization of hemoglobin levels and platelet numbers was achieved in all patients in one year. However, after a median treatment period of 7.6 years (2.2–12.0 years), two patients developed horizontal gaze palsy, one had seizures, four demonstrated mental retardation, and five showed kyphosis. Moreover, lymphadenopathy in the neck, thorax, or abdomen was observed in four patients. Therefore, the progression of neurological symptoms in these patients probably reflected the neurologic natural history of type III GD. Residual somatic symptoms, including kyphosis and lymphadenopathy, may be more common than what we thought. An additional treatment will be necessary to improve the outcome of type III GD.

Introduction: Nurses are generally trained on the procedures of blood transfusion during their years of service. However, the level of knowledge varies among individuals and healthcare centres. Thus, this study addresses a knowledge gap regarding nurses’ knowledge and transfusion safety in the local clinical setting. Objectives: This study aimed to determine nurses’ level of knowledge of various phases of blood transfusion and associate this knowledge with their socio-professional details. Methods: This was a cross-sectional, quantitative study. The target population was in-patient ward nurses at Hospital Pulau Pinang. The systematic random sampling method was used to select 185 nurses to participate in this study. Data were collected using a validated research questionnaire that consisted of 31 items (9 items related to socio-professional factors and 22 knowledge items). Data were analysed using descriptive and inferential analyses. Results: The overall knowledge score was moderate (mean = 70.44%, SD = 11.35). None of the nurses was able to answer all of the knowledge questions correctly. Of the participants, 72.29%, 71.75%, and 67.14% exhibited knowledge of blood bag collection and patient preparation; pre-transfusion nursing activities; and during and post-transfusion nursing responsibilities and management of transfusion reactions, respectively. Factors such as age, years of service, department, and availability of the transfusion policy in the ward significantly affected the mean knowledge scores. Conclusion: Nurses’ knowledge of blood transfusion at Hospital Pulau Pinang was moderate. More training and courses should be provided to improve their knowledge.

The Course Teaching Evaluation System (CTES) is a system which has been created to evaluate the quality of the teaching of courses in UKM. It is one of the student feedback systems which provide important input to continuously improve the quality of study programmes in all faculties. A study on UKM's CTES was conducted. The study focuses on the reliability of student feedback on CTES and the effectiveness of the system in revealing the effectiveness of teaching in a few predetermined aspects. The study was based on stratified random sampling of UKM students. The research methods used include observation made through eye tracker, questionnaire and interview. The research results would fulfil the main aims of the study, which are to explore whether the students have read the questions on CTES in detail before answering them and whether students give the questions sufficient thought and consideration before answering them. The findings would be used to determine the reliability of student input on CTES. The reliability of the feedback is very important in the quest to identify the effectiveness of teaching in the aspects of course content, infrastructure, equipment, laboratory and the teaching achievements of the lecturers.

Benefits of sutureless aortic valve replacement (AVR) have been established. Most western centres have reported advantages in reduced cardiopulmonary bypass, cross clamp, ventilation, and postoperative recovery time. It has established a role in moderate to high-risk surgical patients requiring an AVR. However, the incidence of postoperative atrial fibrillation (POAF) in sutureless AVR is less known.

Aortic valve replacement (AVR) is the current gold standard treatment for aortic stenosis. In the last 15 years popularity for minimally invasive (MI) AVR has grown exponentially. The most common techniques for MI-AVR are a partial sternotomy (PS) or a mini-thoracotomy (MT). Although MI access is technically more challenging and results in longer cross clamp and cardiopulmonary bypass times, MI has resulted in superior outcomes. Many publications have reported reduced postoperative pain, surgical trauma, blood loss, transfusion requirements, ventilation times, hospital stay with also earlier functional recovery and better cosmesis. Reductions in the incidence of postoperative atrial fibrillation (POAF) have also been shown.

Postoperative atrial fibrillation (POAF) is the commonest arrhythmia after cardiac surgery, associated with longer hospital stay, increased morbidity and mortality. Development of POAF is certainly multifactorial, however the exact mechanism remains unknown. Left atrial (LA) enlargement is commonly associated with mitral valve disease.

Singapore’s population is aging rapidly and the burden of chronic disease is growing in tandem. There is increasing realization that there should be greater focus on empowering primary care to deliver quality and cost-effective chronic disease management. General practitioners (GPs) in the private sector, which form the bulk of primary care here, tend to manage far fewer patients with chronic conditions when compared with the public sector’s polyclinics. This is partly due to limited availability of supporting nursing and allied health services in the community. The fee-for-service structure as well as the pricing gradient between the public and private sectors also makes it financially non-viable for GPs to provide such services to their patients. As a result, most patients with diabetes and other chronic conditions are managed in the increasingly over-burdened polyclinics. For instance, over 60% of diabetic patients are currently treated in the polyclinics which are 20% of primary care by service attendance (and about 18% by strength in terms of medical manpower). The difficulty in accessing screening and monitoring services leading to inadequate follow-up raises the risk of complications down the road for patients with chronic conditions. As part of a larger collaborative effort to construct a regional health system, the GP community has been engaged to voice their need for support services to complement their medical services. Based on the GPs’ feedback, a Community Health Center (CHC) has been set up to perform digital diabetic retinal photography, diabetic foot screening as well as nurse counseling and education service for the GPs’ patients, with a strong focus on chronic disease management. Later on, following further inputs from the collaborating GPs, dietetics and physiotherapy services have been added to the range of services provided through the CHC. GPs refer their patients to receive assessments and tests at the CHC and the reports are sent back to the GPs for their follow-up and management. Supported by dedicated funding, the pilot CHC charged affordable fees for the services, which were comparable with the rates for similar services offered in the polyclinics. The fee structure has since been taken over by a tiered pricing mechanism aligned with a national health financing framework, which keeps the services affordable for needy patients. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117112– http://www.ijic.org/ Our report will describe the successes and challenges of this model, and report on the workload, pick-up rates for complications, patients’ and GPs’ feedback. Based on the initial reports, between 1 in 6 and 1 in 10 diabetic patients screened at the CHC were found to have signs of complications requiring referral to specialist care for further work-up or treatment. As the CHC plays a primarily supportive role, patients with abnormal reports are always sent back to their GPs for the clinical decision on treatment or referral, and GPs are happy with such a care partnership where they continue to have oversight of their patients’ care. A larger pilot study is being funded with several more CHCs set-up across the nation. Newer services such as physiotherapy for conditioning and balance training have been offered. We are also studying the feasibility of offering mental health support, COPD assessments, life-style education classes at the CHC. The key concept of this CHC model is the foundation of engaging the GPs to determine the support required to complement their clinical care, so that GPs are able to manage their patients holistically in the community.

Background: The US Federal and Drug Administration (FDA) recently revised statin drug labels to include the information that increases in fasting serum glucose and glycated haemoglobin levels have been reported with the use of statins. Yet in a survey, 87% of the doctors stated that they had never or infrequently observed increases in glucose or HbA1c levels in patients on statin. In this study we would like to determine the association between the use of statins and glycaemic control in a retrospective cohort of patients with hypertension. Methods: A retrospective review of 1060 medical records of patients with hypertension at a primary care clinic was conducted. These records were selected using systematic random sampling (1:4). Data on patient socio-demographic factors; clinical profile; investigation results and prescribed medications were collected. Independent t-test was used for continuous variables while Pearson’s χ2 test was used for categorical variables. Logistic regression was done to adjust for confounders. Results: 810 (76.4%) patients with hypertension were on statins, out of which 792 (97.8%) were taking simvastatin 10 mg or 20 mg daily. Analysis of the whole group regardless of diabetes status showed that the statin user group had higher HbA1c and fasting blood glucose values. The difference in HbA1c levels remained significant (adjusted OR = 1.290, p = 0.044, 95% CI 1.006, 1.654) after adjustment for diabetes, diabetic medication and fasting blood glucose. In the study population who had diabetes, statin users again had significantly higher HbA1c level compared to statin non-users. This difference remained significant (adjusted OR 1.208, p = 0.037, 95% CI 1.012, 1.441) after adjustment for age and diabetic medications. Conclusions: Statins use is associated with increased HbA1c levels among hypertensive patients and hypertensive patients with diabetes. Clinicians managing hypertensive patients on statins should consider monitoring the HbA1c level and ensure that those with diabetes have their hyperglycaemia kept under control.

This paper proposes a new centrality measure called overall centrality measure that can be used to summarize the important information contained in social network. It is an optimal linear combination of the traditional measures where the optimality criterion is similar to that in principal component analysis. The advantages of this method will be illustrated by using stocks prices in Indonesian Stock Exchange where the relationship among stocks is viewed as social relationship. Some important results will be highlighted.

In the past few decades, medicinal chemistry research towards potent and selective antagonists of human adenosine receptors (namely, A1, A2A, A2B, and A3) has been evolving rapidly. These antagonists are deemed therapeutically beneficial in several pathological conditions including neurological and renal disorders, cancer, inflammation, and glaucoma. Up to this point, many classes of compounds have been successfully synthesized and identified as potent human adenosine receptor antagonists. In this paper, an overview of the structure-activity relationship (SAR) profiles of promising nonxanthine pyrazolo derivatives is reported and discussed. We have emphasized the SAR for some representative structures such as pyrazolo-[4,3-e]-1,2,4-triazolo-[1,5-c]pyrimidines; pyrazolo-[3,4-c] or -[4,3-c]quinolines; pyrazolo-[4,3-d]pyrimidinones; pyrazolo-[3,4-d]pyrimidines and pyrazolo-[1,5-a]pyridines. This overview not only clarifies the structural requirements deemed essential for affinity towards individual adenosine receptor subtypes, but it also sheds light on the rational design and optimization of existing structural templates to allow us to conceive new, more potent adenosine receptor antagonists.

An initial study related to the perception of teachers and students toward the sexuality education was carried out in 2008. The study showed that there are big gaps between the perception of the teachers and students towards Malaysia sexuality education today. As a result Malaysia Sexuality Education (MSE) courseware was designed based on learning, instructional design and human computer interaction theories approach. The MSE was developed through a comprehensive methodology which ADDIE model integrated with usage-centered design models to achieve highly usable courseware. There are four constructs in usability evaluation of MSE, namely effectiveness, efficiency, satisfaction and learnability. Result shows that MSE not just increase students' performance in sexuality education, but students and teachers are also satisfied with the error-free interactive of MSE.

In 2006, Malaysia government was introduced the National Sexuality Education Guideline to overcome social problems amongst the juveniles. An early study related to the perception of the teachers and students toward the sexual education curriculum taught in schools currently was carried out. The study showed that there are big gaps between the perception of the students and teachers towards several issues related to the current sexual education in Malaysia School. The theoretical framework of MSE approach animation was designed and developed based on several learning theories and user interface design concept to handle the sensitive and delicate issues of the sexuality subject for Malaysian. In conclusion, the effort of developing the MSE courseware is hopefully will be a solution to the Malaysian teachers and secondary students problems in teaching and learning of sexuality subject matter.

Background: Implementation of guidelines in hypertension remains challenging in primary care. Interventions are needed to improve hypertension management using guidelines. Objectives: To evaluate effectiveness of an intervention using guidelines in reducing blood pressure in patients with hypertension. Method: This before-and-after study was conducted in a primary care clinic for six months. The intervention involved professional training, availability of hypertension guideline and structured format of medical notes for hypertension. Primary outcome is the change in proportion of patients with uncontrolled BP (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) and secondary outcome is the mean BP change at 6 months. Results: A total of 555 patients were recruited. At baseline, 227/555 (40.9%) had uncontrolled BP. By 6 months 186/463 (40.2%) was uncontrolled. Among those with uncontrolled BP at baseline, 51.8% had BP controlled at 6 months; SBP in the uncontrolled group decreased from 147.8 (11.2) to 138.8 (15.2) mmHg (p Conclusion: Although there was no change in the proportion of patients with uncontrolled BP, there was a significant reduction in mean BP of 9/4 mmHg in those with uncontrolled BP. Patients with controlled BP still need continuous monitoring.

Seventeen alpha-hydroxylase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia in which defects in the biosynthesis of cortisol and sex steroid result in mineralocorticoid excess, hypokalemic hypertension and sexual abnormalities such as pseudohermaphroditism in males, and sexual infantilism in females. The disease is inherited in an autosomal recessive pattern, and is caused by mutations in the gene encoding cytochrome P450c17 (CYP17), which is the single polypeptide that mediates both 17alpha-hydroxylase and 17,20-lyase activities. We report the case of a 15-year-old patient with 17OHD who had a female phenotype but male karyotype (46,XY). The diagnosis was made based on classical clinical features, biochemical data and molecular genetic study. Two mutations were identified by polymerase chain reaction amplification and sequencing, including a S106P point mutation in exon 2 and a 9-bp (GACTCTTTC) deletion from nucleotide position 1519 in exon 8 of CYP17. The first of these mutations was found in the father and the second in the mother, and both have been previously reported in Asia. The patient's hypertension and hypokalemia resolved after glucocorticoid replacement and treatment with potassium-sparing diuretics. Sex hormone replacement was prescribed for induction of sexual development and reduction of the final height. Prophylactic gonadectomy was scheduled. In summary, 17OHD should be suspected in patients with hypokalemic hypertension and lack of secondary sexual development so that appropriate therapy can be implemented.

Call admission control and dynamic pricing have been proposed as separate measures to reduce congestion in a network. In this paper, we integrate the call admission control and dynamic pricing problems, formulating them as a Markov decision problem (MDP), operating in a multiservice, resource-sharing cellular system. Our model incorporates price-affected behaviour of network users, considering effects on arrivals, retrials and substitutions among services and time. The network exercises admission control, to reject or accept a new connection requests, and price control to set a state-dependent price per bandwidth time with the objective to maximise the long-term revenue. The results show that the proposed method improves revenue and reduces congestion compared to other conventional sub-optimal policies

In this paper, a new parameter, noise rise factor, that indicates the amount of interference generated by a call is suggested as a basis for setting price. We study the problem of optimal integrated dynamic pricing and radio resource management, in terms of resource allocation and call admission control, in an interference-limited network. The methods of dynamic programming are unsuitable for problems with large state spaces due to the "curse of dimensionality". To overcome this, we solve the problem using the simulation-based methods of neuro-dynamic programming. The results show that the optimal policy suggested provides significant average reward and congestion improvement over conventional policies that charge users based on their load factor.

Giant pulmonary artery aneurysms are rare with a poorly understood natural history. They can be idiopathic but often associated with congenital cardiac deformities, pulmonary hypertension or vasculitides. Indications for surgery and clinical course are still not well defined. We present a case of a giant pulmonary artery aneurysm corrected surgically using a Dacron bifurcation graft with concomitant single concomitant coronary artery bypass graft and 4-year radiology follow-up.

Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma that invariably remains confined within the blood–brain barrier, mainly affecting brain parenchyma with or without leptomeningeal or ocular involvement. It was previously believed that extensive systemic screening is not warranted in PCNSL as systemic dissemination is rare and the yield of screening beyond physical examination, routine blood test and chest radiography is low. More recently the standard practice has changed, as it is believed that 4–12% of patients with presumptive PCNSL are ultimately found on evaluation to have extra-central nervous system disease. The current standard routine diagnostic work up includes utilising MRI with gadolinium, cerebrospinal fluid examination and tissue biopsy guided by imaging abnormalities. The diagnostic use of fludeoxyglucose positron emission tomography (FDG PET) imaging has yet to be defined. We describe the use of FDG PET imaging as part of a diagnostic work up in identifying an occult biopsy site in a 42-year-old man with otherwise non-biopsy feasible neurolymphomatosis of the cauda equine.

Background Clinical practice guidelines (CPGs) are used to standardize care according to evidence-based recommendations. However, the implementation of CPGs in the real world varies; a possible reason for this is the lack of a systematic approach to the implementation of CPG. We, therefore, aimed to develop an intervention to improve the implementation of a local hypertension CPG based on the needs of healthcare professionals (HCPs), best available evidence, and theories.

BACKGROUND/OBJECTIVES: The transforming hand hygiene culture and improvement initiative was a “cross-continents” collaboration of 9 hospitals in 8 different countries across 3 regions of Middle East, Asia Pacific and Europe: The project cohort “met virtually” to systematically apply the Robust Process Improvement methodology in kicking off the local project at the participating health care organization, as well as sharing and learning from each other any successful implementation strategies to overcome the local and global barriers. The improvementworkwere conducted in several different types of hospitals, varying from academic medical centers, public governmental hospitals to specialized care private hospitals. Problem: Reduce Healthcare Associated Infections by improving hand hygiene. System: Expand the scope of hand hygiene accountability beyond regular infection control to transform the culture of patient safety. METHODS: Hand hygiene non compliances of health care providers were measure at Entry and Exit of patient care areas. Pre and post process improvement, which the pilot project unit used the same measurement system to validate improvement changes before and after the interventions. Solutions were targeted only to contributing factors found by each organization, such as relocation of hand gel dispensers, redesign of work flow, using code words to ensure peer’s accountability in hand hygiene etc. Proven solutions linked to contributing factors identifiedbasedonbroadly testeddevelopment efforts in United States with demonstrated effectiveness in reproducing the same success at the international organizations. Robust Process Improvement methodology was integrated into a test proven tool created within United States could be used to enable cross continent hand hygiene compliance improvement with virtual, low cost, collaborative and synergistic problem solving. Used common frame of web enabled Targeted Solutions Tool to record data and provide automated real-time analysis. e Common measurement system and video training to ensure reliable measurement system analysis. e The cohort used direct observation of anonymous observers and Just-in-Time (JIT) coaches as data collectors for measuring hand hygiene non-compliance observations. The anonymous observers collected data on physical barriers of non-compliance as “secret shoppers” without influencing the observed behaviors; the JIT coaches captured non-observable cultural barriers by interviewing health care workers after an observed non-compliance. Since no two organizations are identical in their compliance failures, theHCOs did not implement a bundle of solutions; instead they targeted their improvement solutions to the organization’s unique list of validated contributing factors. RESULTS: Aggregate results across 14 units of 9 international organizations: e Baseline 1⁄4 42.16% (n 1⁄4 5,655) e Improve 1⁄4 71.74% (n 1⁄4 6,408) CONCLUSIONS: Organizations trying to solve the same problem benefit from: o working together and learning from the experience of others, even if these organizations are dissimilar in culture, country and location o using similar a similar, reliable frame for measurement, data collection, analytics and systematic problem solving o solutions that are setting/unit dependent based on the

Background Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD. Methods We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach. Results The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word ‘asthma’ was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care. Conclusions In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit.