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Fulltext Applicability of the World Health Organization recommended new shorter regimen in a multidrug-resistant tuberculosis high burden country

Javaid A, Ahmad N, Khan AH, Shaheen Z

Eur Respir J, 2017 01;49(1).
PMID: 28049176 DOI: 10.1183/13993003.01967-2016
Fulltext Doctors' knowledge of hypertension guidelines recommendations reflected in their practice

Ahmad N, Khan AH, Khan I, Khan A, Atif M

Int J Hypertens, 2018;2018:8524063.
PMID: 29721335 DOI: 10.1155/2018/8524063

Aim: To evaluate doctors' knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008).
Methods: Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors' knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis.
Results: Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines' recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15 ± 1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5-20). Statistically significant correlation (rs = 0.635, P < 0.001) was observed between doctors' knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P = 0.008), left ventricular hypertrophy (OR = 0.091, P = 0.001) and heart failure (OR = 1.923, P = 0.039) were significantly associated with guidelines adherence.
Conclusion: Doctors' knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.
Study site: Cardiology, nephrology, diabetic, and hypertension clinics of Hospital Pulau Pinang, Malaysia
Fulltext Exoskeleton robot control for synchronous walking assistance in repetitive manual handling works based on dual unscented Kalman filter

Sado F, Yap HJ, Ghazilla RAR, Ahmad N

PLoS One, 2018;13(7):e0200193.
PMID: 30001415 DOI: 10.1371/journal.pone.0200193

Prolong walking is a notable risk factor for work-related lower-limb disorders (WRLLD) in industries such as agriculture, construction, service profession, healthcare and retail works. It is one of the common causes of lower limb fatigue or muscular exhaustion leading to poor balance and fall. Exoskeleton technology is seen as a modern strategy to assist worker's in these professions to minimize or eliminate the risk of WRLLDs. Exoskeleton has potentials to benefit workers in prolong walking (amongst others) by augmenting their strength, increasing their endurance, and minimizing high muscular activation, resulting in overall work efficiency and productivity. Controlling exoskeleton to achieve this purpose for able-bodied personnel without impeding their natural movement is, however, challenging. In this study, we propose a control strategy that integrates a Dual Unscented Kalman Filter (DUKF) for trajectory generation/prediction of the spatio-temporal features of human walking (i.e. joint position, and velocity, and acceleration) and an impedance cum supervisory controller to enable the exoskeleton to follow this trajectory to synchronize with the human walking. Experiment is conducted with four subjects carrying a load and walking at their normal speed- a typical scenario in industries. EMG signals taken at two muscles: Right Vastus Intermedius (on the thigh) and Right Gastrocnemius (on the calf) indicated reduction in muscular activation during the experiment. The results also show the ability of the control system to predict spatio-temporal features of the pilots' walking and to enable the exoskeleton to move in concert with the pilot.
Fulltext Light-Addressable Potentiometric Sensors Using ZnO Nanorods as the Sensor Substrate for Bioanalytical Applications

Tu Y, Ahmad N, Briscoe J, Zhang DW, Krause S

Anal Chem, 2018 07 17;90(14):8708-8715.
PMID: 29932632 DOI: 10.1021/acs.analchem.8b02244

Light-addressable potentiometric sensors (LAPS) are of great interest in bioimaging applications such as the monitoring of concentrations in microfluidic channels or the investigation of metabolic and signaling events in living cells. By measuring the photocurrents at electrolyte-insulator-semiconductor (EIS) and electrolyte-semiconductor structures, LAPS can produce spatiotemporal images of chemical or biological analytes, electrical potentials and impedance. However, its commercial applications are often restricted by their limited AC photocurrents and resolution of LAPS images. Herein, for the first time, the use of 1D semiconducting oxides in the form of ZnO nanorods for LAPS imaging is explored to solve this issue. A significantly increased AC photocurrent with enhanced image resolution has been achieved based on ZnO nanorods, with a photocurrent of 45.7 ± 0.1 nA at a light intensity of 0.05 mW, a lateral resolution as low as 3.0 μm as demonstrated by images of a PMMA dot on ZnO nanorods and a pH sensitivity of 53 mV/pH. The suitability of the device for bioanalysis and bioimaging was demonstrated by monitoring the degradation of a thin poly(ester amide) film with the enzyme α-chymotrypsin using LAPS. This simple and robust route to fabricate LAPS substrates with excellent performance would provide tremendous opportunities for bioimaging.
Optimization, characterization, and in vitro assessment of alginate-pectin ionic cross-linked hydrogel film for wound dressing applications

Rezvanian M, Ahmad N, Mohd Amin MC, Ng SF

Int J Biol Macromol, 2017 Apr;97:131-140.
PMID: 28064048 DOI: 10.1016/j.ijbiomac.2016.12.079

Natural polymer-based hydrogel films have great potential for biomedical applications and are good candidates for wound dressings. In this study, we aimed to develop simvastatin-loaded crosslinked alginate-pectin hydrogel films by ionic crosslinking to improve the mechanical characteristics, wound fluid uptake and drug release behavior. Alginate-pectin hydrocolloid films were chemically crosslinked by immersing in different concentrations of CaCl2 (0.5-3% w/v) for 2-20min. The degree of crosslinking was influenced by both contact time and CaCl2 concentration. The optimized conditions for crosslinking were 0.5% and 1% (CaCl2) for 2min. The optimized hydrogel films were then characterized for their physical, mechanical, morphological, thermal, in vitro drug release, and cytocompatibility profiles. Crosslinking improved the mechanical profile and wound fluid uptake capacity of dressings. The hydrogel films were able to maintain their physical integrity during use, and the best results were obtained with the film in which the extent of crosslinking was low (0.5%). Thermal analysis confirmed that the crosslinking process enhanced the thermal stability of hydrogel films. Sustained, slow release of simvastatin was obtained from the crosslinked films and in vitro cytotoxicity assay demonstrated that the hydrogel films were non-toxic.
Risk factors for high death and loss-to-follow-up rates among patients with multidrug-resistant tuberculosis at a programmatic management unit

Javaid A, Shaheen Z, Shafqat M, Khan AH, Ahmad N

Am J Infect Control, 2017 Feb 01;45(2):190-193.
PMID: 27769706 DOI: 10.1016/j.ajic.2016.07.026

Among 186 retrospectively evaluated patients with multidrug-resistant tuberculosis, 33.9% were cured, 6.6% completed treatment, 25% died, 18.3% were lost to follow-up, 2.2% failed treatment, and 13.8% were still undergoing treatment by the end of the study period. Rural residence was a risk factor for loss to follow-up (odds ratio [OR], 3.315; P = .016), whereas baseline body weight <40 kg (OR, 2.175; P = .042) and resistance to ofloxacin (OR, 2.889; P = .025) were risk factors for death. Despite programmatic management, treatment outcomes of the current cohort were distressing.
Fulltext Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme

Ahmad N, Shariff ZM, Mukhtar F, Lye MS

Nutr J, 2018 08 02;17(1):74.
PMID: 30071855 DOI: 10.1186/s12937-018-0379-1

BACKGROUND: Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children.
METHODS: Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children.
RESULTS: Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p
Fabrication of alginate microspheres for drug delivery: A review

Uyen NTT, Hamid ZAA, Tram NXT, Ahmad N

Int J Biol Macromol, 2020 Jun 15;153:1035-1046.
PMID: 31794824 DOI: 10.1016/j.ijbiomac.2019.10.233

Alginate microspheres (AMs) have received much attention as a novel drug delivery system owing to various advantages of alginate such as inexpensiveness, nontoxicity, biocompatibility and biodegradability. The well-designed fabrication method is essential to achieve desired AMs suitable for specific drug delivery system. Reports on AMs preparation techniques have increased rapidly in the last decade. A number of synthesis parameters have been investigated for the improvement of physical, chemical and biological properties of AMs. Hence, this review summarizes the work to date on the fabrication techniques of AMs for drug delivery system, including spray-drying, extrusion and emulsification/gelation technique. Besides, the influence of various factors such as alginate concentration, oil phase, surfactant, cross-linker concentrations, cross-linking time, stirring speed, model drug and drug content on the morphologies, properties and encapsulation efficiency (EE) of AMs via extrusion and emulsification/gelation technique are summarized. Before embarking on the development of any drug delivery system, a thorough understanding of drug release mechanism and factors that impact the drug release profile are essential, which are also covered in this review.
Fulltext Factors associated with tuberculosis disease among children who are household contacts of tuberculosis cases in an urban setting in Malaysia

Azit NA, Ismail A, Ahmad N, Ismail R, Ishak S

BMC Public Health, 2019 Nov 01;19(1):1432.
PMID: 31675946 DOI: 10.1186/s12889-019-7814-x

BACKGROUND: With the rise in prevalence of childhood tuberculosis (TB) globally, contact tracing should be a powerful strategy for early diagnosis and management, especially in children who are household contacts of active TB cases. Here, we aimed to determine the prevalence and factors associated with TB disease in children who are household contacts of TB cases.
METHODS: We used a cross-sectional study with data from the Malaysian TB Information System (TBIS) recorded from 1 January 2014 to 31 December 2017. All children aged 0-14 years who were registered in the TBIS with at least one household contact of TB cases were included in the study. Multiple logistic regression analysis was performed to calculate the adjusted odds ratio (adj. OR) and for adjusting the confounding factors.
RESULTS: A total of 2793 children were included in the study. The prevalence of active TB was 1.5% (95% confidence interval [CI]: 1.31, 1.77%). Children aged 6 weeks [adj. OR 7.48 (95% CI: 2.88, 19.43), p
Fulltext Detection of Antimicrobial Resistance Genes Associated with Carbapenem Resistance from the Whole-Genome Sequence of Acinetobacter baumannii Isolates from Malaysia

Rao M, Rashid FA, Shukor S, Hashim R, Ahmad N

Can J Infect Dis Med Microbiol, 2020;2020:5021064.
PMID: 32318127 DOI: 10.1155/2020/5021064

Background: The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to β-lactams. The aim of this study was to analyze β-lactamase genetic compositions of CrAb in Malaysia.
Methods: Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016.
Results: Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple β-lactamase genes. blaOXA-23 (n = 13) and blaOXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor blaADC, blaOXA-51-like, and blaOXA-23-like genes. blaTEM (n = 7), blaNDM-1 (n = 3), blaCARB-8 (n = 1), and blaPER-3 (n = 1) are amongst other β-lactamase genes found in this study. ISAba1 was found upstream to blaOXA-23 (n = 13), blaOXA-66 (n = 1), and blaADC (n = 11). All blaNDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007.
Conclusion: Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.
Effectiveness of an independent physical activity programme in improving physical activity amongst breast and colorectal cancer survivors: Study protocol for a randomized controlled trial

Mardiana O, Nor Afiah MZ, Ahmad N, Tan KA, Murallitharan M

Med J Malaysia, 2021 07;76(4):480-487.
PMID: 34305108

BACKGROUND: Previous research has documented the benefits of physical activity (PA) for cancer survivors which include improved quality of life, physical, physiological, emotional and social functioning, reduced relapse of cancer and the mitigation of cancer mortality. This study aims to evaluate the effects of an independent PA programme based on PA level, quality of life, self-efficacy, outcome expectations, reinforcement, behavioural capability and observational learning amongst registered National Cancer Society Malaysia's (NCSM) cancer survivors.
METHODS: A two-armed, parallel, double-blinded, randomized, controlled trial, intervention and wait-list control groups will be conducted amongst 106 NCSM's cancer survivors. The programme is developed based on a Social Cognitive Theory that combines both psychoeducation and social media approaches to behavioural intervention. The duration of intervention will be 2 months, in which data will be collected at baseline, 2- month (immediately post-intervention) and 4-month. The primary outcome of the study is to determine the PA level of the participant which will be measured as METminutes/ week of PA using the International Physical Activity Questionnaire (IPAQ). There are four measurements of PA that are measured which are moderate and vigorous PA (MVPA) MET-minutes/week, light PA MET-minutes/week, moderate PA MET-minutes/week and vigorous PA METminutes/ week. A Generalised Estimating Equation (GEE) analysis will be used to evaluate the effectiveness of the intervention, adjusted for baseline covariates on both continuous and categorical outcomes. This study will utilize a significance level of 0.05 with a confidence interval of 95% for means estimation in rejecting null hypothesis. The trial registered to the Australian New Zealand Clinical Trials (ANZCTR) with the Registration Number, ACTRN12620000039987.
CONCLUSION: The programme will be useful as a supplementary prescription to assist policy makers to strengthen non-pharmacological cancer management options and to empower cancer survivors to be self-reliant and self-sufficient to include PA as part of their recovery process.
Fulltext Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Jane Ling MY, Ahmad N, Mohd Yusoff MF, Lim KH

PLoS One, 2022;17(1):e0263355.
PMID: 35100321 DOI: 10.1371/journal.pone.0263355

BACKGROUND: Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

METHODS: We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13-18 years were included in the study. The data were analysed using STATA (v.15).

RESULTS: The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

CONCLUSION: Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.
Stimuli-responsive bacterial cellulose-g-poly(acrylic acid-co-acrylamide) hydrogels for oral controlled release drug delivery

Mohd Amin MC, Ahmad N, Pandey M, Jue Xin C

Drug Dev Ind Pharm, 2014 Oct;40(10):1340-9.
PMID: 23875787 DOI: 10.3109/03639045.2013.819882

This study evaluated the potential of stimuli-responsive bacterial cellulose-g-poly(acrylic acid-co-acrylamide) hydrogels as oral controlled-release drug delivery carriers. Hydrogels were synthesized by graft copolymerization of the monomers onto bacterial cellulose (BC) fibers by using a microwave irradiation technique. The hydrogels were characterized by Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), thermogravimetric analysis (TGA) and scanning electron microscopy (SEM). FT-IR spectroscopy confirmed the grafting. XRD showed that the crystallinity of BC was reduced by grafting, whereas an increase in the thermal stability profile was observed in TGA. SEM showed that the hydrogels exhibited a highly porous morphology, which is suitable for drug loading. The hydrogels demonstrated a pH-responsive swelling behavior, with decreased swelling in acidic media, which increased with increase in pH of the media, reaching maximum swelling at pH 7. The release profile of the hydrogels was investigated in simulated gastric fluid (SGF) and simulated intestinal fluid (SIF). The hydrogels showed lesser release in SGF than in SIF, suggesting that hydrogels may be suitable drug carriers for oral controlled release of drug delivery in the lower gastrointestinal tract.
Fulltext Growth patterns and nutritional status of small for gestational age infants in Malaysia during the first year of life

Ahmad N, Sutan R, Tamil AM, Hajib N

Child Health Nurs Res, 2021 Oct;27(4):317-327.
PMID: 35004520 DOI: 10.4094/chnr.2021.27.4.317

Purpose: This study aimed to identify small for gestational age (SGA) infants' growth patterns, nutritional status, and associated factors.
Methods: This prospective cohort study was conducted at primary-care child health clinics in Greater Kuala Lumpur, Malaysia. The sample consisted of infants who fulfilled the criteria and were born in 2019. The anthropometric data of infants were assessed at birth and at 1, 3, 6, 9, and 12 months.
Results: A total of 328 infants were analysed. In total, 27.7%(n=91) of the subjects were SGA infants, and 237 of them were not. Significant differences in the median weight-for-age and length-for-age z-scores were observed between SGA and non-SGA infants at birth, 1 month, 6 months, and 12 months. There was a significant difference between the growth patterns of SGA and non-SGA infants. Birth weight and sex significantly predicted the nutritional status(stunting and underweight) of SGA infants during their first year of life.
Conclusion: SGA infants can catch up to achieve normal growth during their first year of life. Even though the nutritional status of SGA infants trends worse than non-SGA infants, adequate infant birth weight monitoring and an emphasis on nutritional advice are crucial for maintaining well-being.
Phytochemical constituents from Cassia alata with inhibition against methicillin-resistant Staphylococcus aureus (MRSA)

Hazni H, Ahmad N, Hitotsuyanagi Y, Takeya K, Choo CY

Planta Med, 2008 Dec;74(15):1802-5.
PMID: 18991205 DOI: 10.1055/s-0028-1088340

The methanolic extract of the leaves of CASSIA ALATA was sequentially partitioned in increasing polarity to afford the hexane, chloroform, butanol and residual extract. Crude extracts were evaluated against MRSA using the agar well diffusion assay. The butanol and chloroform extracts both exhibited inhibition against MRSA with inhibition indexes of 1.03 +/- 0.16 and 0.78 +/- 0.07 at the concentration of 50 mg/mL. The butanol extracts were further purified using silica gel and reverse phase chromatography to afford kaempferol ( 1), kaempferol 3- O-beta-glucopyranoside ( 2), kaempferol 3- O-gentiobioside ( 3) and aloe emodin ( 4). The four constituents showed varying degrees of inhibition against MRSA. Both 1 and 4 exhibited MIC (50) values of 13.0 +/- 1.5 microg/mL and 12.0 +/- 1.5 microg/mL, respectively. The kaempferol glycosides 2 and 3 were less active with MIC (50) values of 83.0 +/- 0.9 microg/mL and 560.0 +/- 1.2 microg/mL, respectively. A free hydroxyl group at C-3 of the flavonol structure is a structural requirement for the inhibition of MRSA.
Fulltext Ultrasound-assisted encapsulation of Pandan (Pandanus amaryllifolius) extract

Omer N, Choo YM, Ahmad N, Mohd Yusof NS

Ultrason Sonochem, 2021 Nov;79:105793.
PMID: 34673338 DOI: 10.1016/j.ultsonch.2021.105793

Pandan (Pandanus amaryllifolius) is commonly used as a food ingredient in Southeast Asia due to its delicious flavor, appetizing aroma and bright green colour. Pandan plant is uniquely found only in certain parts of the world. Despite its increasing popularity worldwide, its export market is limited by practical issues. One of the main problems for exporting Pandan to global market is its stability during transport. Due to the volatility of its active constituent, the functional properties of Pandan are lost during storage and shipment. In this study, we explored the ability of ultrasound processing technology to encapsulate the aromatic Pandan extract using lysozyme or chitosan as a shell material. 20 kHz ultrasonicator was used to encapsulate the pandan extract at 150 W of applied power. Two parameters, the ultrasonic probe tip and the core-to-shell ratio were varied to control the properties of the encapsulates. The diameters of the probe tip used were 0.3 and 1.0 cm. The core-to-shell volume ratios used were 1:160 and 1:40. The size distribution and the stability of the synthesized microspheres were characterized to understand and explore the possible parameters variation impact. Both size and size distribution of the microspheres were found to be influenced by the parameters varied to certain extent. The results showed that the mean size of the microspheres was generally smallest when using 1 cm probe tip with lower core-to-shell volume ratio but largest when using the 3 mm tip with higher core-to-shell volume ratio. This indicates that the sonication parameters could be fine-tuned to achieve the encapsulation of Pandan extract for storage and export. The pandan-encapsulated microspheres were also found to be stable during storage at least for one month.
Fulltext The Impact of Meteorological Factors on Communicable Disease Incidence and Its Projection: A Systematic Review

Baharom M, Ahmad N, Hod R, Arsad FS, Tangang F

Int J Environ Res Public Health, 2021 10 22;18(21).
PMID: 34769638 DOI: 10.3390/ijerph182111117

BACKGROUND: Climate change poses a real challenge and has contributed to causing the emergence and re-emergence of many communicable diseases of public health importance. Here, we reviewed scientific studies on the relationship between meteorological factors and the occurrence of dengue, malaria, cholera, and leptospirosis, and synthesized the key findings on communicable disease projection in the event of global warming.
METHOD: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Four databases (Web of Science, Ovid MEDLINE, Scopus, EBSCOhost) were searched for articles published from 2005 to 2020. The eligible articles were evaluated using a modified scale of a checklist designed for assessing the quality of ecological studies.
RESULTS: A total of 38 studies were included in the review. Precipitation and temperature were most frequently associated with the selected climate-sensitive communicable diseases. A climate change scenario simulation projected that dengue, malaria, and cholera incidence would increase based on regional climate responses.
CONCLUSION: Precipitation and temperature are important meteorological factors that influence the incidence of climate-sensitive communicable diseases. Future studies need to consider more determinants affecting precipitation and temperature fluctuations for better simulation and prediction of the incidence of climate-sensitive communicable diseases.
Pluronic-F127 composite film loaded with erythromycin for wound application: formulation, physicomechanical and in vitro evaluations

Alavi T, Rezvanian M, Ahmad N, Mohamad N, Ng SF

Drug Deliv Transl Res, 2019 04;9(2):508-519.
PMID: 29181832 DOI: 10.1007/s13346-017-0450-z

Composite film dressings composed of pluronic F127 (PL)-pectin (PC) and pluronic (PL) F127-gelatin (GL) were investigated as potential drug delivery system for wound healing. Composite films were solvent cast by blending PL with PC or GL in different ratios using glycerol (2.5%) as plasticizer. Erythromycin (ER) (0.1%) was incorporated in films as model hydrophobic antibiotic. The optimized composite films were characterized for physical appearance, morphology, mechanical profile, and thermal behavior. In addition, drug release, antibacterial activity, and cytocompatibility of the films were investigated to assess their potential as drug delivery system. The composite films exhibited excellent wound dressing characters in terms of appearance, stability, and mechanical profile. Moreover, ER-loaded composite films released ER in controlled manner, exhibited antibacterial activity against Staphylococcus aureus, and were non-toxic to human skin fibroblast. These findings demonstrate that these composite films hold the potential to be formulated as antibacterial wound dressing.
Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine

Ahmad N, Choy CY, Aris EA, Balan S

Anesth Analg, 2005 Apr;100(4):987-990.
PMID: 15781511 DOI: 10.1213/01.ANE.0000147790.76114.3A

We compared the efficacy of IV fentanyl with IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blind study we recruited 90 patients aged between 18 and 65 yr, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 3 groups: group F received 2 mL IV fentanyl 50 microg/mL (100 microg), group L received 2 mL of preservative-free lidocaine 2% (40 mg), and group P (placebo) received 2 mL of normal saline. The incidence of withdrawal response after rocuronium was 57%, 30%, and 7% in the placebo, lidocaine, and fentanyl groups, respectively. We found a significant reduction in incidence of withdrawal response in both the fentanyl and lidocaine groups when compared with the placebo group (P < 0.05), with the fentanyl group being most effective (P < 0.05). In conclusion, both fentanyl and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with fentanyl being more effective.
Fulltext Impact of COVID-19 Pandemic on Healthcare Utilization among Patients with Type 2 Diabetes Mellitus: A Systematic Review

Amsah N, Md Isa Z, Ahmad N, Abdul Manaf MR

Int J Environ Res Public Health, 2023 Mar 04;20(5).
PMID: 36901588 DOI: 10.3390/ijerph20054577

As the COVID-19 pandemic continues, healthcare services have been grossly overwhelmed by the pandemic. Due to this circumstance, routine care for individuals with type 2 diabetes mellitus (T2DM) has been temporarily disrupted. The purpose of this systematic review was to summarize the evidence regarding the impact of the COVID-19 pandemic on healthcare utilization among patients with T2DM. A systematic search was conducted in the Web of Science, Scopus, and PubMed databases. The process of identifying the final articles followed the PRISMA guidelines. The inclusion criteria were articles published between 2020 and 2022, written in English, and studies focusing on the research question. Any proceedings and books were excluded. A total of fourteen articles relevant to the research question were extracted. Following that, the included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT) and the Joanna Briggs Institute Critical Appraisal Tool to assess the quality of the studies. The findings were further classified into three themes: reduced healthcare utilization among T2DM patients in routine healthcare services, a surge of telemedicine usage, and delay in the delivery of healthcare services. The key messages include demands for monitoring the long-term effects of the missed care and that better preparedness is crucial for any pandemic in the future. A tight diagnostic workup at the community level and regular follow-ups are crucial in managing the impact of the pandemic among T2DM patients. Telemedicine should be on the agenda of the health system to maintain and complement healthcare services. Future research is warranted to determine effective strategies to deal with the impact of the pandemic on healthcare utilization and delivery among T2DM patients. A clear policy is essential and should be established.

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