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Analysis of Condition Index in Polymesoda expansa (Mousson 1849)

Abdul Rahim A, Idris MH, Kamal AH, Wong SK, Arshad A

Pak J Biol Sci, 2012 Jul 01;15(13):629-34.
PMID: 24218932

The Condition Index (CI) is a method to measure overall health of fish and that has been applied to estimate the effect that different environmental factors have on clam meat quality. The CI of local mangrove clam Polymesoda expansa in Kelulit, Miri Sarawak was determined from October 2010 to November 2011. Condition index that is generally used to characterize the physiological activity of organisms, varied from 1.8% in December 2010 to 3.4% in October 2011, with low values observed during the spawning period. The clam attained their best condition in quality of flesh weight during July-October. In present study, the CI showed a clear relationship with the reproductive cycle of P. expansa. However, no significant correlation (p > 0.05) was found between CI and the different physicochemical parameter of seawater. The data presented is necessary for developing sustainable management strategies and broodstock selection for the species which is crucial in aquaculture development.
Fulltext Prenatal auditory stimulation and impacts on physiological response to feed restriction in broiler chickens at market age

Ahmad-Hanafi S, Zulkifli I, Ramiah SK, Chung ELT, Kamil R, Sazili AQ, et al.

Poult Sci, 2024 Oct;103(10):103948.
PMID: 39127008 DOI: 10.1016/j.psj.2024.103948

Feed restriction could induce physiological stress in broiler chickens, leading to welfare issues. Prenatal stimulation could improve stress-coping mechanisms in poultry. The present study aimed to elucidate the effects of subjecting developing embryos to auditory stimulation on physiological stress response to feed restriction in broiler chickens at market age. A total of 423 hatching eggs of Cobb 500 (Gallus domesticus) were subjected to the following auditory treatments: 1) no additional sound treatment other than the background sound of the incubator's compressors at 40 dB (CONTROL), 2) exposure to pre-recorded traffic noise at 90 dB (NOISE), and 3) exposure to Mozart's Sonata for Two Pianos in D Major, K 488 at 90 dB) (MUSIC). The NOISE and MUSIC treatments were for 20 min/h for 24 h (a total of 8 h/d), starting from embryonic days (ED) 12 to hatching. On d 42, an equal number of birds from each prenatal auditory stimulation (PAS) group were subjected to either ad libitum feeding (AL) or 30-h of feed restriction (FR) in a completely randomised design. The FR chickens exhibited significantly higher serum levels of corticosterone (CORT), and heat shock protein (HSP) 70 compared to those of AL. Prenatal auditory stimulation, particularly NOISE, led to lower serum levels of CORT and alpha-1-acid glycoprotein (AGP) levels compared to the CONTROL group. Additionally, NOISE significantly increased brain mRNA glucocorticoid receptor and HSP70 gene expression. The cecal population of E. coli and Lactobacillus spp. was not significantly affected by prenatal auditory stimulation. In conclusion, our findings suggest that prenatal auditory stimulation, particularly NOISE, positively impacts broiler chickens' ability to cope with feed restriction.
Fulltext Corrigendum to "Prenatal auditory stimulation and impacts on physiological response to feed restriction in broiler chickens at market age" [Poult. Sci. 103(10) (2024) 103948]

Ahmad-Hanafi S, Zulkifli I, Ramiah SK, Chung ELT, Kamil R, Sazili AQ, et al.

Poult Sci, 2024 Nov 26;104(1):104528.
PMID: 39603184 DOI: 10.1016/j.psj.2024.104528
Fulltext Genetic diversity, seasonality and transmission network of human metapneumovirus: identification of a unique sub-lineage of the fusion and attachment genes

Chow WZ, Chan YF, Oong XY, Ng LJ, Nor'E SS, Ng KT, et al.

Sci Rep, 2016 06 09;6:27730.
PMID: 27279080 DOI: 10.1038/srep27730

Human metapneumovirus (HMPV) is an important viral respiratory pathogen worldwide. Current knowledge regarding the genetic diversity, seasonality and transmission dynamics of HMPV among adults and children living in tropical climate remains limited. HMPV prevailed at 2.2% (n = 86/3,935) among individuals presented with acute respiratory tract infections in Kuala Lumpur, Malaysia between 2012 and 2014. Seasonal peaks were observed during the northeast monsoon season (November-April) and correlated with higher relative humidity and number of rainy days (P
Fulltext Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes

Liew SM, Lee PY, Hanafi NS, Ng CJ, Wong SS, Chia YC, et al.

Diabetol Metab Syndr, 2014;6:53.
PMID: 24782916 DOI: 10.1186/1758-5996-6-53

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:Stat ins 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.
KEYWORDS: Diabetes mellitus; HbA1c; Hypertension; Statin
Study site: primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fulltext Healthcare professionals' and policy makers' views on implementing a clinical practice guideline of hypertension management: a qualitative study

Lee PY, Liew SM, Abdullah A, Abdullah N, Ng CJ, Hanafi NS, et al.

PLoS One, 2015;10(5):e0126191.
PMID: 25942686 DOI: 10.1371/journal.pone.0126191

INTRODUCTION: Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG) on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals.
METHODS: This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses) at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data.
RESULTS: Two main themes and three sub-themes emerged from this study. The main themes were (1) variation in the use of CPG and (2) barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations. Third, incorporate local CPG in professional training, link CPG adherence to key performance indicators and provide incentives for its use.
CONCLUSIONS: Barriers to the use of CPG hypertension management span across all stakeholders. The development and implementation of CPG focused mainly on doctors with lack of involvement of other healthcare stakeholders. Guidelines should be made simple, current, reliable, accessible, inclusive of all stakeholders and with good policy support.
Contribution of transposable elements in the plant's genome

Sahebi M, Hanafi MM, van Wijnen AJ, Rice D, Rafii MY, Azizi P, et al.

Gene, 2018 Jul 30;665:155-166.
PMID: 29684486 DOI: 10.1016/j.gene.2018.04.050

Plants maintain extensive growth flexibility under different environmental conditions, allowing them to continuously and rapidly adapt to alterations in their environment. A large portion of many plant genomes consists of transposable elements (TEs) that create new genetic variations within plant species. Different types of mutations may be created by TEs in plants. Many TEs can avoid the host's defense mechanisms and survive alterations in transposition activity, internal sequence and target site. Thus, plant genomes are expected to utilize a variety of mechanisms to tolerate TEs that are near or within genes. TEs affect the expression of not only nearby genes but also unlinked inserted genes. TEs can create new promoters, leading to novel expression patterns or alternative coding regions to generate alternate transcripts in plant species. TEs can also provide novel cis-acting regulatory elements that act as enhancers or inserts within original enhancers that are required for transcription. Thus, the regulation of plant gene expression is strongly managed by the insertion of TEs into nearby genes. TEs can also lead to chromatin modifications and thereby affect gene expression in plants. TEs are able to generate new genes and modify existing gene structures by duplicating, mobilizing and recombining gene fragments. They can also facilitate cellular functions by sharing their transposase-coding regions. Hence, TE insertions can not only act as simple mutagens but can also alter the elementary functions of the plant genome. Here, we review recent discoveries concerning the contribution of TEs to gene expression in plant genomes and discuss the different mechanisms by which TEs can affect plant gene expression and reduce host defense mechanisms.
Fulltext Usability and utility evaluation of the web-based "Should I Start Insulin?" patient decision aid for patients with type 2 diabetes among older people

Lee YK, Lee PY, Ng CJ, Teo CH, Abu Bakar AI, Abdullah KL, et al.

Inform Health Soc Care, 2018 Jan;43(1):73-83.
PMID: 28139158 DOI: 10.1080/17538157.2016.1269108

This study aimed to evaluate the usability (ease of use) and utility (impact on user's decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.
Study site: urban tertiary teaching hospital outpatient clinic in Malaysia (primary care clinic, University Malaya Medical Centre, UMMC, Kuala Lumpur, Malaysia)
Fulltext The role of human Metapneumovirus genetic diversity and nasopharyngeal viral load on symptom severity in adults

Oong XY, Chook JB, Ng KT, Chow WZ, Chan KG, Hanafi NS, et al.

Virol J, 2018 05 23;15(1):91.
PMID: 29792212 DOI: 10.1186/s12985-018-1005-8

BACKGROUND: Human metapneumovirus (HMPV) is established as one of the causative agents of respiratory tract infections. To date, there are limited reports that describe the effect of HMPV genotypes and/or viral load on disease pathogenesis in adults. This study aims to determine the role of HMPV genetic diversity and nasopharyngeal viral load on symptom severity in outpatient adults with acute respiratory tract infections.
METHODS: Severity of common cold symptoms of patients from a teaching hospital was assessed by a four-category scale and summed to obtain the total symptom severity score (TSSS). Association between the fusion and glycoprotein genes diversity, viral load (quantified using an improved RT-qPCR assay), and symptom severity were analyzed using bivariate and linear regression analyses.
RESULTS: Among 81/3706 HMPV-positive patients, there were no significant differences in terms of demographics, number of days elapsed between symptom onset and clinic visit, respiratory symptoms manifestation and severity between different HMPV genotypes/sub-lineages. Surprisingly, elderly patients (≥65 years old) had lower severity of symptoms (indicated by TSSS) than young and middle age adults (p = 0.008). Nasopharyngeal viral load did not correlate with nor predict symptom severity of HMPV infection. Interestingly, at 3-5 days after symptom onset, genotype A-infected patients had higher viral load compared to genotype B (4.4 vs. 3.3 log10 RNA copies/μl) (p = 0.003).
CONCLUSIONS: Overall, HMPV genetic diversity and viral load did not impact symptom severity in adults with acute respiratory tract infections. Differences in viral load dynamics over time between genotypes may have important implications on viral transmission.
Study site: Primary Care Clinic, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fulltext Genotype-phenotype association of Hbe/β thalassemia disease and the role of genetic modifiers

HanafI S, Abdullah WZ, Adnan RA, Bahar R, Johan MF, Azman NF, et al.

Malaysian Journal of Paediatrics and Child Health, 2016;22(1):1-16.
MyJurnal

HbE/β-thalassemia is the most common severe form of thalassemia particularly in SEA region including Malaysia and globally, it comprised of a significant severe form of β-thalassemia disorder. It has various clinical manifestations ranging from very mild anemia to severe manifestation similar to beta thalassemia major. Many different syndromes are observed in HbE/β-thalassemia. Several genetic modifiers have been reported to play important role in contributing to phenotypic variability. The true reasons underlying this phenotypic variability remain unknown. The most reliable predictive factor of the disease phenotype is the nature of the beta globin gene mutation itself. However, the degree of severity is also believed to be affected by other genetic modifiers. For instance, high HbF level ameliorates the clinical severity of β thalassemia patients. Therefore, identification of these genetic modifiers is very important. The association of severe clinical manifestation and the specific β-globin gene mutation has been known. But the wide scope and other potential predictors have been only recently appreciated. This review therefore aimed to reveal the potential genetic modifiers of HbE/βthalassemia patients based on the previous reported studies. A better understanding on the mechanisms underlying the variety of phenotypes of this disease may lead to the direction for a better future management plans. This also promotes “personalized medicine” in patient care.
Fulltext Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors' knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

Hisham R, Ng CJ, Liew SM, Lai PSM, Chia YC, Khoo EM, et al.

BMC Fam Pract, 2018 06 23;19(1):98.
PMID: 29935527 DOI: 10.1186/s12875-018-0779-5

BACKGROUND: Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients' values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.
METHODS: The EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.
RESULTS: The final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: "EBM websites", "evidence-based journals", "types of studies", "terms related to EBM", "practice", "access", "patient preferences" and "support". Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657-0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.
CONCLUSIONS: The EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.
Fulltext Perceptions of complementary/alternative medicine use and influence on evidence-based asthma medicine adherence in Malaysian children

Ramdzan SN, Pinnock H, Liew SM, Sukri N, Salim H, Hanafi NS, et al.

NPJ Prim Care Respir Med, 2019 02 25;29(1):5.
PMID: 30804340 DOI: 10.1038/s41533-019-0118-x

Complementary and alternative medicine (CAM) is widely used especially in Asia including for childhood asthma. The use of CAM could influence adherence to evidence-based (E-B) medicine. We explored the views of carers of Malaysian children with asthma regarding the use of CAM for childhood asthma, and its relationship with self-reported adherence to E-B medicine. We used a screening questionnaire to identify children diagnosed with asthma from seven suburban primary schools in Malaysia. Informed consent was obtained prior to the interviews. We conducted the interviews using a semi-structured topic guide in participants' preferred language (Malay, Mandarin, or Tamil). All interviews were audio-recorded, transcribed verbatim and coded using Nvivo. Analysis was performed thematically, informed by the Necessity-Concerns Framework. A total of 46 carers (16 Malays, 21 Indians, 9 Chinese) contributed to 12 focus groups and one individual interview. We categorised participants' as 'Non-CAM'; 'CAM'; or 'combination' user. Cultural practices and beliefs in the efficacy of CAM resulted in widespread use of CAM. Most carers used CAM as 'complementary' to E-B medicine. Concerns about dependence on or side effects of E-B treatment influenced carers' decisions to rely on CAM as an 'alternative', with an important minority of accounts describing potentially harmful CAM-use. Healthcare professionals should discuss beliefs about the necessity for and concerns about use of both E-B medicine and CAM, and provide balanced information about effectiveness and safety. The aim is to improve adherence to regular E-B preventer medication and prevent delays in seeking medical advice and harmful practices associated with CAM.
Viral Load and Sequence Analysis Reveal the Symptom Severity, Diversity, and Transmission Clusters of Rhinovirus Infections

Ng KT, Oong XY, Lim SH, Chook JB, Takebe Y, Chan YF, et al.

Clin Infect Dis, 2018 07 02;67(2):261-268.
PMID: 29385423 DOI: 10.1093/cid/ciy063

Background: Rhinovirus (RV) is one of the main viral etiologic agents of acute respiratory illnesses. Despite the heightened disease burden caused by RV, the viral factors that increase the severity of RV infection, the transmission pattern, and seasonality of RV infections remain unclear.
Methods: An observational study was conducted among 3935 patients presenting with acute upper respiratory illnesses in the ambulatory settings between 2012 and 2014.
Results: The VP4/VP2 gene was genotyped from all 976 RV-positive specimens, where the predominance of RV-A (49%) was observed, followed by RV-C (38%) and RV-B (13%). A significant regression in median nasopharyngeal viral load (VL) (P < .001) was observed, from 883 viral copies/µL at 1-2 days after symptom onset to 312 viral copies/µL at 3-4 days and 158 viral copies/µL at 5-7 days, before declining to 35 viral copies/µL at ≥8 days. In comparison with RV-A (median VL, 217 copies/µL) and RV-B (median VL, 275 copies/µL), RV-C-infected subjects produced higher VL (505 copies/µL; P < .001). Importantly, higher RV VL (median, 348 copies/µL) was associated with more severe respiratory symptoms (Total Symptom Severity Score ≥17, P = .017). A total of 83 phylogenetic-based transmission clusters were identified in the population. It was observed that the relative humidity was the strongest environmental predictor of RV seasonality in the tropical climate.
Conclusions: Our findings underline the role of VL in increasing disease severity attributed to RV-C infection, and unravel the factors that fuel the population transmission dynamics of RV.
Fulltext Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis

Uzzaman MN, Agarwal D, Chan SC, Patrick Engkasan J, Habib GMM, Hanafi NS, et al.

Eur Respir Rev, 2022 Sep 30;31(165).
PMID: 36130789 DOI: 10.1183/16000617.0076-2022

INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care.
METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence.
RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87).
CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.
The prevalence of gestational diabetes, associated factors and feto-maternal outcome among antenatal women attending health clinics in Terengganu

Abd Latif R, Yusof NA, Yahya R, Muda Z, Tengku Lih TB, Mohamed K, et al.

Malays Fam Physician, 2022 Nov 30;17(3):43-52.
PMID: 36606162 DOI: 10.51866/oal302

INTRODUCTION: Gestational diabetes mellitus (GDM) is a known risk factor for diabetes mellitus (DM). The rising prevalence of GDM in the Asian population (11.7%) may explain the increasing incidence of DM in women. This study examined the prevalence of GDM, its associated factors and the foeto-maternal outcomes of women with GDM in Terengganu.
METHOD: A cross-sectional study was conducted between April and September 2019 using secondary data from antenatal records in 40 health clinics in Terengganu for 2018. All pregnant women aged 25 years and above with or without risk factors for GDM were included in the study. Those with pre-existing type 1 or 2 DM were excluded. A total of 270 respondents were included. The prevalence of GDM and its associated factors were determined using descriptive statistics followed by multiple logistic regression.
RESULTS: The prevalence of GDM in Terengganu was 27.3% (n=72). Logistic regression analysis found that BMI at booking (adjusted OR=4.51, 95% CI 2.13-9.55, p<0.001), history of GDM (adjusted OR=5.31, 95% CI 2.17-12.99, p<0.001) and family history of DM (adjusted OR=4.24, 95% CI 2.23-8.05, p<0.001) were the significant associated risk factors. Of women with GDM, 17.7% (n=11) had postpartum pre-diabetes based on modified oral glucose tolerance at 6 weeks postpartum. Univariate analysis using chi-square tests showed a significant association of neonatal jaundice and hypoglycaemia with GDM.
CONCLUSION: Because the prevalence of GDM in Terengganu is high, surveillance of GDM in highrisk pregnancies and effective glycaemic management should be emphasised to prevent adverse foeto-maternal outcomes.
Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Ramli R, Hanafi NS, Hussein N, Lee PY, Shariff Ghazali S, Cheong AT, et al.

Asia Pac J Public Health, 2023 Feb 28.
PMID: 36852891 DOI: 10.1177/10105395231158684

Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians' level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim's health literacy and facilitated by educational resources, family engagement, and regular health briefing.
Fulltext Global Prevalence of Nosocomial Multidrug-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

Mohd Asri NA, Ahmad S, Mohamud R, Mohd Hanafi N, Mohd Zaidi NF, Irekeola AA, et al.

Antibiotics (Basel), 2021 Dec 08;10(12).
PMID: 34943720 DOI: 10.3390/antibiotics10121508

The emergence of nosocomial multidrug-resistant Klebsiella pneumoniae is an escalating public health threat worldwide. The prevalence of nosocomial infections due to K. pneumoniae was recorded up to 10%. In this systematic review and meta-analysis, which were conducted according to the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis, 1092 articles were screened from four databases of which 47 studies fulfilled the selected criteria. By performing a random-effect model, the pooled prevalence of nosocomial multidrug-resistant K. pneumoniae was estimated at 32.8% (95% CI, 23.6-43.6), with high heterogeneity (I2 98.29%, p-value < 0.001). The estimated prevalence of this pathogen and a few related studies were discussed, raising awareness of the spread of multidrug-resistant K. pneumoniae in the healthcare setting. The emergence of nosocomial multidrug-resistant K. pneumoniae is expected to increase globally in the future, and the best treatments for treating and preventing this pathogen should be acknowledged by healthcare staff.
Fulltext Sociocultural influences on asthma self-management in a multicultural society: A qualitative study amongst Malaysian adults

Koh WM, Abu Bakar AI, Hussein N, Pinnock H, Liew SM, Hanafi NS, et al.

Health Expect, 2021 Dec;24(6):2078-2086.
PMID: 34449970 DOI: 10.1111/hex.13352

BACKGROUND: Supported self-management improves asthma outcomes, but implementation requires adaptation to the local context. Barriers reported in Western cultures may not resonate in other cultural contexts. We explored the views, experiences and beliefs that influenced self-management among adults with asthma in multicultural Malaysia.
METHODS: Adults with asthma were purposively recruited from an urban primary healthcare clinic for in-depth interviews. Audio-recordings were transcribed verbatim and analysed thematically.
RESULTS: We interviewed 24 adults. Four themes emerged: (1) Participants believed in the 'hot and cold' concept of illness either as an inherent hot/cold body constitution or the ambient temperature. Hence, participants tried to 'neutralize' body constitution or to 'warm up' the cold temperature that was believed to trigger acute attacks. (2) Participants managed asthma based on past experiences and personal health beliefs as they lacked formal information about asthma and its treatment. (3) Poor communication and variable advice from healthcare practitioners on how to manage their asthma contributed to poor self-management skills. (4) Embarrassment about using inhalers in public and advice from family and friends resulted in a focus on nonpharmacological approaches to asthma self-management practice.
CONCLUSIONS: Asthma self-management practices were learnt experientially and were strongly influenced by sociocultural beliefs and advice from family and friends. Effective self-management needs to be tailored to cultural norms, personalized to the individuals' preferences and clinical needs, adapted to their level of health literacy and underpinned by patient-practitioner partnerships.
PATIENT AND PUBLIC CONTRIBUTIONS: Patients contributed to data. Members of the public were involved in the discussion of the results.
Fulltext Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries

Agarwal D, Hanafi NS, Chippagiri S, Brakema EA, Pinnock H, Khoo EM, et al.

NPJ Prim Care Respir Med, 2019 05 08;29(1):17.
PMID: 31068586 DOI: 10.1038/s41533-019-0129-7

This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs.
Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia

Hussein N, Ramli R, Liew SM, Hanafi NS, Lee PY, Cheong AT, et al.

NPJ Prim Care Respir Med, 2023 Mar 27;33(1):13.
PMID: 36973274 DOI: 10.1038/s41533-023-00337-8

Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors' practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.

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