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Background: Many patients with type 2 diabetes mellitus (T2DM) do not achieve the desired glycaemic control despite being treated with insulin. Studies found this due to an improper understanding of insulin function, its intensification process and patients' negative perspective on insulin. We developed an education module to enhance adherence to insulin therapy., Methods: This study applied a mixed design. It was conducted in three phases: i) Phase I: literature search and focus group discussions (FGDs), ii) Phase II: module development and iii) Phase III: content and face validation of Universiti Sains Malaysia-Insulin Adherence Module (USM-IAM). FGDs were used to gather patients' opinions. All researchers repeatedly discussed about the module content and arrangement, the words and images used, and the grammar in producing the final draft. Specialists and target audience performed content and face validation of the module., Results: Thirty-six participants were involved in the FGDs. Data saturation was achieved at the 4th FGD. Three themes emerged from qualitative data analysis and were incorporated into the module. USM-IAM was finalised with five units. The content validity index (CVI) was 0.92, while face validity agreements were between 86% and 97%., Conclusion: The CVI and face agreement for USM-IAM exceed the cut-off point for a sound module. It has good potential to be used as a resource for educating patients in enhancing insulin adherence., Competing Interests: Conflict of Interest: None., (© Penerbit Universiti Sains Malaysia, 2024.)

Cornflakes are a popular and convenient breakfast cereal made from corn and widely consumed worldwide, including in Lebanon. However, they are susceptible to mycotoxin contamination, which can have harmful effects on human health. Our study evaluated the occurrence of five mycotoxins (AFB1, OTA, FUM, ZEA, DON) levels in packed cornflakes marketed in Lebanon. A market screening identified 35 different cornflake stock-keeping units (SKU) in the Lebanese market, originating from 10 different brands and having different tastes and shapes. SKUs were collected and tested for five mycotoxins in triplicates using enzyme-linked immunosorbent assay technique. The results showed the presence of the five mycotoxins in the samples. The average levels of AFB1, OTA, ZEA and FUM among positive samples (above limit of detection) were 1.58, 1.2, 15.1 and 774.1 μg/kg, respectively, and were below the EU limits. On the other hand, the average level of DON was 1206.7 μg/kg, exceeding the EU limit. Furthermore, out of the positive samples, 60%, 17%, 9%, 14%, and 6% exceeded the EU limits for DON, OTA, AFB1, FUM, and ZEA, respectively. Notably, SKUs made in Lebanon had significantly (p < 0.05) higher levels of AFB1 and FUM. The packing size of the cornflakes had no significant (p > 0.05) effect on the levels of the five mycotoxins detected in the samples. AFB1, FUM and ZEA levels differed significantly among SKUs (p > 0.05). Considering these findings, further studies should be conducted to assess the exposure to mycotoxins from the consumption of cornflakes in Lebanon, especially among children., (© 2023. The Author(s).)

Background: Prediction of suicide and suicide attempts is an aspirational goal for clinicians and policy makers. This requires scrutiny of various diagnostic accuracy measurements., Objective: To evaluate the diagnostic accuracy of suicide risk scales in inpatient and emergency departments, and combined settings within hospitals, and consider the best scale in predicting suicide and suicide attempts in adults., Design: Systematic review of diagnostic accuracy., Settings: Inpatient and emergency rooms of acute hospitals., Methods: The searched databases included PubMed, Embase, ProQuest, MEDLINE, Web of Science, CINAHL, Cochrane, PsycINFO and Scopus. Grey literature databases (ProQuest Dissertations and Theses, Google Scholar and OpenSIGLE) and reference lists of all included studies were also searched. Eligibility criteria included prospective cohort studies of suicide or attempted suicide in adults. A narrative synthesis was done for true positives, true negatives, false positives and false negatives, and they were calculated for sensitivity, specificity, likelihood ratios, predictive values and diagnostic odds ratios., Results: The included 33 studies differed in the methodological characteristics and scales used. The sensitivity of scales, specificity, positive predictive value, and diagnostic odds ratios ranged from 17 to 100%, 11-93%, 0.43-40.9%, and 0.77-18.5, respectively., Conclusion: The choice of scale for predicting suicide attempts in adults in hospitals depends on many factors. None of the scales evaluated produced accurate diagnostic measurements. The Manchester Self-Harm Rule and Suicide Crisis Syndrome should be used in the emergency department and inpatient setting, respectively, while the Suicide Intent Scale should be used in combined settings., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the author(s)., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Insulin therapy is necessary for patients with type 2 diabetes mellitus (T2DM) to reach the targeted glycaemic level and prevent complications. This study aimed to determine the proportion of adherence to insulin therapy and the associated factors in patients with T2DM., Methods: A cross-sectional study was conducted among 249 patients with T2DM who had been on insulin therapy for at least 2 months in primary care centres of the Ministry of Health in Klang, Malaysia. A validated insulin adherence questionnaire for diabetes mellitus (DM) was used to assess insulin adherence. Data on the sociodemographic characteristics, disease-related factors, treatment-related factors and clinical parameters were extracted from medical records and interviews with patients., Results: The adherence to insulin therapy was 8.43%. The factors associated with insulin adherence were self-monitoring of blood glucose (SMBG) (adjusted odds ratio [AOR]: 5.39; 95% confidence interval (CI): 1.20, 24.13; P = 0.028), exercise (AOR: 3.38; 95% CI: 1.37, 10.03; P = 0.029) and the number of daily insulin injections (AOR: 1.63; 95% CI: 1.09, 2.44; P = 0.017)., Conclusion: The adherence to insulin therapy in primary health care centres in Malaysia was very poor. Patients who practiced SMBG, exercised and frequent daily insulin injections were significantly more adherent to insulin therapy., Competing Interests: Conflicts of Interest None., (© Penerbit Universiti Sains Malaysia, 2021.)

Background: Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking., Objectives: This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses., Methods: The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n = 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n = 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test-retest reliability, convergent validity, and known-group validity of the scale were also analysed., Results: A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent test-retest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics., Conclusions: The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients., Competing Interests: Conflict of Interest All authors declare no actual or potential conflict of interest including any financial, personal, or other relationships with other people or organisations that could inappropriately influence or bias this work., (Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: There is limited information regarding the problems faced by children with large angle infantile esotropia (LAIE). The aim of this study was to explore the problems that children with LAIE encounter from both their perspectives and those of their parents., Methods: This study included children who had LAIE (with angle of 40 prism dioptres or greater), aged 5 and 17 years who had attended the Ophthalmology Clinic, Hospital Universiti Sains Malaysia from March to September 2016. The children and their parents or guardians were interviewed face-to-face using a validated semi-structured interview guide. Interviews were tape-recorded and transcribed verbatim. Content analysis was performed using the NVivo 12 software., Results: A total of 30 children and 30 parents were interviewed. The most common problems identified by the children were social interactions (73.3%, 22 children), visual functions (60.0%, 18 children), emotions (60.0%, 18 children), physical issues (40.0%, 12 children) and difficulties regarding treatment options (26.7%, eight children). The parents reported that their children were more affected in terms of visual functions (100.0%, 30 parents), social interactions (56.7%, 17 parents), emotions (43.3%, 13 parents), physical issues (20.0%, six parents), and difficulties regarding treatment options (16.7%, five parents)., Conclusion: The major problems that the children with LAIE identified were social interactions, while the parents observed that problems with visual functions was the most common issue encountered by their children. This suggests that the children affected have different perspectives from their parents and require support.

In this paper, we propose and validate an artificial neural network-based equalizer for the constant power 4-level pulse amplitude modulation in an optical camera communications system. We introduce new terminology to measure the quality of the communications link in terms of the number of row pixels per symbol Npps, which allows a fair comparison considering the progress made in the development of the current image sensors in terms of the frame rates and the resolutions of each frame. Using the proposed equalizer, we experimentally demonstrate a non-flickering system using a single light-emitting diode (LED) with Npps of 20 and 30 pixels/symbol for the unequalized and equalized systems, respectively. Potential transmission rates of up to 18.6 and 24.4 kbps are achieved with and without the equalization, respectively. The quality of the received signal is assessed using the eye-diagram opening and its linearity and the bit error rate performance. An acceptable bit error rate (below the forward error correction limit) and an improvement of ~66% in the eye linearity are achieved using a single LED and a typical commercial camera with equalization.

Aims and Objectives: This study aims to explore nurses' perceptions and experiences regarding pressure injuries caused by medical devices and to understand the perceived challenges and barriers nurses face in preventing medical device-related pressure injuries., Background: Nurses have a responsibility to prevent pressure injuries and play a major role in their prevention. As there has been a lack of research on medical device-related pressure injuries, not much is known about nurses' perceptions and experiences. This therefore hinders the establishment of effective and efficient interventions in nurses' education and in the practical environment., Design: A descriptive qualitative design was adopted, and the COREQ checklist was employed to report on the current study., Methods: The study was conducted at an acute care hospital in Singapore. Purposive sampling was used, and a total of 21 enrolled and registered nurses who had recent experiences with medical device-related pressure injuries were recruited between August and December 2018. Face-to-face interviews were conducted using a semi-structured interview guide. A thematic analysis was performed to analyse the qualitative data., Results: Five themes emerged regarding pressure injuries: (1) preventable yet unavoidable, (2) everyone's responsibility, (3) harmonising theory with practice reality, (4) pre-existing conditions may limit injury prevention and management; and (5) nurses expressed a need for experiential training., Conclusions: The study's findings could be used to develop improvements in nursing practice and policy at acute care hospitals, as well as to improve awareness of medical device-related pressure injuries among healthcare professionals. Moreover, the findings can also inform future research studies to develop effective evidence-based practices and improve patient outcomes., Relevance to the Clinical Practice: This study reveals the unique challenges and dilemmas that nurses face and will help to inform healthcare institutions and management in developing programmes and improving protocols to reduce the incidence rate of pressure injuries caused by medical device., (© 2020 John Wiley & Sons Ltd.)

Objective: To investigate diet adherence, medication adherence and self-care behaviour among patients with chronic heart failure (CHF) in a multi-ethnic society and identify the significant factors associated with their diet and medication adherence., Methods: A cross-sectional descriptive correlational study was conducted with a convenience sample of 107 patients with CHF recruited from two cardiology wards of a public tertiary hospital in Singapore. Study variables were measured using the Dietary Sodium Restriction Questionnaire, the Medication Adherence Rating Scale-5 items and the European Heart Failure Self-care Behaviour Scale-12 items., Results: Our sample reported positive attitudes towards diet adherence, poor self-care behaviour, and good medication adherence. The multiple linear regression results indicated that lower income, Chinese ethnicity, diabetic complications, current smoking, lower New York Heart Association classification I and II, and poorer self-care behaviour predicted poorer diet adherence. In addition, absence of hypertension, having non-myocardial infarction as a cause of CHF, and moderately diminished ejection fraction were identified as significant predictors of poorer medication adherence., Conclusion: The findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Despite the widespread implementation of medical emergency teams (METs) in hospitals to provide immediate interventions to deteriorating ward patients, little is known about how junior doctors and nurses escalate care for deteriorating ward patients in hospitals with established MET services., Objectives: The objective of this research study was to explore the experiences of junior doctors and nurses in escalating care for clinically deteriorating patients in general wards., Methods: Twenty-four individual interviews were conducted with 10 junior doctors and 14 registered nurses of a 1000-bed acute general hospital with the most established MET service in Singapore. Interviews were transcribed verbatim and analysed using an interpretive thematic analysis approach., Findings: Three salient themes emerged from thematic analysis: (1) MET activations versus the primary team doctors' reviews, (2) challenges in obtaining medical reviews, and (3) unspoken rules of the escalation of care. Participants' decisions to call the MET or to escalate to the primary team doctors not only depended on the severity of a patient's deterioration and their perceptions of the primary team doctors' capacity to manage the patient but also were largely influenced by sociocultural factors that were shaped by the hierarchy of medical professions. Key challenges faced by nurses in obtaining medical reviews from junior doctors for patients with early deterioration included presenting "convincing" evidence of patient deterioration and "packaging" information about patient deterioration., Conclusions: The decision to call a MET or the primary team doctors is a complex judgement that is greatly influenced by the dynamics of perceived hierarchy between the medicine and nursing professions and within the medicine profession. Educational and organisational changes that enhance doctor-nurse interprofessional and intraprofessional collaboration among all levels of doctors may improve the process of the escalation of care for deteriorating patients and thus improve patient safety for hospitalised patients., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

The ever-increasing number of vehicles on a global level signifies the need for communications between vehicles and the surrounding environment. Visible light communications (VLC) is a viable complementary technology to congested radio-frequency-based wireless systems. In order to increase the reliability of the VLC link, two novel algorithms based on (i) channel inversion (CI) and (ii) frame subtraction and CI (FSCI) schemes are proposed to successfully extract the data in a non-line-of-sight multiple-input-multiple-output spatial-division multiplexing optical camera communications system. We have adopted differential modulation and frame subtraction schemes and proposed a unique packet structure to mark the packet and the position of the footprint of transmitters (Txs) in the image frame. We show that the FSCI scheme with much simpler receiver structures can offer almost the same bit error rate performance compared with the hybrid selection/equal gain combining (HS/EGC) technique at lower transmit power (illumination) levels of <13dBm for a single Tx and improved performance at higher illumination levels of >20dBm for multiple Txs. Compared with HS/EGC, CI schemes have a higher tolerance to the spacing between Txs, where the payload threshold level can be set to a fixed value of 0.5.

Background: The implementation of early warning scoring systems and medical emergency teams that aim to reduce failure to rescue in general wards is only effective if frontline nurses can recognize and act on clinical deterioration in a timely manner. While much of the research to date has primarily focused on registered nurses as recognizers of clinical deterioration, little research has sought to explore the role of enrolled nurses in recognizing clinical deterioration and to provide a big picture of how enrolled and registered nurses recognize clinical deterioration in general ward patients., Objectives: To conduct an exploration of the experiences of enrolled and registered nurses in recognizing clinically deteriorating patients in general wards., Design: A qualitative, descriptive design., Setting: General wards at a 1,000-bed acute general hospital in Singapore., Participants: A purposive sample of 22 enrolled and registered nurses who had at least 6 months of nursing experience and who were working in the general wards., Methods: Individual semi-structured interviews were conducted between October 2016 and February 2017. Interviews were transcribed verbatim and analyzed using thematic analysis., Results: Four salient themes emerged from the data analysis. The first, 'Having a sense of knowing', illustrates how knowing a patient and past experiences facilitated the early recognition of clinical deterioration before the patient turned haemodynamically unstable. The second, 'Patient assessment practices', depicts the physical assessment skills that nurses used to detect clinical deterioration. The third, 'Delegation of routine patient care and assessment to enrolled nurses', demonstrates that nursing activities were delegated to enrolled nurses with lesser directional and supervisory aspects that "delegation" implies, which can potentially compromise patient safety. The fourth, 'Missing the big picture', identifies overwhelming workload and fixation on specific parameters of a patient as reasons for both enrolled and registered nurses missing the big picture of the patient's deterioration., Conclusions: This study provides a snapshot of the recognition of clinical deterioration among enrolled and registered nurses in general wards. Our findings illuminate the need to support the roles of enrolled and registered nurses, with an emphasis on patient assessment and strengthening collaborative practices among nurses, to improve early recognition and timely treatment of clinically deteriorating ward patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Preceptorship is important to newly graduated nurses as they transit from being a student to a practitioner, but it can be stressful for the preceptors. With the current problem of nurse shortage, perceptions about preceptorship need to be explored. The objective of the study is to explore the perceptions, experiences, and needs of nursing preceptors and their preceptees on preceptorship, using a descriptive qualitative design. Audio-recorded semi-structured interviews were conducted from August 2016 to November 2016 in an acute tertiary hospital in Singapore. Ten preceptor-preceptee pairs were interviewed. Thematic analysis was used to analyze the interview transcripts. Four themes emerged from the thematic analysis: (1) social role of the preceptor, (2) letting go of preceptees, (3) communication and the use of technology, and (4) involvement of nursing managers. This study reported about contextual influence on the perceptions of preceptorship, showing both positive and negative aspects of preceptorship. Future multi-centered and longitudinal studies are needed to explore preceptors' and preceptees' perceptions of preceptorship so that intervention programmes can be developed to support them., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We propose, for the first time to the best of our knowledge, a novel non-line-of-sight 2×N indoor optical camera communication system, where N is the number of pixels in the camera with a unique packet structure and a detection methodology for extracting the data from the recorded video streams. A comprehensive theoretical model for the proposed system is presented. The proposed system is experimentally investigated, and the measured results show that higher International Standards Organization (ISO) levels and exposure times lead to a reduced transmit power level by 3 dB for every doubling of the exposure time and ISO at a bit error rate of 10 -3 . It is also shown that when the overlapping area of two interfering transmitters is larger than approximately 30% of the footprints, the data cannot be recovered.

Discriminating bacterial from nonbacterial acute exacerbation chronic obstructive pulmonary disease (AE-COPD) is difficult. In this study, we evaluated T/NK-cells' subsets in peripheral blood of both stable COPD and AE-COPD patients for identifying their rule in the pathogenesis of the disease and highlighting rule of laboratory biomarkers as total and differential leukocytic count, different T/NK lymphocytes' subsets, CD64 neutrophil expression and high sensitive C-reactive protein (CRP) in discriminating bacterial versus nonbacterial AE-COPD to limit overuse of antibiotics. The studied groups were divided into 30 patients with stable COPD disease (control group) and 30 patients with AE-COPD; of which 22 were classified as bacterial and 8 as non-bacterial AE-COPD groups. Total and differential leukocytic count (TLC), high sensitive-CRP and flow-cytometric immunophenotyping using monoclonal antibodies against CD3, CD4, CD8, CD16, CD56 and CD64 were analyzed for each group. Parameters that were significantly different between control and AE-COPD groups included peripheral blood CD64 percent expression, cytotoxic-T cells (Tc), T-helper (Th), NK, NK-T and total lymphocytes' percentages. Using same parameters to further differentiate between bacterial and non-bacterial AE-COPD patients; CRP and CD64% were highly significant between 2 groups (P < 0.001), with higher CRP level and CD64 expression in the bacterial group with mean value; 22.27 mg/L and 83.89%, respectively. A cutoff of 15mg/L and 59.5% for both CRP and CD64 expression were used to discriminate between bacterial and non-bacterial COPD patients. In conclusion, CD64 expression and high sensitive-CRP performed better than several leukocytes concentrations in discriminating bacterial versus non-bacterial AE-COPD. The percentage of CD3CD8 (Tc), CD3CD4 (Th), CD16CD56 (NK) cells were higher in AE-COPD than stable COPD., (Copyright© by the Egyptian Association of Immunologists.)

Background: Statins are a class of potent drugs that can be used to reduce cholesterol, especially low-density lipoprotein cholesterol (LDL-C). However, their effectiveness is limited if adherence to treatment is poor. The objectives of the study are to estimate the proportion of diabetic patient who has achieved LDL-C goal and to determine the association of LDL-C achievement with socio demographic factors and statin therapy adherence., Methods: This is a cross-sectional study involving 234 patients with type 2 diabetes mellitus (T2DM) and dyslipidaemia attending an outpatient clinic in a hospital in Kelantan. Interviews and self-administered questionnaires were used to determine their sociodemographic and clinical characteristics. Adherence to therapy was assessed using the Medication Compliance Questionnaire (MCQ). The associations between the achievement of LDL targets and sociodemographic/clinical factors, including adherence, were analysed with simple logistic regression., Results: About 37.6% of patients achieved their LDL-C target. The percentage of patients who adhered to statin use was 98.3%, and 20.5% of these patients reported full adherence. There was no significant association between achievement of LDL-C targets with adherence or any other sociodemographic factors, such as age, gender and educational or economic status (all P -value < 0.05)., Conclusion: Despite a high level of adherence, the majority of patients failed to achieve LDL-C targets. More concerted efforts are needed to improve this.

Background/aim: Nevirapine is a reverse-transcriptase inhibitor widely used in combination therapy to treat HIV infection. Nevirapine is extensively metabolized in the liver and CYP2B6 is mainly responsible for oxidation of 3-hydroxynevirapine (3-OH NVP). This study aims to explore CYP2B6 activity by measuring 2-hydroxynevirapine (2-OH NVP) and 3-OH NVP in plasma and to identify factors associated with nevirapine pharmacokinetic parameters., Materials and Methods: A total of 112 patients were recruited and treated with nevirapine-based antiretroviral therapy. Plasma nevirapine and metabolite concentrations were assayed using high-performance liquid chromatography via liquid-liquid extraction., Results: Thirty-nine (34.8%) of the patients had no 3-OH NVP detected in their plasma while 2-OH NVP was detected in all patients. Metabolite concentrations were low compared to nevirapine. Positive correlations were observed between nevirapine and its metabolites, 2-OH NVP (P < 0.01) and 3-OH NVP (P = 0.012). Nevirapine concentration was decreased when concomitantly administered with methadone. Univariate analysis showed that ALT level, AST level, and detection of 3-OH NVP were associated with nevirapine pharmacokinetic parameters., Conclusion: The variability of nevirapine pharmacokinetic parameters was caused by liver enzymes and the presence of 3-OH NVP metabolites. The presence of 3-OH NVP can probably be used to distinguished CYP2B6 activity and efficacy of nevirapine in patients with HIV infection.

Aims: Nevirapine is the first non-nucleoside reverse-transcriptase inhibitor approved and is widely used in combination therapy to treat HIV-1 infection. The pharmacokinetics of nevirapine was extensively studied in various populations with a parametric approach. Hence, this study was aimed to determine population pharmacokinetic parameters in Malaysian HIV-infected patients with a non-parametric approach which allows detection of outliers or non-normal distribution contrary to the parametric approach., Methods: Nevirapine population pharmacokinetics was modelled with Pmetrics. A total of 708 observations from 112 patients were included in the model building and validation analysis. Evaluation of the model was based on a visual inspection of observed versus predicted (population and individual) concentrations and plots weighted residual error versus concentrations. Accuracy and robustness of the model were evaluated by visual predictive check (VPC). The median parameters' estimates obtained from the final model were used to predict individual nevirapine plasma area-under-curve (AUC) in the validation dataset. The Bland-Altman plot was used to compare the AUC predicted with trapezoidal AUC., Results: The median nevirapine clearance was of 2.92 L/h, the median rate of absorption was 2.55/h and the volume of distribution was 78.23 L. Nevirapine pharmacokinetics were best described by one-compartmental with first-order absorption model and a lag-time. Weighted residuals for the model selected were homogenously distributed over the concentration and time range. The developed model adequately estimated AUC., Conclusions: In conclusion, a model to describe the pharmacokinetics of nevirapine was developed. The developed model adequately describes nevirapine population pharmacokinetics in HIV-infected patients in Malaysia.

Background: The Structured Migraine Interview (SMI) is a valid and reliable instrument for migraine diagnosis. However, a Malay version of the SMI is not available to be applied to the local Malaysian population. This study was designed to access the validity and reliability of a new Malay version of the SMI questionnaire., Methods: Patients with headache attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, were screened against the inclusion/exclusion criteria before recruitment. A standard translation procedure was used to translate and adapt the questionnaire into the Malay language. The translated version was tested for face, content and construct validities. Subsequently, validity and reliability studies were conducted (1(st) compilation), followed by retesting seven days later (2(nd) compilation)., Results: A total of 157 patients between 15 and 60 years of age were enrolled in this study. The kappa value was 0.70 (p < 0.001) with high sensitivity (0.97) and specificity (0.63). The misclassification rate was 0.15, with a positive predictive value of 0.82 and a negative predictive value of 0.92. The positive likelihood ratio was 2.62, while the negative likelihood ratio was 0.05. The Cronbach's alpha was 0.93 (1(st) compilation) and 0.90 (2(nd) compilation), respectively. The Spearman's correlation coefficient ranged from 0.86 (Question 4) to 0.95 (Question 1). The overall concordance for item 1 was very high (97%), followed by item 4 (83%), item 2 (71%) and finally item 3 (64%)., Conclusion: The Malay version of the SMI questionnaire is comparable to the English version in terms of validity and reliability. It was highly reliable with good internal consistency and can be used for the diagnosis of migraine in clinical settings in Malaysia.

Background: Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls., Methods: Female diagnosed migraine patients (n= 100) and healthy controls (n=100) completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF) questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire., Results: Females with migraines had significantly lower total WHOQOL-BREF scores (84.3) than did healthy controls (91.9, P<0.001). Similarly, physical health (23.4 versus 27.7, P<0.001) and psychological health scores (21.7 versus 23.2, P< 0.001) were significantly lower than those for healthy controls. Seventy-three percent of patients experienced severe disability, with significantly higher number of days with headaches (13.8 days/3 months, P< 0.001) and pain scores (7.4, P< 0.013). Furthermore, migraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores., Conclusions: The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients.

Hispidin oligomers are styrylpyrone pigments isolated from the medicinal fungi Inonotus xeranticus and Phellinus linteus. They exhibit diverse biological activities and strong free radical scavenging activity. To rationalize the antioxidant activity of a series of four hispidin oligomers and determine the favored mechanism involved in free radical scavenging, DFT calculations were carried out at the B3P86/6-31+G (d, p) level of theory in gas and solvent. The results showed that bond dissociation enthalpies of OH groups of hispidin oligomers (ArOH) and spin density delocalization of related radicals (ArO•) are the appropriate parameters to clarify the differences between the observed antioxidant activities for the four oligomers. The effect of the number of hydroxyl groups and presence of a catechol moiety conjugated to a double bond on the antioxidant activity were determined. Thermodynamic and kinetic studies showed that the PC-ET mechanism is the main mechanism involved in free radical scavenging. The spin density distribution over phenoxyl radicals allows a better understanding of the hispidin oligomers formation.

Ensuring adherence to chemotherapy is important to prevent disease progression, prolong survival and sustain good quality of life. Capecitabine is a complex chemotherapeutic agent with many side effects that might affect patient adherence to treatment. This cross sectional study aimed to determine adherence to capecitabine and its contributing factors among cancer outpatients in Malaysia. One hundred and thirteen patients on single regime capecitabine were recruited from Hospital Sultan Ismail and Hospital Kuala Lumpur from October 2013 to March 2014. Adherence was determined based on adherence score using validated Medication Compliance Questionnaire. Patient socio-demographics, disease, and treatment characteristics were obtained from medical records. Satisfaction score was measured using the validated Patient Satisfaction with Healthcare questionnaire. The mean adherence score was 96.1% (standard deviation: 3.29%). The significant contributing factors of adherence to capecitabine were Malay ethnicity [β=1.3; 95% confidence interval (CI): 0.21, 2.43; p value=0.020], being female [β=1.8; 95%CI: 0.61, 2.99; p value=0.003]), satisfaction score [β=0.08; 95%CI: 0.06, 1.46; p value=0.035], presence of nausea or vomiting [β=2.3; 95%CI: 1.12, 3.48; p value <0.001] and other side effects [β=1.45; 95%CI: 0.24, 2.65; p value=0.019]. Adherence to capecitabine was generally high in our local population. Attention should be given to non-Malay males and patients having nausea, vomiting or other side effects. Sufficient information, proactive assessment and appropriate management of side effects would improve patient satisfaction and thus create motivation to adhere to treatment plans.

Background: The study was designed to determine the validity and reliability of the Bahasa Melayu version (MIDAS-M) of the Migraine Disability Assessment (MIDAS) questionnaire., Methods: Patients having migraine for more than six months attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, were recruited. Standard forward and back translation procedures were used to translate and adapt the MIDAS questionnaire to produce the Bahasa Melayu version. The translated Malay version was tested for face and content validity. Validity and reliability testing were further conducted with 100 migraine patients (1st administration) followed by a retesting session 21 days later (2nd administration)., Results: A total of 100 patients between 15 and 60 years of age were recruited. The majority of the patients were single (66%) and students (46%). Cronbach's alpha values were 0.84 (1st administration) and 0.80 (2nd administration). The test-retest reliability for the total MIDAS score was 0.73, indicating that the MIDAS-M questionnaire is stable; for the five disability questions, the test-retest values ranged from 0.77 to 0.87., Conclusion: The MIDAS-M questionnaire is comparable with the original English version in terms of validity and reliability and may be used for the assessment of migraine in clinical settings.

Structural modification of steroids through whole-cell biocatalysis is an invaluable procedure for the production of active pharmaceutical ingredients (APIs) and key intermediates. Modifications could be carried out with regio- and stereospecificity at positions hardly available for chemical agents. Much attention has been focused recently on the biotransformation of 17α-ethynyl substituted steroidal drugs using fungi, bacteria and plant cell cultures in order to obtained novel biologically active compounds with diverse structure features. Present article includes studies on biotransformation on 17α-ethynyl substituted steroidal drugs using microorganisms and plant cell cultures. Various experimental and structural elucidation methods used in biotransformational processes are also highlighted., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Identifying the molecular mechanisms of intrinsic aging is critical in developing modalities for reversal of cutaneous aging., Objective: The objective was to evaluate the expression of epidermal Fas, epidermal thickness, collagen, and elastic fibers degeneration in unexposed skin of aged individuals compared with young ones., Materials and Methods: Skin biopsies were taken from normal skin of the back of 22 old subjects (age range: 48-75 years) and 15 young subjects (age range: 18-28 years). Skin sections were stained with hematoxylin and eosin, Masson trichrome, orcein. Epidermal thickness was measured with image analyzer and scoring was done for collagen and elastic fiber degeneration. Fas immunostaining was done. Quantitative and qualitative data were compared statistically between the old and young subjects., Results: A statistically significant decreased epidermal thickness was found in old compared with young skin (P<0.05). A statistically significant number of patients showed decreased epidermal thickness, density, and fragmentation of both collagen and elastic fibers in old compared with young skin (P<0.001). Epidermal Fas expression was detected in 19 of 22 old subjects (86.4%) compared with 2 of 15 young subjects (13.3%) (P<0.001). There was no statistically significant correlation between age of old subjects and each of epidermal thickness, collagen, and elastic fiber degeneration., Conclusion: The decreased epidermal thickness and morphological alteration of collagen and elastic fibers are not correlated with aging and Fas-mediated apoptosis could be involved in thinning of the epidermis in unexposed aged skin.

Aims: The aims were to develop and validate a new Prescription Quality Index (PQI) for the measurement of prescription quality in chronic diseases., Methods: The PQI were developed and validated based on three separate surveys and one pilot study. Criteria were developed based on literature search, discussions and brainstorming sessions. Validity of the criteria was examined using modified Delphi method. Pre-testing was performed on 30 patients suffering from chronic diseases. The modified version was then subjected to reviews by pharmacists and clinicians in two separate surveys. The rater-based PQI with 22 criteria was then piloted in 120 patients with chronic illnesses. Results were analysed using SPSS version 12.0.1, Results: Exploratory principal components analysis revealed multiple factors contributing to prescription quality. Cronbach's α for the entire 22 criteria was 0.60. The average intra-rater and inter-rater reliability showed good to moderate stability (intraclass correlation coefficient 0.76 and 0.52, respectively). The PQI was significantly and negatively correlated with age (correlation coefficient -0.34, P<0.001), number of drugs in prescriptions (correlation coefficient -0.51, P<0.001) and number of chronic diseases/conditions (correlation coefficient -0.35, P<0.001)., Conclusions: The PQI is a promising new instrument for measuring prescription quality. It has been shown that the PQI is a valid, reliable and responsive tool to measure quality of prescription in chronic diseases., (© 2010 The Authors. British Journal of Clinical Pharmacology © 2010 The British Pharmacological Society.)

The objective of the study is to translate the Rose Questionnaire (RQ) into a Bahasa Melayu version and adapt it cross-culturally, and to measure its inter-rater and intrarater reliability. This cross sectional study was conducted in the respondents' homes or workplaces in Kelantan, Malaysia. One hundred respondents aged 30 and above with different socio-demographic status were interviewed for face validity. For each inter-rater and intra-rater reliability, a sample of 150 respondents was interviewed. Inter-rater and intra-rater reliabilities were assessed by Cohen's kappa. The overall inter-rater agreements by the five pair of interviewers at point one and two were 0.86, and intrarater reliability by the five interviewers on the seven-item questionnaire at poinone and two was 0.88, as measured by kappa coefficient. The translated Malay version of RQ demonstrated an almost perfect inter-rater and intra-rater reliability and further validation such as sensitivity and specificity analysis of this translated questionnaire is highly recommended.

This cross-sectional study was aimed to identify the predictors of medication noncompliance in hypertensive patients. The study was conducted at the Family Medicine Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, which is a university-based teaching hospital. All hypertensive patients aged 40 or over-registered from January to June 2004, who had been on treatment for at least 3 months, were screened. Previously validated self-administered questionnaires were used to assess the compliance and psychosocial factors. A total of 240 hypertensive patients were recruited in the study. Of these, 55.8% were noncompliant to medication. Logistic regression showed that age (adjusted odds ratio (OR): 0.96; 95% confidence interval (CI): 0.92-0.997; P: 0.035), patient satisfaction (adjusted OR: 0.97; 95% CI: 0.93-0.998; P: 0.036) and medication barrier (adjusted OR: 0.95; 95% CI: 0.91-0.987; P: 0.009) were significant predictors of medication noncompliance. Therefore, younger age, poor patient satisfaction and medication barrier were identified as independent psychosocial predictors of medication noncompliant in hypertensive patients.