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Fulltext The prevalence and inter-relationship of negative body image perception, depression and susceptibility to eating disorders among female medical undergraduate students

Manaf NA, Saravanan C, Zuhrah B

J Clin Diagn Res, 2016 Mar;10(3):VC01-VC04.
PMID: 27134977 DOI: 10.7860/JCDR/2016/16678.7341

Introduction: Female students are thought to be more negatively impacted by body image ideals and often more susceptible to various eating related disorders compared to men. A previous study using a sample of female students in Malaysia did not identify whether the increase in susceptibility to eating disorders can be explained by the level of body image acceptance.
Aim: To identify the prevalence of depression and susceptibility to eating disorders among a sample of 206 female students in one of the private universities in Malaysia and explore the relationship between depression, body image and susceptibility to eating disorders. In addition, this study aimed to determine whether depression is a mediator between body image and susceptibility to eating disorders among female college students.
Materials and Methods: The Body Image Acceptance and Action Questionnaire were used to assess body image acceptance, the Patient Health Questionnaire to measure depression and the Eating Attitude Test- 26 was used to assess susceptibility to eating disorders.
Results: The results showed that 65.5% (n=135) of the students were depressed and 6.3% (n=13) were susceptible to eating disorders. There was a significant positive relationship between depression and eating disorders and a negative relationship between body image and depression as well as between body image and eating disorder. Further, the regression model showed that depression was partially mediating the effect of body image on eating disorders.
Conclusion: Body image and depression contribute to eating disorders and treating depression could reduce susceptibility to eating disorders.
Keywords: Unhealthy body perception, Psychological problems, Relationship between body image and eating disorder
Medical Tourist's Perception in Selecting their Destination: A Global Perspective

Sarwar AA, Manaf NA, Omar A

Iran J Public Health, 2012;41(8):1-7.
PMID: 23113218

BACKGROUND: The need for better healthcare has grown significantly in recent years. In addition, the rising healthcare costs in the U.S. and in many European countries have forced many patients to seek medical treatment abroad, which has created the demand for medical tourism. With little yet known as to the perception of a medical tourist's destination selection, this study aims to explore medical tourist's perception in selecting their destination while going for medical treatment.
METHODS: Realizing the current need to examine closely the perception of medical tourists, this study had conducted a secondary study to collect data for assessing and identification of the key factors on patient's perception and destination selection criteria.
RESULTS: The result confirms the existence of a very strong relationship between cost, service quality, treatment types and availability and marketing impact on the perception of the medical tourists' in selecting their medical tourism destination.
CONCLUSION: This study offers support for the proposed conceptual model and an empirical basis for comparison in future research.
Thermal distribution analysis of three-dimensional tumor-embedded breast models with different breast density compositions

Wahab AA, Salim MI, Ahamat MA, Manaf NA, Yunus J, Lai KW

Med Biol Eng Comput, 2016 Sep;54(9):1363-73.
PMID: 26463520 DOI: 10.1007/s11517-015-1403-7

Breast cancer is the most common cancer among women globally, and the number of young women diagnosed with this disease is gradually increasing over the years. Mammography is the current gold-standard technique although it is known to be less sensitive in detecting tumors in woman with dense breast tissue. Detecting an early-stage tumor in young women is very crucial for better survival chance and treatment. The thermography technique has the capability to provide an additional functional information on physiological changes to mammography by describing thermal and vascular properties of the tissues. Studies on breast thermography have been carried out to improve the accuracy level of the thermography technique in various perspectives. However, the limitation of gathering women affected by cancer in different age groups had necessitated this comprehensive study which is aimed to investigate the effect of different density levels on the surface temperature distribution profile of the breast models. These models, namely extremely dense (ED), heterogeneously dense (HD), scattered fibroglandular (SF), and predominantly fatty (PF), with embedded tumors were developed using the finite element method. A conventional Pennes' bioheat model was used to perform the numerical simulation on different case studies, and the results obtained were then compared using a hypothesis statistical analysis method to the reference breast model developed previously. The results obtained show that ED, SF, and PF breast models had significant mean differences in surface temperature profile with a p value <0.025, while HD breast model data pair agreed with the null hypothesis formulated due to the comparable tissue composition percentage to the reference model. The findings suggested that various breast density levels should be considered as a contributing factor to the surface thermal distribution profile alteration in both breast cancer detection and analysis when using the thermography technique.
Cyclodextrin based polymer sorbents for micro-solid phase extraction followed by liquid chromatography tandem mass spectrometry in determination of endogenous steroids

Manaf NA, Saad B, Mohamed MH, Wilson LD, Latiff AA

J Chromatogr A, 2018 Mar 30;1543:23-33.
PMID: 29478831 DOI: 10.1016/j.chroma.2018.02.032

Sorbents were prepared by cross-linking β-cyclodextrin (β-CD) using two different types of cross-linker units at variable reactant mole ratios. The resulting polymers containing β-CD were evaluated as sorbents in micro-solid phase extraction (μ-SPE) format for the extraction of the endogenous steroids testosterone (T), epitestosterone (E), androsterone (A), etiocholanolone (Etio), 5α-androstane-3α,17β-diol (5αAdiol) and 5β-androstane-3α,17β-diol (5βAdiol). The best sorbent (C1; cyclodextrin polymer) showed superior extraction characteristics compared with commercial sorbents (C18 and Bond Elut Plexa). Parameters influencing the extraction efficiency of the C1 sorbent such as extraction and desorption times, desorption solvent and volume of sample were investigated. The extracts were separated using a Hypersil Gold column (50 × 2.1 mm, 1.9 μm) under gradient elution coupled to a LC-MS/MS. The compounds were successfully separated within 8 min. The method offers good repeatability (RSD  0.995) were within the range of 1-200 ng mL-1 for T and E, 250-4000 ng mL-1 for A and Etio and 25-500 ng mL-1 for 5αAdiol and 5βAdiol, respectively. The method was applied for the determination of steroid profile of urine from volunteers.
Feasibility of A-mode ultrasound attenuation as a monitoring method of local hyperthermia treatment

Manaf NA, Aziz MN, Ridzuan DS, Mohamad Salim MI, Wahab AA, Lai KW, et al.

Med Biol Eng Comput, 2016 Jun;54(6):967-81.
PMID: 27039402 DOI: 10.1007/s11517-016-1480-2

Recently, there is an increasing interest in the use of local hyperthermia treatment for a variety of clinical applications. The desired therapeutic outcome in local hyperthermia treatment is achieved by raising the local temperature to surpass the tissue coagulation threshold, resulting in tissue necrosis. In oncology, local hyperthermia is used as an effective way to destroy cancerous tissues and is said to have the potential to replace conventional treatment regime like surgery, chemotherapy or radiotherapy. However, the inability to closely monitor temperature elevations from hyperthermia treatment in real time with high accuracy continues to limit its clinical applicability. Local hyperthermia treatment requires real-time monitoring system to observe the progression of the destroyed tissue during and after the treatment. Ultrasound is one of the modalities that have great potential for local hyperthermia monitoring, as it is non-ionizing, convenient and has relatively simple signal processing requirement compared to magnetic resonance imaging and computed tomography. In a two-dimensional ultrasound imaging system, changes in tissue microstructure during local hyperthermia treatment are observed in terms of pixel value analysis extracted from the ultrasound image itself. Although 2D ultrasound has shown to be the most widely used system for monitoring hyperthermia in ultrasound imaging family, 1D ultrasound on the other hand could offer a real-time monitoring and the method enables quantitative measurement to be conducted faster and with simpler measurement instrument. Therefore, this paper proposes a new local hyperthermia monitoring method that is based on one-dimensional ultrasound. Specifically, the study investigates the effect of ultrasound attenuation in normal and pathological breast tissue when the temperature in tissue is varied between 37 and 65 °C during local hyperthermia treatment. Besides that, the total protein content measurement was also conducted to investigate the relationship between attenuation and tissue denaturation level at different temperature ranges. The tissues were grouped according to their histology results, namely normal tissue with large predominance of cells (NPC), cancer tissue with large predominance of cells (CPC) and cancer with high collagen fiber content (CHF). The result shows that the attenuation coefficient of ultrasound measured following the local hyperthermia treatment increases with the increment of collagen fiber content in tissue as the CHF attenuated ultrasound at the highest rate, followed by NPC and CPC. Additionally, the attenuation increment is more pronounced at the temperature over 55 °C. This describes that the ultrasound wave experienced more energy loss when it propagates through a heated tissue as the tissue structure changes due to protein coagulation effect. Additionally, a significant increase in the sensitivity of attenuation to protein denaturation is also observed with the highest sensitivity obtained in monitoring NPC. Overall, it is concluded that one-dimensional ultrasound can be used as a monitoring method of local hyperthermia since its attenuation is very sensitive to the changes in tissue microstructure during hyperthermia.