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Tessier E, Litt D, Ribeiro S, Abdul Aziz N, Campbell H, Amirthalingam G, Fry NK, Andrews N. Mixture modelling of Bordetella pertussis serology samples to evaluate anti-pertussis toxin immunoglobulin G titre thresholds for positivity: England 2008-2022. J Med Microbiol 2023; 72. [PMID: 38047762 DOI: 10.1099/jmm.0.001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction. Antibody testing for evidence of a recent Bordetella pertussis infection by estimating anti-pertussis toxin immunoglobulin G (anti-PT-IgG) titres by enzyme-linked immunosorbent assays is often recommended for those with a cough lasting more than 14 days. Interpreting results varies, with studies recommending different anti-PT-IgG titre thresholds for assigning positivity. In England, early work looking at antibody titre distributions for samples submitted from April 2010 to July 2012 found an optimal threshold of greater than 70 IU ml-1 for good sensitivity, specificity and positive predictive value.Aim. The aim of this study is to use the same mixture modelling technique to determine if the 70 IU ml-1 threshold remains appropriate when assessing data before, during and after the outbreak of pertussis in 2011-2012.Methods. We reviewed titres for all serology-tested samples in England between 1 July 2008 to 30 June 2022. IgG titres were used to calculate the positivity based on the current threshold of 70 IU ml-1, the median duration of cough for individuals who tested positive and, through mixture modelling, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of assay thresholds.Results. Positivity rates increased from 21.7 % prior to the outbreak to 30.3 % during the outbreak and dropped to 25.1 % post-outbreak; similar to estimates from the mixture model of 20.5, 33.3 and 28.7 %, respectively. Although the estimated sensitivity dropped during and after the outbreak when applying the 70 IU ml-1 threshold, the PPV remained high and therefore no change to this threshold is warranted.Conclusion. Mixture modelling is a useful tool to establish thresholds, but reassessment should also be done when there have been changes to prevalence and/or testing regimes to determine whether there have been any changes in sensitivity, specificity, PPV, and NPV and whether the threshold should be revised.
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Affiliation(s)
- Elise Tessier
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - David Litt
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Sonia Ribeiro
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Nurin Abdul Aziz
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | | | - Norman K Fry
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Nick Andrews
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
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Kirsebom FCM, Harman K, Lunt RJ, Andrews N, Groves N, Abdul Aziz N, Hope R, Stowe J, Chand M, Ramsay M, Dabrera G, Kall M, Bernal JL. Vaccine effectiveness against hospitalisation estimated using a test-negative case-control study design, and comparative odds of hospital admission and severe outcomes with COVID-19 sub-lineages BQ.1, CH.1.1. and XBB.1.5 in England. Lancet Reg Health Eur 2023; 35:100755. [PMID: 38115965 PMCID: PMC10730318 DOI: 10.1016/j.lanepe.2023.100755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 12/21/2023]
Abstract
Background Since the first emergence of Omicron BA.1 in England in November 2021, numerous sub-lineages have evolved. In September 2022, BA.5 dominated. The prevalence of BQ.1 increased from October, while the prevalence of CH.1.1 and XBB.1.5 increased from December 2022 and January 2023, respectively. Little is known about the effectiveness of the vaccines against hospitalisation with these sub-lineages, nor the relative severity, so we here used national-level electronic health records from England to estimate vaccine effectiveness and variant severity. Methods The study period for tests contributing to all analyses was from 5th December 2022 to 2nd April 2023, when the variants of interest were co-circulating. A test-negative case-control study was used to estimate the incremental effectiveness of the bivalent BA.1 booster vaccines against hospitalisation, relative to those with waned immunity where the last dose was at least 6 months prior. The odds of hospital admission for those testing PCR positive on the day of an attendance to accident and emergency departments and the odds of intensive care unit admission or death amongst COVID-19 admissions were compared between variants. Additionally, a Cox proportional hazards survival regression was used to investigate length of stay amongst hospitalised cases by variant. Findings Our vaccine effectiveness study included 191,229 eligible tests with 1647 BQ.1 cases, 877 CH.1.1 cases, 1357 XBB.1.5 cases and 187,348 test negative controls. There was no difference in incremental vaccine effectiveness against hospitalisation with BQ.1, CH.1.1 or XBB.1.5, nor was there a difference in the severity of these variants. Effectiveness against hospitalisation was 48.0% (95% C.I.; 38.5-56.0%), 29.7% (95% C.I.; 7.5-46.6%) and 52.7% (95% C.I.; 24.6-70.4%) against BQ.1, CH.1.1 and XBB.1.5, respectively, at 5-9 weeks post booster vaccination. Compared to BQ.1, the odds of hospital admission were 0.87 (95% C.I.; 0.77-0.99) and 0.88 (95% C.I.; 0.75-1.02) for CH.1.1 and XBB.1.5 cases attending accident and emergency departments, respectively. There was no significant difference in the odds of admission to intensive care units or death for those with CH.1.1 (OR 0.96, 95% C.I.; 0.71-1.30) or XBB.1.5 (OR 0.67, 95% C.I.; 0.44-1.02) compared to BQ.1. There was also no significant difference in the length of hospital stay by variant. Interpretation Together, these results provide reassuring evidence that the bivalent BA.1 booster vaccines provide similar protection against hospitalisation with BQ.1, CH.1.1 and XBB.1.5, and that the emergent CH.1.1 and XBB.1.5 sub-lineages do not cause more severe disease than BQ.1. Funding None.
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Affiliation(s)
| | - Katie Harman
- UK Health Security Agency, London, United Kingdom
| | | | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Russell Hope
- UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | - Meera Chand
- UK Health Security Agency, London, United Kingdom
- Guys and St Thomas’s Hospital NHS Trust, London, United Kingdom
| | - Mary Ramsay
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Meaghan Kall
- UK Health Security Agency, London, United Kingdom
| | - Jamie Lopez Bernal
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom
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Sinnathamby MA, Zaidi A, Twohig KA, Aliabadi S, Aziz NA, Groves N, Gallagher E, Thelwall S, Dabrera G. Descriptive epidemiology of SARS-CoV-2 Beta (B.1.351) variant cases in England, December 2020 to June 2022. Influenza Other Respir Viruses 2023; 17:e13204. [PMID: 38019701 PMCID: PMC10651643 DOI: 10.1111/irv.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of the SARS-CoV-2 Beta (B.1.351) variant in November 2020 raised concerns of increased transmissibility and severity. We describe the epidemiology of 949 confirmed SARS-CoV-2 Beta variant cases in England, identified between December 2020 and June 2022. Most cases were detected in the first 3 months. A total of 10 deaths (1.1%; 10/949) were identified among all cases and of those with travel information, 38 (4.9%; 38/781) cases with hospital admissions within 14 days of a positive test being detected. 52.9% (413/781) cases were imported. This study reinforces the importance of monitoring of travel-associated cases to inform public health response and reduce transmissibility of new variants.
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Affiliation(s)
- Mary A. Sinnathamby
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Asad Zaidi
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Katherine A. Twohig
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Shirin Aliabadi
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Nurin Abdul Aziz
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Natalie Groves
- Genomics Public Health Analysis, TARZET Division, Clinical and Emerging Infections DirectorateUK Health Security AgencyLondonUK
| | - Eileen Gallagher
- Genomics Public Health Analysis, TARZET Division, Clinical and Emerging Infections DirectorateUK Health Security AgencyLondonUK
| | - Simon Thelwall
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
| | - Gavin Dabrera
- COVID‐19 Vaccines and Epidemiology Division, Public Health Programmes DirectorateUK Health Security AgencyLondonUK
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Flannagan J, Chudasama DY, Hope R, Collin SM, Bhattacharya A, Merrick R, Aziz NA, Hopkins S, Dabrera G, Lamagni T. Attribution of nosocomial seeding to long-term care facility COVID-19 outbreaks. Epidemiol Infect 2023; 151:e191. [PMID: 37876042 PMCID: PMC10728972 DOI: 10.1017/s0950268823001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) were disproportionately affected by the COVID-19 pandemic. We assessed the extent to which hospital-associated infections contributed to COVID-19 LTCF outbreaks in England. We matched addresses of cases between March 2020 and June 2021 to reference databases to identify LTCF residents. Linkage to health service records identified hospital-associated infections, with the number of days spent in hospital before positive specimen date used to classify these as definite or probable. Of 149,129 cases in LTCF residents during the study period, 3,748 (2.5%) were definite or probable hospital-associated and discharged to an LTCF. Overall, 431 (0.3%) were identified as index cases of potentially nosocomial-seeded outbreaks (2.7% (431/15,797) of all identified LTCF outbreaks). These outbreaks involved 4,521 resident cases and 1,335 deaths, representing 3.0% and 3.6% of all cases and deaths in LTCF residents, respectively. The proportion of outbreaks that were potentially nosocomial-seeded peaked in late June 2020, early December 2020, mid-January 2021, and mid-April 2021. Nosocomial seeding contributed to COVID-19 LTCF outbreaks but is unlikely to have accounted for a substantial proportion. The continued identification of such outbreaks after the implementation of preventative policies highlights the challenges of preventing their occurrence.
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Affiliation(s)
| | | | - Russell Hope
- United Kingdom Health Security Agency, London, UK
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Abdul Aziz N, Nash SG, Zaidi A, Nyberg T, Groves N, Hope R, Lopez Bernal J, Dabrera G, Thelwall S. Risk of severe outcomes among SARS-CoV-2 Omicron BA.4 and BA.5 cases compared to BA.2 cases in England. J Infect 2023; 87:e8-e11. [PMID: 37100176 PMCID: PMC10124096 DOI: 10.1016/j.jinf.2023.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Affiliation(s)
| | | | - Asad Zaidi
- UKHSA COVID-19 Vaccines and Epidemiology Division, UK
| | - Tommy Nyberg
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Russell Hope
- UKHSA HCAI, Fungal, AMR, AMU & Sepsis Division, UK
| | - Jamie Lopez Bernal
- UKHSA COVID-19 Surveillance Cell, UK; NIHR Health Protection Research Unit for Respiratory Infections, UK
| | - Gavin Dabrera
- UKHSA COVID-19 Vaccines and Epidemiology Division, UK
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Tessier E, Webster H, Aziz NA, Flannagan J, Zaidi A, Charlett A, Dabrera G, Lamagni T. The impact of COVID-19 on residents of long-term care facilities with learning disabilities and/or autism. Influenza Other Respir Viruses 2023; 17:e13139. [PMID: 37123814 PMCID: PMC10133727 DOI: 10.1111/irv.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
Background The COVID-19 pandemic has had disproportionate impact on vulnerable populations including those with learning disabilities. Assessing the incidence and risk of death in such settings can improve the prevention of COVID-19. We describe individuals who tested positive for SARS-CoV-2 while residing in care homes for learning disabilities and/or autism and investigate the risk of death compared with individuals living in their own homes. Methods Surveillance records for COVID-19 infections in England from 02 February 2020 to 31 March 2022 were extracted. Data on property type, variant wave, vaccination, hospitalisation and death were derived through data linkage and enrichment. Care home residents with learning disabilities and/or autism and diagnosed with COVID-19 were identified and analysed, and logistic regression analyses compared the risk of death of individuals living in private residence. We assessed interaction parameters by post-estimation analyses. Results A total of 3501 individuals were identified as diagnosed with SARS-CoV-2 whilst living in 632 care home properties for learning disabilities and/or autism. Of the 3686 episodes of infection, 80.4% were part of an outbreak. The crude case fatality rate was 2.6% and 0.6% among care home residents with autism and/or learning disabilities and their counterparts in households, respectively.The post-estimation analyses found over eight times the odds of death among care home residents in 60 years old compared with their counterparts living in private homes. Conclusions Care home residents with learning disabilities and/or autism have a greater risk of death from COVID-19. Optimising guidance to meet their needs is of great importance.
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Affiliation(s)
- Elise Tessier
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Harriet Webster
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Nurin Abdul Aziz
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Joe Flannagan
- All Hazards and Intelligence DivisionUK Health Security AgencyLondonUK
| | - Asad Zaidi
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Andre Charlett
- Statistics, Modelling and Economic DivisionUK Health Security AgencyLondonUK
| | - Gavin Dabrera
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Theresa Lamagni
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
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Dabrera G, Allen H, Zaidi A, Flannagan J, Twohig K, Thelwall S, Marchant E, Aziz NA, Lamagni T, Myers R, Charlett A, Capelastegui F, Chudasama D, Clare T, Coukan F, Sinnathamby M, Ferguson N, Hopkins S, Chand M, Hope R, Kall M. Assessment of mortality and hospital admissions associated with confirmed infection with SARS-CoV-2 Alpha variant: a matched cohort and time-to-event analysis, England, October to December 2020. Euro Surveill 2022; 27:2100377. [PMID: 35593163 PMCID: PMC9121661 DOI: 10.2807/1560-7917.es.2022.27.20.2100377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BackgroundThe emergence of the SARS-CoV-2 Alpha variant in England coincided with a rapid increase in the number of PCR-confirmed COVID-19 cases in areas where the variant was concentrated.AimOur aim was to assess whether infection with Alpha was associated with more severe clinical outcomes than the wild type.MethodsLaboratory-confirmed infections with genomically sequenced SARS-CoV-2 Alpha and wild type between October and December 2020 were linked to routine healthcare and surveillance datasets. We conducted two statistical analyses to compare the risk of hospital admission and death within 28 days of testing between Alpha and wild-type infections: a matched cohort study and an adjusted Cox proportional hazards model. We assessed differences in disease severity by comparing hospital admission and mortality, including length of hospitalisation and time to death.ResultsOf 63,609 COVID-19 cases sequenced in England between October and December 2020, 6,038 had the Alpha variant. In the matched cohort analysis, we matched 2,821 cases with Alpha to 2,821 to cases with wild type. In the time-to-event analysis, we observed a 34% increased risk in hospitalisation associated with Alpha compared with wild type, but no significant difference in the risk of mortality.ConclusionWe found evidence of increased risk of hospitalisation after adjusting for key confounders, suggesting increased infection severity associated with the Alpha variant. Rapid assessments of the relative morbidity in terms of clinical outcomes and mortality associated with emerging SARS-CoV-2 variants compared with dominant variants are required to assess overall impact of SARS-CoV-2 mutations.
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Affiliation(s)
- Gavin Dabrera
- National Infection Service, Public Health England, London, United Kingdom
| | - Hester Allen
- National Infection Service, Public Health England, London, United Kingdom
| | - Asad Zaidi
- National Infection Service, Public Health England, London, United Kingdom
| | - Joe Flannagan
- National Infection Service, Public Health England, London, United Kingdom
| | - Katherine Twohig
- National Infection Service, Public Health England, London, United Kingdom
| | - Simon Thelwall
- National Infection Service, Public Health England, London, United Kingdom
| | - Elizabeth Marchant
- National Infection Service, Public Health England, London, United Kingdom
| | - Nurin Abdul Aziz
- National Infection Service, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Richard Myers
- National Infection Service, Public Health England, London, United Kingdom
| | - André Charlett
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Dimple Chudasama
- National Infection Service, Public Health England, London, United Kingdom
| | - Tom Clare
- National Infection Service, Public Health England, London, United Kingdom
| | - Flavien Coukan
- National Infection Service, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- National Infection Service, Public Health England, London, United Kingdom
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Susan Hopkins
- National Infection Service, Public Health England, London, United Kingdom
| | - Meera Chand
- National Infection Service, Public Health England, London, United Kingdom
| | - Russell Hope
- National Infection Service, Public Health England, London, United Kingdom
| | - Meaghan Kall
- National Infection Service, Public Health England, London, United Kingdom
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- https://www.cogconsortium.uk
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Nyberg T, Ferguson NM, Nash SG, Webster HH, Flaxman S, Andrews N, Hinsley W, Bernal JL, Kall M, Bhatt S, Blomquist P, Zaidi A, Volz E, Aziz NA, Harman K, Funk S, Abbott S, Hope R, Charlett A, Chand M, Ghani AC, Seaman SR, Dabrera G, De Angelis D, Presanis AM, Thelwall S. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. Lancet 2022; 399:1303-1312. [PMID: 35305296 PMCID: PMC8926413 DOI: 10.1016/s0140-6736(22)00462-7] [Citation(s) in RCA: 674] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The omicron variant (B.1.1.529) of SARS-CoV-2 has demonstrated partial vaccine escape and high transmissibility, with early studies indicating lower severity of infection than that of the delta variant (B.1.617.2). We aimed to better characterise omicron severity relative to delta by assessing the relative risk of hospital attendance, hospital admission, or death in a large national cohort. METHODS Individual-level data on laboratory-confirmed COVID-19 cases resident in England between Nov 29, 2021, and Jan 9, 2022, were linked to routine datasets on vaccination status, hospital attendance and admission, and mortality. The relative risk of hospital attendance or admission within 14 days, or death within 28 days after confirmed infection, was estimated using proportional hazards regression. Analyses were stratified by test date, 10-year age band, ethnicity, residential region, and vaccination status, and were further adjusted for sex, index of multiple deprivation decile, evidence of a previous infection, and year of age within each age band. A secondary analysis estimated variant-specific and vaccine-specific vaccine effectiveness and the intrinsic relative severity of omicron infection compared with delta (ie, the relative risk in unvaccinated cases). FINDINGS The adjusted hazard ratio (HR) of hospital attendance (not necessarily resulting in admission) with omicron compared with delta was 0·56 (95% CI 0·54-0·58); for hospital admission and death, HR estimates were 0·41 (0·39-0·43) and 0·31 (0·26-0·37), respectively. Omicron versus delta HR estimates varied with age for all endpoints examined. The adjusted HR for hospital admission was 1·10 (0·85-1·42) in those younger than 10 years, decreasing to 0·25 (0·21-0·30) in 60-69-year-olds, and then increasing to 0·47 (0·40-0·56) in those aged at least 80 years. For both variants, past infection gave some protection against death both in vaccinated (HR 0·47 [0·32-0·68]) and unvaccinated (0·18 [0·06-0·57]) cases. In vaccinated cases, past infection offered no additional protection against hospital admission beyond that provided by vaccination (HR 0·96 [0·88-1·04]); however, for unvaccinated cases, past infection gave moderate protection (HR 0·55 [0·48-0·63]). Omicron versus delta HR estimates were lower for hospital admission (0·30 [0·28-0·32]) in unvaccinated cases than the corresponding HR estimated for all cases in the primary analysis. Booster vaccination with an mRNA vaccine was highly protective against hospitalisation and death in omicron cases (HR for hospital admission 8-11 weeks post-booster vs unvaccinated: 0·22 [0·20-0·24]), with the protection afforded after a booster not being affected by the vaccine used for doses 1 and 2. INTERPRETATION The risk of severe outcomes following SARS-CoV-2 infection is substantially lower for omicron than for delta, with higher reductions for more severe endpoints and significant variation with age. Underlying the observed risks is a larger reduction in intrinsic severity (in unvaccinated individuals) counterbalanced by a reduction in vaccine effectiveness. Documented previous SARS-CoV-2 infection offered some protection against hospitalisation and high protection against death in unvaccinated individuals, but only offered additional protection in vaccinated individuals for the death endpoint. Booster vaccination with mRNA vaccines maintains over 70% protection against hospitalisation and death in breakthrough confirmed omicron infections. FUNDING Medical Research Council, UK Research and Innovation, Department of Health and Social Care, National Institute for Health Research, Community Jameel, and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Tommy Nyberg
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
| | - Neil M Ferguson
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK.
| | - Sophie G Nash
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Harriet H Webster
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Nick Andrews
- COVID-19 Surveillance Cell, UK Health Security Agency, London, UK
| | - Wes Hinsley
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Jamie Lopez Bernal
- NIHR Health Protection Research Unit for Respiratory Infections, Imperial College London, London, UK; COVID-19 Surveillance Cell, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Samir Bhatt
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Paula Blomquist
- Outbreak Surveillance Team, UK Health Security Agency, London, UK
| | - Asad Zaidi
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Erik Volz
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Nurin Abdul Aziz
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Katie Harman
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Russell Hope
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Andre Charlett
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK; Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK; Joint Modelling Team, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit for Behavioural Science and Evaluation at the University of Bristol, University of the West of England, and University of Cambridge, Bristol, UK
| | - Meera Chand
- COVID-19 Genomics Cell, UK Health Security Agency, London, UK
| | - Azra C Ghani
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Shaun R Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Daniela De Angelis
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK; Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK; Joint Modelling Team, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit for Behavioural Science and Evaluation at the University of Bristol, University of the West of England, and University of Cambridge, Bristol, UK
| | - Anne M Presanis
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Simon Thelwall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
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Alimul Hidayat AA, Uliyah M, Aziz NA, Ubudiyah M. Self-efficacy, motivation and adolescent's adherence of a health protocol during pandemic COVID-19 in Indonesia. Eur Rev Med Pharmacol Sci 2022; 26:2572-2578. [PMID: 35442472 DOI: 10.26355/eurrev_202204_28494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Compliance with the 5M health protocols of washing hands, wearing masks, keeping a distance of at least one meter, avoiding crowds, and reducing mobility is the best effort to prevent COVID-19. Adolescents are non-compliant in implementing health protocols during the pandemic. Therefore, this study aimed to investigate the level of compliance with the 5M health protocols. It also examines the relationship between self-efficacy, motivation, and compliance with health protocols. MATERIALS AND METHODS Data analysis was conducted on a cross-sectional survey of 978 adolescents in Surabaya, Indonesia. Multiple logistic regression was performed to analyze the relationship between the three. Furthermore, adolescent self-efficacy was measured using the General Self Efficacy Scale (GSES), while motivation scale and sociodemographic questionnaire were measured to assess the motivation and characteristics of the respondents. RESULTS Adolescent self-efficacy in compliance with health protocols is around (92.0%) with an average GSES score of 25.52 + 4.64. The analysis showed that adolescents with high self-efficacy and motivation had a high level of adherence (OR 2.804, 95% CI 2.008, 3.915) and high motivation (OR 2.926, 95% CI 2.087, 4.102), compared to those with low self-efficacy and motivation. CONCLUSIONS The results suggested that initial identification of self-efficacy and motivation should be addressed to ensure compliance with health protocols to prevent the pandemic.
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Then Moli SM, Aziz NA, Noor Azimah M, Rani H. Cross-sectional survey on primary care medical doctors' practices on oral health care in pregnancy and its association with knowledge and attitude. Med J Malaysia 2022; 77:217-223. [PMID: 35338630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Oral health care is an important indicator of the overall wellbeing of pregnant women. Optimizing the utilisation of dental care during pregnancy goes a long way in ensuring an improved and optimal pregnancy outcome. OBJECTIVE This study aimed to assess the practices of primary care doctors on oral health care in pregnancy and its association with the level of knowledge and attitude. MATERIALS AND METHODS This cross-sectional study was conducted among primary care doctors in nine public health clinics in Petaling District. A self-administered questionnaire consisting of socio-demographic characteristics, knowledge, attitude, and practices related to oral health care in pregnancy was used. RESULTS A total of 138 primary care doctors participated in this study with a response rate of 98.0%. Most primary care doctors frequently advised patients not to delay dental visits until after pregnancy (84.8%), advised patients to see dentists (69.7%), and referred patients to dentists during pregnancy (63.6%). However, only 18.9% perform assessments routinely to detect oral health issues. The median (IQR) score for knowledge was 17(4) (range score: 0-23) and attitude was 23(3) (range score: 6-30). Knowledge median score (p:0.026) and practices of referring patients to dentists (p:0.017) were significantly associated. There was a positive correlation between overall practices of primary care doctors and their age, years of experience, and knowledge. CONCLUSION Most primary care doctors frequently advise and refer pregnant patients to see dentist. Primary care doctors with higher knowledge score, who were older and had more experience, had better overall practices on oral health care in pregnancy.
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Affiliation(s)
- S M Then Moli
- Seri Kembangan Health Clinic, Seri Kembangan, Selangor, Malaysia
| | - N A Aziz
- UKM Medical Centre, Medical Faculty, Department of Family Medicine, Cheras, Kuala Lumpur, Malaysia.
| | - M Noor Azimah
- UKM Medical Centre, Medical Faculty, Department of Family Medicine, Cheras, Kuala Lumpur, Malaysia
| | - H Rani
- UKM, Faculty of Dentistry, Department of Family Oral Health, Cheras, Kuala Lumpur, Malaysia
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11
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Hussein Z, Aziz NA, Dhanaraj E, Brahmachari B, Kothekar M. Safety and effectiveness of a biosimilar biphasic insulin in the management of diabetes mellitus during routine clinical practice in Asian patients. Med J Malaysia 2020; 75:372-378. [PMID: 32723997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Biosimilar insulins have the potential to increase access to treatment among patients with diabetes mellitus (DM), reduce treatment costs, and expand market competition. There are no published studies evaluating the performance of biosimilar insulins in routine clinical practice in Asia. This study assessed the safety and effectiveness of biphasic isophane insulin injection in Malaysian DM patients. MATERIALS AND METHODS In this open label, single-arm, observational, post marketing study, patients received biphasic isophane insulin injection as per the Prescribing Information; and were assessed for safety (adverse events including hypoglycaemia), effectiveness (glycosylated haemoglobin [HbA1c]; fasting blood sugar, [FBS]; and patient's condition by patient and physician) over a period of 24 weeks. RESULTS Adult male and female diabetes patients (N=119; type 2 DM, n=117) with a mean (SD) diabetes duration of 13 years were included. No new safety signals have been identified. Significant reduction in HbA1c was observed at weeks 12 and 24 (mean [SD] - baseline: 9.6% [1.9]; Week 12: 9.0% [1.7] and at Week 24: 9.1% [1.7]; p < 0.001). There were 10 serious and 9 non-serious adverse events reported in the study. Expected mild events included hypoglycaemia and injection site pruritus. However, the majority of the adverse events were non-study drug related events. No deaths were reported during the study. DISCUSSION Biphasic isophane insulin injection was well tolerated with no new safety concerns. It was found effective in post- marketing studies conducted in routine clinical settings when administered in DM patients in this study.
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Affiliation(s)
- Z Hussein
- Hospital Putrajaya, 62000 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia.
| | - N A Aziz
- Hospital Pulau Pinang, Jalan Residensi, 10990 George Town, Pulau Pinang, Malaysia
| | - E Dhanaraj
- Biocon Research Limited, Bangalore, India.
| | | | - M Kothekar
- Biocon Research Limited, Bangalore, India
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12
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Razak SAA, Murad NAA, Masra F, Chong DLS, Abdullah N, Jalil N, Alauddin H, Sabudin RZAR, Ithnin A, Khai LC, Aziz NA, Muda Z, Ibrahim H, Latiff ZA. Genetic Modifiers of Fetal Haemoglobin (HbF) and Phenotypic Severity in β-Thalassemia Patients. Curr Mol Med 2019; 18:295-305. [PMID: 30289070 DOI: 10.2174/1566524018666181004121604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/19/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The phenotypic severity of β-thalassemia is highly modulated by three genetic modifiers: β-globin (HBB) mutations, co-inheritance of α-thalassemia and polymorphisms in the genes associated with fetal haemoglobin (HbF) production. This study was aimed to evaluate the effect of HbF related polymorphisms mainly in the HBB cluster, BCL11A (B-cell CLL/lymphoma 11A) and HBS1L-MYB (HBS1-like translational GTPase-MYB protooncogene, transcription factor) with regards to clinical severity. METHODS A total of 149 patients were included in the study. HBA and HBB mutations were characterised using multiplex PCR, Sanger sequencing and multiplex ligationdependent probe amplification. In addition, 35 HbF polymorphisms were genotyped using mass spectrometry and PCR-restriction fragment length polymorphism (PCRRFLP). The genotype-phenotype association was analysed using SPSS version 22. RESULTS Twenty-one HBB mutations were identified in the study population. Patients with HBB mutations had heterogeneous phenotypic severity due to the presence of other secondary modifiers. Co-inheritance of α-thalassemia (n = 12) alleviated disease severity of β-thalassemia. In addition, three polymorphisms (HBS1LMYB, rs4895441 [P = 0.008, odds ratio (OR) = 0.38 (0.18, 0.78)], rs9376092 [P = 0.030, OR = 0.36 (0.14, 0.90)]; and olfactory receptor [OR51B2] rs6578605 [P = 0.018, OR = 0.52 (0.31, 0.89)]) were associated with phenotypic severity. Secondary analysis of the association between single-nucleotide polymorphisms with HbF levels revealed three nominally significant SNPs: rs6934903, rs9376095 and rs9494149 in HBS1L-MYB. CONCLUSION This study revealed 3 types of HbF polymorphisms that play an important role in ameliorating disease severity of β-thalassemia patients which may be useful as a predictive marker in clinical management.
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Affiliation(s)
- S A A Razak
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A A Murad
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - F Masra
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - D L S Chong
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Abdullah
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Jalil
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - H Alauddin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - R Z A R Sabudin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - A Ithnin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - L C Khai
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A Aziz
- Institute for Medical Research (IMR), Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Z Muda
- Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - H Ibrahim
- Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Z A Latiff
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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13
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Stuitje G, van Belzen MJ, Gardiner SL, van Roon-Mom WMC, Boogaard MW, Tabrizi SJ, Roos RAC, Aziz NA. Age of onset in Huntington's disease is influenced by CAG repeat variations in other polyglutamine disease-associated genes. Brain 2019; 140:e42. [PMID: 28549075 DOI: 10.1093/brain/awx122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Geerte Stuitje
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine J van Belzen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sarah L Gardiner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Merel W Boogaard
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, UCL Huntington's Disease Centre, University College London Institute of Neurology, London, UK
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - N A Aziz
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Neurodegenerative Disease, UCL Huntington's Disease Centre, University College London Institute of Neurology, London, UK
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14
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Nor Azlin MN, Aziz NA, Saperi BS, Aljunid SM. Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community. Med J Malaysia 2016; 71:313-321. [PMID: 28087954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community. METHODS A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients' medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL). RESULTS A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were 'energy' and 'social role'. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01). CONCLUSIONS It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.
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Affiliation(s)
- M N Nor Azlin
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, School of Rehabilitation Sciences, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
| | - N A Aziz
- Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - B S Saperi
- Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - S M Aljunid
- Universiti Kebangsaan Malaysia, International Center for Casemix and Clinical Coding, Malaysia
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15
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Aziz NA, Peeters-Scholte CM, de Bruine FT, Klumper FJ, Adama van Scheltema PN, Lopriore E, Steggerda SJ. Fetal cerebellar hemorrhage: three cases with postnatal follow-up. Ultrasound Obstet Gynecol 2016; 47:785-786. [PMID: 26426778 DOI: 10.1002/uog.15772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/14/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N A Aziz
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - C M Peeters-Scholte
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F T de Bruine
- Department of Neuroradiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F J Klumper
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - P N Adama van Scheltema
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - E Lopriore
- Department of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 AZ, Leiden, The Netherlands
| | - S J Steggerda
- Department of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 AZ, Leiden, The Netherlands
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Aziz NA, Pindus DM, Mullis R, Walter FM, Mant J. Understanding stroke survivors' and informal carers' experiences of and need for primary care and community health services--a systematic review of the qualitative literature: protocol. BMJ Open 2016; 6:e009244. [PMID: 26739728 PMCID: PMC4716193 DOI: 10.1136/bmjopen-2015-009244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/04/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Despite the rising prevalence of stroke, no comprehensive model of postacute stroke care exists. Research on stroke has focused on acute care and early supported discharge, with less attention dedicated to longer term support in the community. Likewise, relatively little research has focused on long-term support for informal carers. This review aims to synthesise and appraise extant qualitative evidence on: (1) long-term healthcare needs of stroke survivors and informal carers, and (2) their experiences of primary care and community health services. The review will inform the development of a primary care model for stroke survivors and informal carers. METHODS AND ANALYSIS We will systematically search 4 databases: MEDLINE, EMBASE, PsycINFO and CINAHL for published qualitative evidence on the needs and experiences of stroke survivors and informal carers of postacute care delivered by primary care and community health services. Additional searches of reference lists and citation indices will be conducted. The quality of articles will be assessed by 2 independent reviewers using a Critical Appraisal Skills Programme (CASP) checklist. Disagreements will be resolved through discussion or third party adjudication. Meta-ethnography will be used to synthesise the literature based on first-order, second-order and third-order constructs. We will construct a theoretical model of stroke survivors' and informal carers' experiences of primary care and community health services. ETHICS AND DISSEMINATION The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. The study does not require ethical approval as no patient identifiable data will be used.
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Affiliation(s)
- N A Aziz
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK Department of Family Medicine, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - D M Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - R Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - F M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - J Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Tong CV, Velaiutham S, Aziz NA, Lim SL, Khaw CH. Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion. Med J Malaysia 2015; 70:249-250. [PMID: 26358023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.
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Affiliation(s)
- C V Tong
- Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presinct 7, 62250 Putrajaya, Malaysia.
| | | | - N A Aziz
- Hospital Pulau Pinang, Georgetown, Malaysia
| | - S L Lim
- Hospital Pulau Pinang, Georgetown, Malaysia
| | - C H Khaw
- Hospital Pulau Pinang, Georgetown, Malaysia
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18
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van Wamelen DJ, Aziz NA, Roos RAC, Swaab DF. Hypothalamic alterations in Huntington's disease patients: comparison with genetic rodent models. J Neuroendocrinol 2014; 26:761-75. [PMID: 25074766 DOI: 10.1111/jne.12190] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/26/2014] [Accepted: 07/26/2014] [Indexed: 11/27/2022]
Abstract
Unintended weight loss, sleep and circadian disturbances and autonomic dysfunction are prevalent features of Huntington's disease (HD), an autosomal dominantly inherited neurodegenerative disorder caused by an expanded CAG repeat sequence in the HTT gene. These features form a substantial contribution to disease burden in HD patients and appear to be accompanied by a number of neuroendocrine and metabolic changes, pointing towards hypothalamic pathology as a likely underlying mechanism. Neuronal inclusion bodies of mutant huntingtin, which are hallmarks of the disease, occur throughout the hypothalamus, and indicate local mutant huntingtin expression that could interfere with hypothalamic neuropeptide production. Also, several genetic rodent models of HD show features that could be related to hypothalamic pathology, such as weight loss and circadian rhythm disturbances. In these rodents, several hypothalamic neuropeptide populations are affected. In the present review, we summarise the changes in genetic rodent models of HD for individual hypothalamic nuclei, compare these observations to the hypothalamic changes that occur in HD patients, and make an inventory of the work that still needs to be done. Surprisingly, there is only limited overlap in the hypothalamic changes reported in HD patients and genetic rodent models. At present, the only similarity between the hypothalamic alterations in HD patients and genetic rodent models is a decrease in the number of orexin-expressing neurones in the lateral hypothalamus. Possible reasons for these discrepancies, as well as potential consequences for the development of novel therapeutic strategies, are discussed.
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Affiliation(s)
- D J van Wamelen
- Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam ZO, The Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Blebil AQ, Sulaiman SAS, Hassali MA, Dujaili JA, Subramaniam K, Aziz NA. Evaluation of Smoking Status among Diabetes Patients in the State of Penang, Malaysia. TROP J PHARM RES 2013. [DOI: 10.4314/tjpr.v12i3.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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van Wamelen DJ, Aziz NA, Anink JJ, Roos RAC, Swaab DF. Neuropeptide alterations in the infundibular nucleus of Huntington's disease patients. J Neuroendocrinol 2013; 25:198-205. [PMID: 22928483 DOI: 10.1111/j.1365-2826.2012.02379.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 08/05/2012] [Accepted: 08/24/2012] [Indexed: 11/29/2022]
Abstract
Data from transgenic mouse models of Huntington's disease (HD) suggest that dysfunction of the hypothalamic infundibular nucleus (INF) (in rodents, the arcuate nucleus) may contribute to unintended weight loss and insatiable appetite among HD patients. Using post-mortem paraffin-embedded tissue, we assessed the total number of INF neurones by thionin staining and four major regulatory neuropeptides in the INF of HD patients by immunocytochemistry and in situ hybridisation. In HD patients, the total number of neurones in the INF was unchanged compared to control subjects (P = 0.92), whereas it contained over 30% less neuropeptide Y-immunoreactive (IR) neurones (P = 0.016), as well as reduced peptide levels, in fibres to the paraventricular and ventromedial nucleus (P = 0.003, P = 0.005, respectively). Conversely, neuropeptide Y mRNA expression levels were increased three-fold (P = 0.047). No changes were observed in the number of neurones immunoreactive for α-melanocyte-stimulating hormone, agouti-related peptide, and cocaine- and amphetamine-regulated transcript (P ≥ 0.17). Our findings suggest changes in the pathology of the INF neuropeptide Y-expressing neurones in HD patients without changes in other (an)orexigenic neuropeptides and without neuronal cell loss. These findings indicate that unintended weight loss in patients suffering from this disease may be partly a result of neuropeptidergic alterations in the hypothalamic infundibular nucleus.
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Affiliation(s)
- D J van Wamelen
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Ahmad N, Hassan Y, Tangiisuran B, Meng OL, Aziz NA, Khan AH. Guidelines Adherence and Hypertension Control in an Outpatient Cardiology Clinic in Malaysia. TROP J PHARM RES 2012. [DOI: 10.4314/tjpr.v11i4.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sharifuddin N, Abdul AAF, Hamzah MS, Abdul RR, Zainuddin Z, Puteh SEW, Abdul HMZ, Aziz NA. A cross-sectional study of hypertensive outpatients to determine the necessity of asking about erectile dysfunction symptoms. S Afr Fam Pract (2004) 2011. [DOI: 10.1080/20786204.2011.10874119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Aziz AF Abdul
- Department of Family Medicine, University Kebangsaan, Malaysia Medical Centre
| | - MS Hamzah
- Department of Family Medicine, University Kebangsaan, Malaysia Medical Centre
| | - Rashid R Abdul
- Department of Family Medicine, University Kebangsaan, Malaysia Medical Centre
| | - Z Zainuddin
- Urology Unit, University Kebangsaan, Malaysia Medical Centre
| | - SEW Puteh
- department of Community Health, University Kebangsaan, Malaysia Medical Centre
| | - Hamid MZ Abdul
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
| | - NA Aziz
- Department of Family Medicine, University Kebangsaan, Malaysia Medical Centre
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Abstract
Recently, a massive loss of both hypocretin and melanin-concentrating hormone (MCH) neurones was found in the hypothalamus of Parkinson's disease (PD) patients. Because both hypocretin and MCH play a key role in the regulation of sleep, energy homeostasis and autonomic function, partly by modulation of the somatotrophic, thyrotrophic and lactotrophic axes, neuroendocrine dysregulation may contribute to some of the non-motor features of PD. In eight de novo, medication-free PD patients and eight age-, sex- and body mass index-matched controls, we measured serum levels of growth hormone (GH), thyroid-stimulating hormone (TSH) and prolactin every 10 min for 24 h. Auto-deconvolution, cosinor and approximate entropy analysis were applied to quantify GH, TSH and prolactin secretion rates, diurnal rhythmicity, as well as regularity of hormone release. Sleep was polygraphically-recorded throughout the night. Total 24-h secretion of GH (191 ± 31 versus 130 ± 39 mU/l/24 h), TSH (38 ± 9 versus 36 ± 2 mU/l/24 h) and prolactin (102 ± 14 versus 116 ± 17 μg/l/24 h), as well as their diurnal rhythmicity and regularity of release, were not significantly different between PD patients and controls (all P ≥ 0.12). Fasting levels of insulin-like growth factor-1 were also unaltered in PD patients. However, free thyroxine (T(4) ) levels were significantly higher in PD patients compared to controls (16.19 ± 0.80 versus 13.88 ± 0.40 pmol/l; P = 0.031). In PD patients, prolactin levels were related to disease duration (r = 0.76, P = 0.028), whereas both GH (r = -0.91, P = 0.002) and free T(4) (r = -0.71, P = 0.050) levels correlated inversely with body fat content. Apart from a mild increase in free T(4) levels, we found no indications for altered somatotrophic, thyrotrophic and lactotrophic axes activity in early-stage PD patients.
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Affiliation(s)
- N A Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Hassan Y, Zainal ZA, Aziz NA, Al-Jabi SW, Ismail O. Prevention of Radiocontrast-Induced Nephropathy after Coronary Angiography: N-Acetylcysteine plus Saline Hydration versus Saline Hydration. TROP J PHARM RES 2011. [DOI: 10.4314/tjpr.v10i2.66553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
BACKGROUND Recently, a loss of hypothalamic dopamine D(2) receptors was demonstrated in Huntington's disease (HD). Activation of dopamine D(2) receptors is known to inhibit the function of both thyrotropic and lactotropic axes. OBJECTIVE To assess whether the activity of the thyrotropic and lactotropic axes is disturbed in patients with HD, contributing to symptoms such as unintended weight loss. PARTICIPANTS AND METHODS In nine medication-free patients with early-stage HD (six men, three women) and nine age-, sex- and body mass index-matched controls, we measured serum levels of thyroid-stimulating hormone (TSH) and prolactin (men only) every 10 min for 24 h. Multiparameter auto-deconvolution and approximate entropy analysis were applied to quantify basal, pulsatile and total TSH and prolactin secretion rates as well as the regularity of hormone release. RESULTS Compared with controls, TSH and prolactin secretion tended to be slightly, but not significantly, higher in patients with HD (TSH: 1.13 ± 0.14 vs 0.91 ± 0.19 mU/l, P = 0.40; prolactin: 213 ± 18 vs 209 ± 11 pmol/l, P = 0.87). However, in patients with HD, total T(3) levels were significantly higher (1.60 ± 0.05 vs 1.35 ± 0.09, P = 0.045), while T(4) levels tended to be higher as well (91.9 ± 3.9 vs 81.3 ± 3.1, P = 0.085). Prolactin secretion was significantly more irregular in patients with HD (Approximate entropy (ApEn): 1.06 ± 0.08 vs 0.80 ± 0.09, P = 0.037). Total T(3) levels were negatively associated with motor impairment (r = -0.72, P = 0.030), whereas increasing free T(4) levels were associated with a larger mutant cytosine-adenine-guanine (CAG) repeat size (r = +0.68, P = 0.044). CONCLUSION Our findings indicate a mild hyperactivity of the thyrotropic axis and a disturbed regulation of the lactotropic axis in patients with early-stage HD.
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Affiliation(s)
- N A Aziz
- Departments of Neurology Endocrinology and Metabolic Diseases Clinical Chemistry, Leiden University Medical Center, Leiden, The Netherlands.
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Hamid MZA, Aziz NA, Anita AR, Norlijah O. Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia. Southeast Asian J Trop Med Public Health 2010; 41:1192-1199. [PMID: 21073041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. We also aimed to assess the practices of universal precautions amongst these workers and its correlation with the facts. We carried out a cross-sectional study from January to July 2008 involving various levels of health-care workers in Serdang Hospital, Selangor, Malaysia. A self-administered questionnaire assessing knowledge of blood-borne diseases and universal precautions, and actual practice of universal precautions was used. Two hundred fifteen respondents participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice of universal precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions.
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Affiliation(s)
- M Z A Hamid
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia.
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Aziz NA, Anguelova GV, Marinus J, van Dijk JG, Roos RAC. Autonomic symptoms in patients and pre-manifest mutation carriers of Huntington's disease. Eur J Neurol 2010; 17:1068-74. [PMID: 20192977 DOI: 10.1111/j.1468-1331.2010.02973.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Although autonomic function tests have revealed abnormalities of the autonomic nervous system in Huntington's disease (HD), autonomic symptoms and their association with other symptoms and signs of HD have not yet been assessed in large groups of patients or pre-manifest mutation carriers. Therefore, we aimed at delineating the characteristics and correlates of autonomic symptoms in HD. METHODS Using the scales for outcomes in Parkinson's disease-autonomic symptoms (SCOPA-AUT) and Beck Depression Inventory questionnaires, autonomic symptoms and depressed mood were assessed in 63 patients with HD, 21 pre-manifest mutation carriers, and 85 controls. The Unified Huntington's Disease Rating Scale was used to assess other HD symptoms and signs. RESULTS Relative to controls, patients with HD experienced significantly more gastrointestinal, urinary, cardiovascular and, in men, sexual problems. The most prevalent symptoms were swallowing difficulties, erection and ejaculation problems, dysphagia, sialorrhea, early abdominal fullness, straining for defecation, fecal and urinary incontinence, urgency, incomplete bladder emptying, and light-headedness whilst standing. Pre-manifest mutation carriers experienced significantly more swallowing difficulties and light-headedness on standing up compared with controls. In patients with HD, autonomic symptoms were associated with a greater degree of functional disability, more severe depression, and antidepressant drugs use. However, depression was the only independent predictor of autonomic dysfunction. CONCLUSIONS Autonomic symptoms are highly prevalent in patients with HD and may even precede the onset of motor signs. Moreover, autonomic dysfunction is related to functional disability and depression in HD.
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Affiliation(s)
- N A Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Aziz NA, Leelavathi M, Tohid H, Hamzah MS. Challenges in managing dementia in a primary health care setting: A case report. S Afr Fam Pract (2004) 2009. [DOI: 10.1080/20786204.2009.10873919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Aziz NA, Jurgens CK, Landwehrmeyer GB, van Roon-Mom WMC, van Ommen GJB, Stijnen T, Roos RAC. Normal and mutant HTT interact to affect clinical severity and progression in Huntington disease. Neurology 2009; 73:1280-5. [PMID: 19776381 DOI: 10.1212/wnl.0b013e3181bd1121] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Huntington disease (HD) is an autosomal dominant neurodegenerative disorder caused by a CAG repeat expansion in the HD gene (HTT). We aimed to assess whether interaction between CAG repeat sizes in the mutant and normal allele could affect disease severity and progression. METHODS Using linear regression and mixed-effects models, the influence of mutant and normal CAG repeat sizes interaction was assessed on 1) age at onset in 921 patients with HD, 2) clinical severity and progression in 512 of these patients with follow-up data available, and 3) basal ganglia volume on magnetic resonance images in 16 premanifest HD mutation carriers. RESULTS Normal and mutant CAG repeat sizes interacted to influence 1) age at onset (p = 0.001), 2) severity or progression of motor, cognitive, and functional, but not behavioral, symptoms in patients with HD (all p < 0.05), and 3) in premanifest subjects, basal ganglia volumes (p < 0.05). In subjects with mutant CAG expansions in the low range, increasing size of the normal repeat correlated with more severe symptoms and pathology, whereas for those subjects with expansions in the high range, increasing size of the normal repeat correlated with less severe symptoms and pathology. CONCLUSIONS Increasing CAG repeat size in normal HTT diminishes the association between mutant CAG repeat size and disease severity and progression in Huntington disease. The underlying mechanism may involve interaction of the polyglutamine domains of normal and mutant huntingtin (fragments) and needs further elucidation. These findings may have predictive value and are essential for the design and interpretation of future therapeutic trials.
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Affiliation(s)
- N A Aziz
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands.
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Flavin R, Smyth P, Barrett C, Russell S, Wen H, Wei J, Laios A, O'Toole S, Ring M, Denning K, Li J, Aherne S, Sammarae D, Aziz NA, Alhadi A, Finn SP, Loda M, B S, Sheils O, O'Leary JJ. miR-29b expression is associated with disease-free survival in patients with ovarian serous carcinoma. Int J Gynecol Cancer 2009; 19:641-7. [PMID: 19509563 DOI: 10.1111/igc.0b013e3181a48cf9] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Micro-RNAs are a group of small noncoding RNAs approximately 22 nucleotides in length. Recent work has shown differential expression of mature micro-RNAs in human cancers. We characterized the alteration in expression of miR-29b in ovarian serous carcinoma. miR-29b expression was analyzed using quantitative stem-loop reverse transcriptase polymerase chain reaction on a set of 50 formalin-fixed, paraffin-embedded ovarian serous carcinoma samples. Protein expression of p53, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, and insulinlike growth factor 1 was quantified in the corresponding tissue microarray. The expression profile of miR-29b was correlated with clinicopathological and patient survival data. We provide definitive evidence that miR-29b is down-regulated in a significant proportion of ovarian serous carcinomas and is associated with specific clinicopathological features, most notably high miR-29b expression being associated with reduced disease-free survival.
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Affiliation(s)
- Richard Flavin
- Department of Histopathology, Trinity College, Dublin, Ireland.
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Aziz NA, van der Burg JMM, Landwehrmeyer GB, Brundin P, Stijnen T, Roos RAC. Weight loss in Huntington disease increases with higher CAG repeat number. Neurology 2008; 71:1506-13. [PMID: 18981372 DOI: 10.1212/01.wnl.0000334276.09729.0e] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Huntington disease (HD) is a hereditary neurodegenerative disorder caused by an expanded number of CAG repeats in the huntingtin gene. A hallmark of HD is unintended weight loss, the cause of which is unknown. In order to elucidate the underlying mechanisms of weight loss in HD, we studied its relation to other disease characteristics including motor, cognitive, and behavioral disturbances and CAG repeat number. METHODS In 517 patients with early stage HD, we applied mixed-effects model analyses to correlate weight changes over 3 years to CAG repeat number and various components of the Unified Huntington's Disease Rating Scale (UHDRS). We also assessed the relation between CAG repeat number and body weight and caloric intake in the R6/2 mouse model of HD. RESULTS In patients with HD, mean body mass index decreased with -0.15 units per year (p < 0.001). However, no single UHDRS component, including motor, cognitive, and behavioral scores, was independently associated with the rate of weight loss. Patients with HD with a higher CAG repeat number had a faster rate of weight loss. Similarly, R6/2 mice with a larger CAG repeat length had a lower body weight, whereas caloric intake increased with larger CAG repeat length. CONCLUSIONS Weight loss in Huntington disease (HD) is directly linked to CAG repeat length and is likely to result from a hypermetabolic state. Other signs and symptoms of HD are unlikely to contribute to weight loss in early disease stages. Elucidation of the responsible mechanisms could lead to effective energy-based therapeutics.
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Affiliation(s)
- N A Aziz
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands.
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Aziz NA, Leonardi-Bee J, Phillips M, Gladman JRF, Legg L, Walker MF. Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev 2008; 2008:CD005952. [PMID: 18425928 PMCID: PMC6464721 DOI: 10.1002/14651858.cd005952.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current practice of rehabilitation intervention mainly concentrates on the first six months of stroke. At present, there is no agreed consensus about the benefits of such a service more than one year after stroke. OBJECTIVES To ascertain whether therapy-based rehabilitation services can influence outcome one year or more after stroke. SEARCH STRATEGY We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched September 2007), Effective Practice and Organisation of Care Group (last searched October 2006) and Dementia and Cognitive Improvement Group (last searched October 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), PEDro (1952 to October 2006), British Nursing Index (1993 to October 2006), DARE (1994 to October 2006), HMIC (1979 to October 2006) and NHS EED (1991 to October 2006). We also searched dissertation databases and ongoing trials and research registers, scanned reference lists and contacted researchers and experts in the field. SELECTION CRITERIA All randomised controlled trials of community-based stroke patients, in which at least 75% were recruited one year after stroke and received a therapy-based rehabilitation intervention that was compared with conventional care. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data on a number of pre-specified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living at the end of scheduled follow up. MAIN RESULTS We identified five trials of 487 participants that were eligible for the review. Overall, there was inconclusive evidence as to whether therapy-based rehabilitation intervention one year after stroke was able to influence any relevant patient or carer outcome. Trials varied in design, type of interventions provided, quality, and outcomes assessed. AUTHORS' CONCLUSIONS This review highlights the dearth of evidence investigating long-term therapy-based rehabilitation interventions for patients with stroke.
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Affiliation(s)
- N A Aziz
- Universiti Kebangsaan Malaysia, Department of Family Medicine, Medical Faculty, Cheras, Kuala Lumpur, Malaysia, 53000.
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Hamid MZA, Aziz NA, Zulkifli ZS, Norlijah O, Azhar RK. Clinical features and risk factors for HIV encephalopathy in children. Southeast Asian J Trop Med Public Health 2008; 39:266-272. [PMID: 18564712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.
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Affiliation(s)
- M Z A Hamid
- Department of Pediatrics, Faculty of Medicine and Health, Universiti Putra Malaysia, Serdang, Selangor.
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Aziz NA, Swaab DF, Pijl H, Roos RAC. Hypothalamic dysfunction and neuroendocrine and metabolic alterations in Huntington's disease: clinical consequences and therapeutic implications. Rev Neurosci 2007; 18:223-51. [PMID: 18019608 DOI: 10.1515/revneuro.2007.18.3-4.223] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Huntington's disease (HD) is a hereditary neurodegenerative disorder characterized by cognitive, psychiatric, behavioural and motor disturbances. Although the course of HD is also frequently complicated by unintended weight loss, sleep disturbances and autonomic nervous system dysfunction, the aetiology of these signs and symptoms remains largely unknown. In recent years, many novel findings from both animal and human studies have emerged that indicate considerable hypothalamic, endocrine and metabolic alterations in HD. However, a comprehensive overview of these findings is lacking and their precise clinical significance is far from clear. Therefore, in this review we attempt to put these recent developments in the field into perspective by integrating them with previous findings in a comprehensible manner, and by discussing their clinical relevance, with a special focus on body weight, sleep and autonomic functions in HD, which will also allow for the identification of future lines of research in this area.
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Affiliation(s)
- N A Aziz
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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Tong SF, Aziz NA, Chin GL. Predictive value of thrombocytopaenia in the diagnosis of dengue infection in outpatient settings. Med J Malaysia 2007; 62:390-393. [PMID: 18705473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Thrombocytopaenia is often relied upon as an important criterion for the diagnosis of dengue infection among patients presenting with an acute non-specific febrile illness. This study was aimed to assess usefulness of thrombocytopaenia in the diagnosis of acute dengue virus infection. This was a clinic based prospective cohort study from May to November 2003. Consecutive patients presenting with acute non-specific febrile illness of less than two weeks were selected from two urban primary care centres. We did full blood count examination (FBC) on the day of visit and dengue serology on day five of illness for all patients enrolled. We repeated the FBC examination for patients who had initial normal platelet counts. Thrombocytopaenia was defined as platelet count < 150 X 10(9)/L. Eighty-seven patients enrolled in the study. Complete data was available for 73 patients. The prevalence of acute dengue virus infection was 27.6%. The sensitivity and specificity were 88% and 71% respectively. The likelihood of acute dengue infection in the presence of thrombocytopaenia was 2.52 and likelihood of not having dengue infection in normal platelet count patients was 5.22. Thrombocytopaenia has fair predictive value in diagnosing acute dengue virus infection. It was more useful to exclude than to diagnose dengue infection.
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Affiliation(s)
- S F Tong
- Department of Family Medicine, Medical Faculty, National University of Malaysia, Jalan Yaacob Latif, Cheras, 56000 Kuala Lumpur.
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Sweeney KJ, Kell MR, Aziz NA, Prunty N, Holloway P, Kennedy M, Flanagan F, Kerin MJ. The clinical and pathological differences in prevalent round screen-detected and symptomatic invasive breast cancer. Ir Med J 2007; 100:550-552. [PMID: 17955686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The potential benefits of breast cancer screening include the detection of cancers at a more favourable stage, however, cancers detected during the prevalent round of screening may differ from true screen-detected cancers. These differences are poorly defined. This study prospectively assessed all women between 50 and 64 years of age undergoing curative surgery for breast cancer, both screen-detected and symptomatic, in one screening centre during the prevalent round of the national breast cancer-screening programme. Four hundred and thirty seven patients (364 screen-detected and 73 symptomatic patients) underwent surgery for breast cancer. Symptomatic breast cancers were of a higher grade (p < 0.0001; Chi2) and less likely to be oestrogen receptor positive (49% versus 88%; p < 0.0001; Fisher's exact test); however there was no difference in size of tumour or axillary nodal positivity. This study suggests that tumours detected by screening during the prevalent round of a screening programme are of a more prognostically favourable type than symptomatic breast cancers in the same age group.
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Affiliation(s)
- K J Sweeney
- Department of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7.
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Ping CC, Hassan Y, Aziz NA, Ghazali R, Awaisu A. Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine?zinc): a case of decompensated liver cirrhosis in Wilson's disease. J Clin Pharm Ther 2007; 32:101-7. [PMID: 17286794 DOI: 10.1111/j.1365-2710.2007.00794.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. CASE SUMMARY A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. DISCUSSION Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20-30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. CONCLUSION In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs in clinical practice is certainly a subject of serious concern. Systems for better management of patients with rare diseases need to be instituted by all the institutions concerned.
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Affiliation(s)
- C C Ping
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Aziz NA, Norzila MZ, Hamid MZA, Noorlaili MT. Skills amongst parents of children with asthma: a pilot interventional study in primary care setting. Med J Malaysia 2006; 61:534-9. [PMID: 17623952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.
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Affiliation(s)
- N A Aziz
- Division of Rehabilitation and Ageing, School of Community Science, Medical School, B Floor, Queen Medical School, Nottingham, NG7 2UH, England
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van As AB, Aziz NA. Antibiotic prophylaxis in the management of dog bites. S Afr Med J 2002; 92:171. [PMID: 12040924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Kamel MI, Kamel NM, Foda N, Khashab S, Aziz NA. Epidemiological and risk predictors of severity of school injuries. East Mediterr Health J 1999; 5:676-83. [PMID: 11338689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Accidents are the leading cause of morbidity and mortality among schoolchildren. Epidemiological and risk predictors of injury severity were investigated among all school injuries presenting at the Students' Hospital in Alexandria during the scholastic year 1996-97. In all, 3422 injured pupils were surveyed. Age, nature of injury, place and mechanism of school injury and referral method were significant risk predictors for hospitalization. Age, referral method and nature of injury were significant predictors of referral to specialized health services. Injury severity score was significantly predicted by the presence of acute disease during time of injury, place and mechanism of injury as well as by provision of first aid and referral method and time.
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Affiliation(s)
- M I Kamel
- Community Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Abstract
With increasing budgetary restraints on the health system, it is apparent that the main contribution that radiology departments can make to significant cost reduction in hospitals is to decrease the length of time between requesting an X-ray examination and receiving the report (and images). Digital radiography (DR) was introduced into the Radiology Department at the Royal Adelaide Hospital as a pilot project to research the cost-benefits and efficiency of the system, and to determine future directions for planning a digital department. The business plan developed prior to implementation of this pilot project predicted a saving of one bed-day per inpatient when a fully digital department with a picture archiving and communication system (PACS) is installed. This initial study comparing DR and conventional radiography (convR) provides baseline data and shows encouraging results for more rapid transmission of reports to clinicians.
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Affiliation(s)
- S L Langlois
- Department of Radiology, Royal Adelaide Hospital, Australia
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43
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Abstract
In a 6-month study period, 170 pharmacist interventions in an intensive care unit (ICU) were analysed. Of the interventions, 68.8% were solicited and 31.2% were initiated by the pharmacists. The majority of the interventions were initiated by specialists (69.4%) followed by the medical officers (15.9%) and nurses (9.4%). Most of the interventions occurred during the grand rounds (75.9%), followed by ward visits (12.9%) and communication through the satellite pharmacy (10.5%). The most frequent type of intervention made was for indication or therapeutic efficacy followed by general product information, drug regimen, laboratory assessment, disease state, pharmaceutical availability and adverse drug reaction or side effect. It was also found that 83.7% of pharmacists' suggestions were accepted, 6.4% were accepted with changes, and 9.9% were not accepted. The majority of the interventions were made by direct verbal communications followed by telephone and written communications. In conclusion the study indicates that pharmacist therapeutic recommendations form an important integral element of patient care in an ICU.
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Affiliation(s)
- Y Hassan
- School of Pharmacy, Department of Pharmacy, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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44
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Abstract
This study examined out-patients' interpretation of prescription instructions at a community hospital. The results showed a wide range of misinterpretation with respect to drug name, dose schedule, and auxiliary labels. Age level, education and financial status emerged as the most significant variables associated with the patient's response. Therefore, both physicians and pharmacists may wish to review their traditional prescribing and dispensing procedures to help out-patients make better use of potent medication.
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Affiliation(s)
- A Sarriff
- Department of Clinical Pharmacy, Hospital Universiti Sains Malaysia, Kelantan
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