Validation of the Malay Translation of Drug Attitude Inventory.

INTRODUCTION: The Drug Attitude Inventory 9 (DAI-9) is a nine-item self-rated questionnaire. The questionnaire assessed positive and negative attitudes of patients toward taking medication, presence of medication side effects and perceived autonomy in treatment decision. Aim: This study aimed to validate the psychometric properties of the Malay translation of Drug Attitude Inventory 9 (MDAI-9). METHOD: DAI-9 was translated from English to Malay via forward and backward translation process to produce MDAI-9. MDAI-9 was then validated on patients with psychosis who were attending psychiatry out-patient clinics. Results: There were 54 participants in this study. The subscale (attitude towards psychotropic medications) has a Cronbach's α of 0.93, whereas the subscale that assesses the presence of side effect problems has a Cronbach's α of 0.86. Exploratory factor analysis supported a two-factor model. Kaiser-Meyer-Olkin's measure of sampling adequacy was 0.64 and Bartlett's test of sphericity was significant (​​​​​X2   (36) = 281.8, p <0.001). CONCLUSION: In conclusion, MDAI-9 is reliable and valid.

Psychometric Properties of the Malay Translation of the Medication Adherence Rating Scale.

INTRODUCTION: The Medication Adherence Rating Scale (MARS) is a self-rated questionnaire that assesses medication compliance. AIM: This study aimed to validate the Malaysian language translation of the MARS (MARS-M). METHOD: The original scale was translated to Malay via forward and backward translation process. The psychometric properties of the MARS-M were validated on clinical samples (N = 54). RESULTS: The MARS-M was filled by 54 participants. Exploratory factor analysis supported a two-factor model. Factor 1 of the MARS-M consisted of four items (α = 0.84), while factor 2 consisted of three items (α = 0.78).Kaiser-Meyer-Olkin measure of sampling adequacy was 0.60, and Bartlett's test of sphericity was significant (X2 (28) = 66.4, p <0.001). CONCLUSION: The MARS-M is reliable and valid.

Constructing a student development model for undergraduate vocational universities in China using the Fuzzy Delphi Method and Analytic Hierarchy Process.

As the industrial structure changes, the severe shortage of high-quality technical and skilled talent in China is one of the most significant factors affecting the high-quality development of China's economy. Bridging the gap between cultivating talent from new undergraduate vocational universities and the demand for industrial talent is regarded as an efficient strategy to address the talent shortage. In addressing the gap, China is hindered by a lack of clarity regarding student development goals and effective assessment instruments. Thus, this study aimed to use the Fuzzy Delphi Method (FDM) and the Analytical Hierarchy Process (AHP) to overcome the above challenges. Specifically, we used the FDM to establish a five-level undergraduate vocational education student development model with two 2nd-level indicators, three 3rd-level indicators, eight 4th-level indicators, and 33 5th-level indicators to clarify student development goals. Then, the AHP was applied to determine the indicator weights, and a student development assessment instrument was developed to help universities acquire student development data and improve the matching degree between talent supply and demand. This study could help undergraduate vocational universities cultivate high-quality technical and skilled talent quickly to meet the demand for China's new economic system and to promote industry independence and global competitiveness.

Time-dependent effects of acoustic trauma and tinnitus on extracellular levels of amino acids in the inferior colliculus of rats.

Chronic tinnitus is a debilitating condition with very few management options. Acoustic trauma that causes tinnitus has been shown to induce neuronal hyperactivity in multiple brain areas in the auditory pathway, including the inferior colliculus. This neuronal hyperactivity could be attributed to an imbalance between excitatory and inhibitory neurotransmission. However, it is not clear how the levels of neurotransmitters, especially neurotransmitters in the extracellular space, change over time following acoustic trauma and the development of tinnitus. In the present study, a range of amino acids were measured in the inferior colliculus of rats during acoustic trauma as well as at 1 week and 5 months post-trauma using in vivo microdialysis and high-performance liquid chromatography. Amino acid levels in response to sound stimulation were also measured at 1 week and 5 months post-trauma. It was found that unilateral exposure to a 16 kHz pure tone at 115 dB SPL for 1 h caused immediate hearing loss in all the animals and chronic tinnitus in 58 % of the animals. Comparing to the sham condition, extracellular levels of GABA were significantly increased at both the acute and 1 week time points after acoustic trauma. However, there was no significant difference in any of the amino acid levels measured between sham, tinnitus positive and tinnitus negative animals at 5 months post-trauma. There was also no clear pattern in the relationship between neurochemical changes and sound frequency/acoustic trauma/tinnitus status, which might be due to the relatively poorer temporal resolution of the microdialysis compared to electrophysiological responses.

Adolescents' experiences and views of the national school-based thalassaemia screening programme in Malaysia: a qualitative study.

In 2016, a national school-based thalassemia screening programme was implemented in Malaysia. This study aimed to explore the experiences and views of adolescents from an urban school who had undergone the screening programme. We carried out in-depth interviews with 18 participants aged between 18 and 19 years old, with 12 of them identified as carriers during the school screening. Interviews were transcribed verbatim and analysed using thematic analysis. Three main themes emerged from this study: (1) issues encountered at various levels of the school screening programme: appropriate age for screening, thalassaemia education in school, parental consent and follow-up visit and post-test counselling; (2) experiencing emotional rollercoaster: worry, anxiety, shame, stigma; (3) choosing future partners after carrier status was known-prepared or unprepared? Various issues and screening-related challenges were encountered before, during and after the screening test. Recommendations include improving thalassaemia screening education for both school-going adolescents and parents, and better follow-up care and support for those identified as carriers. These will help stakeholders to be well informed and supportive of thalassaemia screening in schools.

Assessment of immune function and prediction of survival and infection in patients with severe alcoholic hepatitis: An exploratory study.

Background and Aim: Alcoholic hepatitis (AH), a severe complication of long-term alcohol misuse, has a 30% 90-day mortality. Infections are common and associated with higher mortality. There is currently no accurate method to predict infection in these patients. We aimed to test a measure of immune function, the QuantiFERON Monitor (QFM), in predicting clinical outcomes in patients with severe AH. Methods: Peripheral blood was taken at baseline, and QFM performed according to the manufacturer's instructions. In parallel, QFM samples were analyzed with a cytokine multiplex. Clinical outcomes of mortality at 28 and 90 days and development of infection were recorded prospectively. Results: Forty-nine patients were recruited (mean age 51, 59% male and mean discriminant function 57.8). Interferon (IFN)-γ release measured by standard QFM was significantly higher in survivors compared to non-survivors at 28 (102 vs 16 IU/mL, P = 0.02) and 90 days (115 vs 32 IU/mL; P = 0.046). The area under the receiver operating characteristic curve (AUROC) was 0.79 for 28-day mortality. IFN-γ, IL-10, and IL-23 release measured by multiplex were significantly lower in patients who developed a subsequent infection compared to those who did not (115 vs 27 IU/mL, P = 0.037; 457 vs 202 pg/mL, P = 0.008; and 1039 vs 663 pg/mL, p = 0.01, respectively). Conclusion: Immune dysfunction is associated with poorer outcomes in patients with severe AH. Measurement of IFN-γ release by standard QFM accurately predicts early mortality, which can be applied to clinical practice as a biomarker of survival. Adaptation of the test to measure IL-10 could be used as a biomarker of subsequent infection to guide clinical treatment decisions.

Growth-control of hexagonal CdS-decorated ZnO nanorod arrays with low-temperature preheating treatment for improved properties and efficient photoelectrochemical applications.

The limitations of oxide semiconductor-based solar cells in achieving high energy conversion efficiencies have prompted incessant research efforts towards the creation of efficient heterostructures. Despite its toxicity, no other semiconducting material can fully replace CdS as a versatile visible light-absorbing sensitizer. Herein, we explore the aptness of preheating treatment in the successive ionic layer adsorption and reaction (SILAR) deposition technique and improve the understanding of the principle and the effects of a controlled growth environment on thus-formed CdS thin films. Single hexagonal phases of nanostructured cadmium sulfide (CdS)-sensitized zinc oxide nanorods arrays (ZnO NRs) have been developed without the support of any complexing agent. The influences of film thickness, cationic solution pH and post-thermal treatment temperature on the characteristics of binary photoelectrodes have been investigated experimentally. Interestingly, the preheating-assisted deposition of CdS, which is rarely applied for the SILAR technique, resulted in improved photoelectrochemical performance similar to the post-annealing effect. The X-ray diffraction pattern revealed that optimized ZnO/CdS thin films were polycrystalline with high crystallinity. Examination of the morphology of the fabricated films via field emission scanning electron microscopy showed that film thickness and medium pH altered the growth mechanism of nanoparticles, thereby changing their particle sizes, which had a significant influence on the film's optical behavior. The effectiveness of CdS as a photosensitizer and the band edge alignment for ZnO/CdS heterostructures were evaluated using ultra-violet visible spectroscopy. Facile electron transfer in the binary system as evidenced in electrochemical impedance spectroscopy Nyquist plots, therefore, promotes higher photoelectrochemical efficiencies from 0.40% to 4.30% under visible light illumination as compared with the pristine ZnO NRs photoanode.

Widespread gaps in the quality of care for primary biliary cholangitis in UK.

OBJECTIVE: Primary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines. DESIGN: Data were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts. RESULTS: 790 patients' medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297). CONCLUSION: Our findings identify a broad-based deficiency in 'real-world' PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

Osteoporosis awareness among patients in Singapore (OASIS)-a community hospital perspective.

This study examines factors associated with osteoporosis awareness and knowledge using Osteoporosis Prevention and Awareness Tool (OPAAT). Of 410 patients, majority of patients had a OPAAT score < 24 (n = 362, 88.3%). Lower education level (odds ratio (OR) (primary education): 3.63; OR (no formal education): 111.5; p < 0.001) and diabetic patients (OR: 1.67; p = 0.003) were associated with lower OPAAT scores. INTRODUCTION: Lack of osteoporosis awareness forms a critical barrier to osteoporosis care and has been linked with increased institutionalization, healthcare expenditures, and decreased quality of life. This study aims to identify factors associated with osteoporosis awareness and knowledge among female Singaporeans. METHODOLOGY: A cross-sectional study was conducted among adult female patients (aged 40 to 90 years old) who were admitted into Outram Community Hospital from April to October 2020. Osteoporosis awareness and knowledge were assessed using interviewer-administered Osteoporosis Prevention and Awareness Tool (OPAAT). High knowledge was defined as a OPAAT score ≥ 24. Multivariate logistical regression analyses were used to identify predictors of low OPAAT scores. RESULTS: Of 410 patients recruited, their mean age was 71.9 ± 9.5 years old and majority of patients had a OPAAT score < 24 (n = 362, 88.3%). Patients with lower OPAAT scores tended to be older (72.5 ± 9.2 vs 67.5 ± 10.1, p < 0.001), attained lower education level (p < 0.001), and were more likely to live in public housing (92.5% vs 81.5%, p = 0.009). The prevalence of diabetes mellitus was higher in patients with low OPAAT scores (39.2% vs 18.8%, p = 0.006). After adjustment for covariates, lower education level (odds ratio (OR) (primary education): 3.63; OR (no formal education): 11.5; p < 0.05) and patients with diabetes mellitus (OR: 1.67; p = 0.03) were associated with lower OPAAT knowledge scores. CONCLUSION: Elderly female patients in community hospital have inadequate osteoporosis awareness despite being at risk of fractures. There is a need to address the knowledge gap in osteoporosis, especially among diabetic patients or patients with lower education.

Graphene Wrapping of Electrospun Nanofibers for Enhanced Electrochemical Sensing.

This paper presents a scalable method of developing ultrasensitive electrochemical biosensors. This is achieved by maximizing sensor conductivity through graphene wrapping of carbonized electrospun nanofibers. The effectiveness of the graphene wrap was determined visually by scanning electron microscopy and chemically by Fourier transform infrared spectroscopy, Raman spectroscopy, and X-ray diffraction. The sensing performance of different electrode samples was electrochemically characterized using cyclic voltammetry and electrochemical impedance spectroscopy, with the graphene-wrapped carbonized nanofiber electrode showing significantly improved performance. The graphene-wrapped carbonized nanofibers exhibited a relative conductivity of ∼14 times and an electroactive surface area of ∼2 times greater compared to the bare screen-printed carbon electrode despite experiencing inhibitive effects from the carbon glue used to bind the samples to the electrode. The results indicate potential for a highly conductive, inert sensing platform.

Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home.

INTRODUCTION: Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this 'hub-and-spoke' healthcare model. METHODS: A retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa), was performed. RESULTS: The 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008). CONCLUSION: Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home without compromising patient survival and long-term clinical outcomes.

An Illustration of Interpersonal Psychotherapy for Perinatal Depression.

This is a case of a 38-year-old married woman presenting with major depressive disorder one month after the birth of her third child. The depressive episode began in the context of interpersonal difficulties with her husband. In addition, she was also battling an internal conflict of continuing to pursue her career dream as an obstetrician and fulfilling her responsibility as a wife and a mother. Interpersonal psychotherapy (IPT) was selected as the treatment choice as an evidence-based peripartum treatment that could specifically address the two presenting problem areas, i.e., marital interpersonal dispute and role transition. This paper provides an illustration of IPT sessions conducted with verbatim selections of the sessions.

Oxidative stress in alcohol-related liver disease.

Alcohol consumption is one of the leading causes of the global burden of disease and results in high healthcare and economic costs. Heavy alcohol misuse leads to alcohol-related liver disease, which is responsible for a significant proportion of alcohol-attributable deaths globally. Other than reducing alcohol consumption, there are currently no effective treatments for alcohol-related liver disease. Oxidative stress refers to an imbalance in the production and elimination of reactive oxygen species and antioxidants. It plays important roles in several aspects of alcohol-related liver disease pathogenesis. Here, we review how chronic alcohol use results in oxidative stress through increased metabolism via the cytochrome P450 2E1 system producing reactive oxygen species, acetaldehyde and protein and DNA adducts. These trigger inflammatory signaling pathways within the liver leading to expression of pro-inflammatory mediators causing hepatocyte apoptosis and necrosis. Reactive oxygen species exposure also results in mitochondrial stress within hepatocytes causing structural and functional dysregulation of mitochondria and upregulating apoptotic signaling. There is also evidence that oxidative stress as well as the direct effect of alcohol influences epigenetic regulation. Increased global histone methylation and acetylation and specific histone acetylation inhibits antioxidant responses and promotes expression of key pro-inflammatory genes. This review highlights aspects of the role of oxidative stress in disease pathogenesis that warrant further study including mitochondrial stress and epigenetic regulation. Improved understanding of these processes may identify novel targets for therapy.

Effect of zinc treatment on clinical outcomes in patients with liver cirrhosis: A systematic review and meta-analysis.

BACKGROUND: Zinc is an essential trace element integral to many cellular and immune functions. Zinc deficiency is highly prevalent in patients with cirrhosis and related to disease severity. AIM: To evaluate whether zinc supplementation improves clinical outcomes (disease severity and mortality) in patients with cirrhosis. METHODS: This prospectively registered systematic review (PROSPERO reference: CRD42018118219) included all studies in Medline, Embase or Cochrane database with inclusion criteria of adult human studies, comparing zinc supplementation of at least 28 d with standard care or placebo in patients with cirrhosis. Mortality and clinical severity score data were extracted. Random effects meta-analyses compared mortality at 6 mo and 2 years. Risk of bias was assessed using the National Institutes of Health quality assessment tool. RESULTS: Seven hundred and twelve articles were identified of which four were eligible. Zinc formulations and doses varied (elemental zinc 3.4-214 mg daily) for different intervention periods in patients with differing etiology and severity of cirrhosis. Two studies were considered to be at high risk of bias. There was no significant difference in 6-mo mortality between patients treated with zinc versus controls [risk ratio 0.98 (0.90-1.05)]. Changes in severity scores were not reported in any study. CONCLUSION: Zinc supplementation is not associated with reduced mortality in patients with cirrhosis. Findings are limited by the small number of eligible studies and significant heterogeneity in intervention and patient population.

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit.

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344). Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

When all else fails: supervised treatment in outpatient for schizophrenia (STOPS).

This was about a case of a patient requiring admission to psychiatry ward twice a year for relapse schizophrenia due to medication non-compliance. Medication adherence was previously monitored by her husband. However, following the death of her husband, she stopped treatment. The lack of insight and poor family support further contributed to her relapse. She presented with positive and negative symptoms of schizophrenia during her relapse, neglecting her hygiene and oral intake. She was also found to have anaemia as a result of poor diet when she was in relapse. Community psychiatry services had attempted to ensure compliance with postdischarge plan but failed as patient was not present every home visits. Supervised treatment in outpatient for schizophrenia (STOPS) provided an alternative method to ensure compliance in this patient. Patient has remained in remission for 1 year since the use of STOPS.

Investigation of uterotonic properties of Ananas comosus extracts.

ETHNOPHARMACOLOGICAL RELEVANCE: In folklore medicine Ananas comosus (pineapple) is reputed to act as an abortifacient and in expectant women as a means of inducing labor. Several reports have claimed abortifacient property of A. comosus fruit (ripe or unripe). Ripe fruit has been used orally as traditional medicine in inducing abortion in Kerala state of India while the juice of unripe fruit was used for abortion in Bangladesh. However, scientific evidence supporting the efficacy of pineapple extracts in inducing uterine contractions is clearly lacking. AIM OF THE STUDY: This study investigated the pharmacological effects of different fractions of pineapple extract with a range of maturities to identify the most potent uterotonic fraction. MATERIALS AND METHODS: The ethanolic crude extracts of pineapple (edible part) were prepared and fractionated through a series of liquid-liquid partitions. Fractions were separately tested on isolated uterine muscle from pregnant SD rats and human pregnant myometrium, which were cut into strips along the longitudinal axis of uterus. The strips were mounted vertically in organ baths (37°C) and exposed to cumulative addition of fractions (0.1-10mgml-1), serotonin (0.05-5µM) and different inhibitors to delineate the mechanism of action of the active ingredients of the extract. RESULTS: Aqueous fraction (F4) possesses uterine stimulant property which was blocked by verapamil but unaffected by indomethacin, prazosin and atosiban. Notably, ketanserin (10µM) diminished the maximal contractile response induced by both F4 and 5HT by 74.3% and 92.1% respectively. CONCLUSIONS: These results may indicate the presence of 5HT or 5HT-like compound(s) and serotonergic pathways may contribute to the uterotonic activity of pineapple extract.

A Dietary Medium-Chain Fatty Acid, Decanoic Acid, Inhibits Recruitment of Nur77 to the HSD3B2 Promoter In Vitro and Reverses Endocrine and Metabolic Abnormalities in a Rat Model of Polycystic Ovary Syndrome.

Hyperandrogenism is the central feature of polycystic ovary syndrome (PCOS). Due to the intricate relationship between hyperandrogenism and insulin resistance in PCOS, 50%-70% of these patients also present with hyperinsulinemia. Metformin, an insulin sensitizer, has been used to reduce insulin resistance and improve fertility in women with PCOS. In previous work, we have noted that a dietary medium-chain fatty acid, decanoic acid (DA), improves glucose tolerance and lipid profile in a mouse model of diabetes. Here, we report for the first time that DA, like metformin, inhibits androgen biosynthesis in NCI-H295R steroidogenic cells by regulating the enzyme 3ß-hydroxysteroid dehydrogenase/Δ5-Δ4-isomerase type 2 (HSD3B2). The inhibitory effect on HSD3B2 and androgen production required cAMP stimulation, suggesting a mechanistic action via the cAMP-stimulated pathway. Specifically, both DA and metformin reduced cAMP-enhanced recruitment of the orphan nuclear receptor Nur77 to the HSD3B2 promoter, coupled with decreased transcription and protein expression of HSD3B2. In a letrozole-induced PCOS rat model, treatment with DA or metformin reduced serum-free testosterone, lowered fasting insulin, and restored estrous cyclicity. In addition, DA treatment lowered serum total testosterone and decreased HSD3B2 protein expression in the adrenals and ovaries. We conclude that DA inhibits androgen biosynthesis via mechanisms resulting in the suppression of HSD3B2 expression, an effect consistently observed both in vitro and in vivo. The efficacy of DA in reversing the endocrine and metabolic abnormalities of the letrozole-induced PCOS rat model are promising, raising the possibility that diets including DA could be beneficial for the management of both hyperandrogenism and insulin resistance in PCOS.

A hitherto unrecognised case of progressive multifocal leukoencephalopathy.

A 65-year-old man presented with a 6-week history of increasing confusion with associated cognitive decline. Empirical antibiotic cover for a urinary tract infection was prescribed with no response. After exhaustive radiological and pathological investigations were carried out, a diagnosis of John Cunningham virus encephalopathy was made. This case report describes the varied clinical presentation of symptoms and their management options, along with the latest clinical opinions behind them.