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Abdel-Aty H, Warren-Oseni K, Bagherzadeh-Akbari S, Hansen VN, Jones K, Harris V, Tan MP, Mcquaid D, McNair HA, Huddart R, Dunlop A, Hafeez S. Mapping Local Failure Following Bladder Radiotherapy According to Dose. Clin Oncol (R Coll Radiol) 2022; 34:e421-e429. [PMID: 35691760 PMCID: PMC9515812 DOI: 10.1016/j.clon.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
AIMS To determine the relationship between local relapse following radical radiotherapy for muscle-invasive bladder cancer (MIBC) and radiation dose. MATERIALS AND METHODS Patients with T2-4N0-3M0 MIBC were recruited to a phase II study assessing the feasibility of intensity-modulated radiotherapy to the bladder and pelvic lymph nodes. Patients were planned to receive 64 Gy/32 fractions to the bladder tumour, 60 Gy/32 fractions to the involved pelvic nodes and 52 Gy/32 fractions to the uninvolved bladder and pelvic nodes. Pre-treatment set-up was informed by cone-beam CT. For patients who experienced local relapse, cystoscopy and imaging (CT/MRI) was used to reconstruct the relapse gross tumour volume (GTVrelapse) on the original planning CT . GTVrelapse D98% and D95% was determined by co-registering the relapse image to the planning CT utilising deformable image registration (DIR) and rigid image registration (RIR). Failure was classified into five types based on spatial and dosimetric criteria as follows: A (central high-dose failure), B (peripheral high-dose failure), C (central elective dose failure), D (peripheral elective dose failure) and E (extraneous dose failure). RESULTS Between June 2009 and November 2012, 38 patients were recruited. Following treatment, 18/38 (47%) patients experienced local relapse within the bladder. The median time to local relapse was 9.0 months (95% confidence interval 6.3-11.7). Seventeen of 18 patients were evaluable based on the availability of cross-sectional relapse imaging. A significant difference between DIR and RIR methods was seen. With the DIR approach, the median GTVrelapse D98% and D95% was 97% and 98% of prescribed dose, respectively. Eleven of 17 (65%) patients experienced type A failure and 6/17 (35%) patients type B failure. No patients had type C, D or E failure. MIBC failure occurred in 10/17 (59%) relapsed patients; of those, 7/11 (64%) had type A failure and 3/6 (50%) had type B failure. Non-MIBC failure occurred in 7/17 (41%) patients; 4/11 (36%) with type A failure and 3/6 (50%) with type B failure. CONCLUSION Relapse following radiotherapy occurred within close proximity to the original bladder tumour volume and within the planned high-dose region, suggesting possible biological causes for failure. We advise caution when considering margin reduction for future reduced high-dose radiation volume or partial bladder radiotherapy protocols.
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Affiliation(s)
- H Abdel-Aty
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Bagherzadeh-Akbari
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - V N Hansen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - K Jones
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - V Harris
- Department of Radiotherapy, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - M P Tan
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Mcquaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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Chiew CL, Mat S, Hui KS, Tan MP. 455 PROSPECTIVE EVALUATION OF FRAILTY IN INDIVIDUALS WITH KNEE PAIN IN MALAYSIAN ELDERS LONGITUDINAL RESEARCH (MELOR) STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab119.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Osteoarthritis (OA) is a major cause of physical impairment in older persons. Few studies have determined the relationship between the presence of OA and frailty. We evaluated the prospective relationship between knee pain and frailty in a Malaysian longitudinal cohort.
Method
Data from Malaysian Elders Longitudinal Research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted questionnaires and hospital-based health-checks from 2013–2015. The presence of knee pain was determined with the single question, ‘do you have pain in your knee(s)?’. Frailty status was determined at follow-up in 2019 using SARC-F.
Results
Data from 1,226 individuals, mean age (SD) = 68.97 (7.48), range = 54–97 years and 56.6% women at baseline, were included. 408 (33.3%) had knee pain. Individuals with knee pain were significantly more likely to be female (66.2% vs 51.8%, p < 0.001). Ethnic differences existed in the presence of knee pain (Malay 43.4% vs Chinese 24.8% vs Indian 31.9%, p < 0.001). Individuals with knee pain was more likely to have diabetes (40.1% vs 29.9%, p < 0.001), hypertension (38.3% vs 27.0%, p < 0.001), dyslipidaemia (38.4% vs 26.5%, p < 0.001) and obesity (52.6% vs 30.2%, p < 0.001). After adjustment for confounders, individuals with knee pain were more significantly to develop frailty at follow-up [odds ratio (95% confidence interval) =2.71(1.61–4.58)].
Conclusion
Knee pain was associated with an increased risk of frailty with 5-years follow-up in an urban population in Kuala Lumpur. More detailed evaluation using imaging and clinical diagnosis of osteoarthritis is now indicated. Future studies should also seek to identify modifiable risk factors for the development of frailty in individuals with knee OA and develop strategies to prevent frailty.
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Affiliation(s)
- C L Chiew
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S Mat
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K S Hui
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M P Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan MP, Silva E. The case for breast-conservation treatment rates to be a quality metric. Curr Oncol 2020; 27:e442-e443. [PMID: 32905204 PMCID: PMC7467797 DOI: 10.3747/co.27.6539] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We read the article titled “Mastectomy versus breastconservation therapy: an examination of how individual, clinicopathologic, and physician factors influence decision-making” by Gu et al. […]
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Affiliation(s)
- M P Tan
- MammoCare, 38 Irrawaddy Road, 06-21, 329563 Singapore,
- Department of Surgery, 986345 University of Nebraska Medical Center, Omaha, Nebraska 68198-63445 U.S.A.,
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Effendi-Tenang I, Tan MP, Khaliddin N, Jamaluddin Ahmad M, Amir NN, Kamaruzzaman SB, Ramli N. Vision impairment and cognitive function among urban-dwelling malaysians aged 55 years and over from the Malaysian Elders Longitudinal Research (MELoR) study. Arch Gerontol Geriatr 2020; 90:104165. [PMID: 32650156 DOI: 10.1016/j.archger.2020.104165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/19/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Published literature on vision impairment and cognitive function amongst older Malaysians remains scarce. This study investigates the association between vision impairment and cognitive function in an older Malaysian population. METHODS Subjects aged 55 years and above from the Malaysian Elders Longitudinal Research (MELoR) study with available information on vision and Montreal Cognitive Assessment (MoCA) scores were included. Data were obtained through a home-based interview and hospital-based health check by trained researchers. Visual acuity (VA) was assessed with logMAR score with vision impairment defined as VA 6/18 or worse in the better-seeing eye. Cognition was evaluated using the MoCA-Blind scoring procedure. Those with a MoCA-Blind score of <19/22 were considered to have cognitive impairment. RESULTS Data was available for 1144 participants, mean (SD) age = 68.57 (±7.23) years. Vision impairment was present in 143 (12.5 %) and 758 (66.3 %) had MoCA-Blind score of <19. Subjects with vision impairment were less likely to have a MoCA-Blind score of ≥19 (16.8 % vs 36.2 %, p < 0.001). Vision impairment was associated with poorer MoCA-Blind scores after adjustments for age, gender, and ethnicity (β = 2.064; 95 % CI, -1.282 to 3.320; P = 0.003). In those who had > 6 years of education attainment, vision impairment was associated with a significant reduction of cognitive function and remained so after adjustment for age and gender (β = 1.863; 95 % CI, 1.081-3.209; P = 0.025). CONCLUSION Our results suggest that vision impairment correlates with cognitive decline. Therefore, maintaining good vision is an important interventional strategy for preventing cognitive decline in older adults.
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Affiliation(s)
- I Effendi-Tenang
- Department of Ophthalmology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Malaysia.
| | - M P Tan
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
| | - N Khaliddin
- Department of Ophthalmology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Malaysia.
| | - M Jamaluddin Ahmad
- Department of Ophthalmology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Malaysia.
| | - N N Amir
- Department of Ophthalmology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Malaysia.
| | - S B Kamaruzzaman
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - N Ramli
- Department of Ophthalmology, University Malaya Medical Centre, Kuala Lumpur, Malaysia; University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Malaysia.
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Nisha M, Aiman M, Asyhira N, Syafiq H, Atiqah N, Kumarasamy V, Tan MP, Davamani F. Risk factors associated with soil transmitted helminth (STH) infection in two indigenous communities in Malaysia. Trop Biomed 2020; 37:379-388. [PMID: 33612807] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Soil-transmitted helminth (STH) could possibly cause mild to severe health effects such as diarrhea, weakness, intestinal blood loss, and impaired cognitive development and growth. In Malaysia, previous studies depicted a high prevalence rate of STH was due to poor hygiene practice and low efficacies of anthelminthic drugs. This study was conducted to investigate hand hygiene practice and WASH criteria's (Water, sanitation and hygiene) related to STH infection among two indigenous tribes in Peninsular Malaysia. A cross-sectional study was carried out to study the relationship among STH infection compared to water quality, sanitation, and hygiene conditions. A total of 190 individuals from two indigenous villages participated in the study, with ages ranging from 5 to 60 years old. In addition, Pearson's Chisquare (X2) test was utilized to test the relationship among STH with demographic socioeconomic and behavioral factors. The confidence interval (CI) of 95% is used to estimate the precision of the odds ratio (OR). Multivariate logistic regression models were also used to identify the risk factors associated with STH infections. The overall findings indicated a prevalence rate of 72% for STH, and distributed mainly among children aged < 12 years. Furthermore, multivariate analyses using logistic regression revealed chronic health problems, incorrect hand washing, and walking bare footed were associated with STH infection. Overall results indicated high prevalence of STH among the indigenous villagers, which aligns with the published literature and proves to be a problem need to be addressed as neglected disease. Interestingly, there was a significant relationship between the presences of chronic diseases and STH infection, which prompted other questions the awareness needs to be educated and the simple and low-cost intervention on the proper way of hand washing may help to reduce STH infection in these indigenous communities.
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Affiliation(s)
- M Nisha
- Investigative Biomedical Science Research Cluster, Institute of Medical Science Technology, Universiti Kuala Lumpur (UniKL MESTECH), A1-1, Jalan TKS 1, Taman Kajang Sentral, Selangor, 43000 Kajang, Selangor, Malaysia
| | - M Aiman
- Investigative Biomedical Science Research Cluster, Institute of Medical Science Technology, Universiti Kuala Lumpur (UniKL MESTECH), A1-1, Jalan TKS 1, Taman Kajang Sentral, Selangor, 43000 Kajang, Selangor, Malaysia
| | - N Asyhira
- Investigative Biomedical Science Research Cluster, Institute of Medical Science Technology, Universiti Kuala Lumpur (UniKL MESTECH), A1-1, Jalan TKS 1, Taman Kajang Sentral, Selangor, 43000 Kajang, Selangor, Malaysia
| | - H Syafiq
- Investigative Biomedical Science Research Cluster, Institute of Medical Science Technology, Universiti Kuala Lumpur (UniKL MESTECH), A1-1, Jalan TKS 1, Taman Kajang Sentral, Selangor, 43000 Kajang, Selangor, Malaysia
| | - N Atiqah
- Investigative Biomedical Science Research Cluster, Institute of Medical Science Technology, Universiti Kuala Lumpur (UniKL MESTECH), A1-1, Jalan TKS 1, Taman Kajang Sentral, Selangor, 43000 Kajang, Selangor, Malaysia
| | - V Kumarasamy
- Faculty of Medicine and Biomedical Sciences, MAHSA University, Jalan SP 2, Bandar Saujana Putra, 42610, Jenjarum, Selangor, Malaysia
| | - M P Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya
| | - F Davamani
- International Medical University (IMU), No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Tan MP, Harris V, Warren-Oseni K, McDonald F, McNair H, Taylor H, Hansen V, Sharabiani M, Thomas K, Jones K, Dearnaley D, Hafeez S, Huddart RA. The Intensity-Modulated Pelvic Node and Bladder Radiotherapy (IMPART) Trial: A Phase II Single-Centre Prospective Study. Clin Oncol (R Coll Radiol) 2020; 32:93-100. [PMID: 31400946 PMCID: PMC6966321 DOI: 10.1016/j.clon.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/20/2022]
Abstract
AIMS Node-positive bladder cancer (NPBC) carries a poor prognosis and has traditionally been treated palliatively. However, surgical series suggest that a subset of NPBC patients can achieve long-term control after cystectomy and lymph node dissection. There is little published data regarding the use of radiotherapy to treat NPBC patients. This is in part due to concerns regarding the toxicity of whole-pelvis radiotherapy using conventional techniques. We hypothesised that, using intensity-modulated radiotherapy (IMRT), the pelvic nodes and bladder could be treated within a radical treatment volume with acceptable toxicity profiles. MATERIALS AND METHODS The Intensity-modulated Pelvic Node and Bladder Radiotherapy (IMPART) trial was a phase II single-centre prospective study designed to assess the feasibility of delivering IMRT to treat the bladder and pelvic nodes in patients with node-positive or high-risk node-negative bladder cancer (NNBC). The primary end point was meeting predetermined dose constraints. Secondary end points included acute and late toxicity, pelvic relapse-free survival and overall survival. RESULTS In total, 38 patients were recruited and treated between June 2009 and November 2012; 22/38 (58%) had NPBC; 31/38 (81.6%) received neoadjuvant chemotherapy; 18/38 (47%) received concurrent chemotherapy; 37/38 (97%) patients had radiotherapy planned as per protocol. Grade 3 gastrointestinal and genitourinary acute toxicity rates were 5.4 and 20.6%, respectively. At 1 year, the grade 3 late toxicity rate was 5%; 1-, 2- and 5-year pelvic relapse-free survival rates were 55, 37 and 26%, respectively. The median overall survival was 1.9 years (95% confidence interval 1.1-3.8) with 1-, 2- and 5-year overall survival rates of 68, 50 and 34%, respectively. CONCLUSION Delivering IMRT to the bladder and pelvic nodes in NPBC and high-risk NNBC is feasible, with low toxicity and low pelvic nodal recurrence rates. Long-term control seems to be achievable in a subset of patients. However, relapse patterns suggest that strategies targeting both local recurrence and the development of distant metastases are required to improve patient outcomes.
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Affiliation(s)
- M P Tan
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Harris
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - F McDonald
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H McNair
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H Taylor
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Hansen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - M Sharabiani
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; The School of Public Health, Imperial College London, London, UK
| | - K Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; ICBARC, London, UK
| | - K Jones
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - D Dearnaley
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Hafeez
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - R A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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Tay CL, Myint PK, Mohazmi M, Soiza RL, Tan MP. Prevalence and documented causes of hyponatraemia among geriatric patients attending a primary care clinic. Med J Malaysia 2019; 74:121-127. [PMID: 31079122] [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: 06/09/2023]
Abstract
INTRODUCTION Hyponatraemia is the commonest electrolyte abnormality and has major clinical implications. However, few studies of hyponatraemia in the primary care setting has been published to date. OBJECTIVES To determine the prevalence, potential causes and management of hyponatraemia and to identify factors associated with severity of hyponatraemia among older persons in a primary care setting. METHODS Electronic records were searched to identify all cases aged ≥60 years with a serum sodium <135mmol/l, attending outpatient clinic in 2014. Patients' medical records with the available blood test results of glucose, potassium, urea and creatinine were reviewed. RESULTS Of the 21,544 elderly, 5873 patients (27.3%) had electrolyte profile tests. 403 (6.9%) had hyponatraemia in at least one blood test. Medical records were available for 253, mean age 72.9±7.3 years, 178 (70.4%) had mild hyponatraemia, 75 (29.6%) had moderate to severe hyponatraemia. Potential causes were documented in 101 (40%). Patients with moderate to severe hyponatraemia were five times more likely to have a cause of hyponatraemia documented (p<0.01). Medications were the commonest documented cause of hyponatraemia (31.7%). Hydrochlorothiazide use was attributed in 25 (78.1%) of 32 with medication-associated hyponatraemia. Repeat renal profile (89%) was the commonest management of hypotonic hyponatraemia. CONCLUSION Whilst hyponatraemia was common in the clinic setting, many cases were not acknowledged and had no clear management strategies. In view of mild hyponatraemia has deleterious consequences, future studies should determine whether appropriate management of mild hyponatraemia will lead to clinical improvement.
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Affiliation(s)
- C L Tay
- Simpang Health Clinic, Taiping, Perak, Malaysia.
| | - P K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition College of Life Sciences & Medicine, University of Aberdeen, United Kingdom
| | - M Mohazmi
- University of Malaya Medical Centre, Department of Primary Care Medicine, Kuala Lumpur, Malaysia
| | - R L Soiza
- Aberdeen Royal Infirmary Foresterhill, Department of Geriatric Medicine, Aberdeen, United Kingdom
| | - M P Tan
- University of Malaya Medical Centre, Department of Medicine, Geriatric Unit, Kuala Lumpur, Malaysia
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Liao SJ, Chong MC, Tan MP, Chua YP. Tai Chi with music improves quality of life among community-dwelling older persons with mild to moderate depressive symptoms: A cluster randomized controlled trial. Geriatr Nurs 2018; 40:154-159. [PMID: 30173939 DOI: 10.1016/j.gerinurse.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/26/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P < 0.001, ηp2= 0.435, F = 18.696, P < 0.001, ηp2= 0.364, F = 17.473, P< 0.001, ηp2= 0.348, and F = 29.576, P < 0.001, ηp2= 0.475 for physical, psychological, social, and environment domains respectively). This intervention represents an economically viable solution to better QOL and healthy ageing in a highly populous developing nation.
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Affiliation(s)
- S J Liao
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Ya'an Polytechnic College, 130 Yucai Road, Yucheng District, Ya'an City, Sichuan Province, China
| | - M C Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - M P Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Wellness Research Cluster, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y P Chua
- Institute of Educational Leadership, Faculty of Education, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Liao SJ, Tan MP, Chong MC, Chua YP. The Impact of Combined Music and Tai Chi on Depressive Symptoms Among Community-Dwelling Older Persons: A Cluster Randomized Controlled Trial. Issues Ment Health Nurs 2018; 39:398-402. [PMID: 29436896 DOI: 10.1080/01612840.2017.1417519] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The effectiveness of pharmacological treatment may be limited in older persons. Several studies using Tai Chi or music therapy separately confirmed positive effects in the reduction of depressive symptoms. We conducted a cluster randomized controlled trial to evaluate the possible synergistic effect of combined music and Tai Chi on depressive symptoms. METHODS One hundred and seven older adults with mild to moderate depressive symptoms were recruited from Ya'an city. Fifty-five participants were cluster randomized to combined music and Tai Chi group for three months, while the other fifty-two individuals were randomized to the control group that entailed routine health education delivered monthly by community nurses. The primary outcome of depressive symptoms was measured with the Geriatric Depression Scale (GDS) at baseline and monthly for three months. RESULTS At three-month follow-up, a statistically significant improvement in depressive symptoms was found in the intervention group compared with control group (F(3,315) = 69.661, P < 0.001). Following adjustments for socio-demographic data, the true effect of intervention on depressive symptoms was significant (F = 41.725, P < 0.01, ηp2 = 0.574). CONCLUSIONS Combined music and Tai Chi reduced depressive symptoms among community-dwelling older persons. This represents an economically viable solution to the management of depression in highly populous developing nations.
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Affiliation(s)
- S J Liao
- a University of Malaya , Department of Nursing Science, Faculty of Medicine , Kuala Lumpur , Malaysia.,b Department of Nursing Science , Ya'an Polytechnic College , Ya'an City , Sichuan Province , China
| | - M P Tan
- c University of Malaya, Division of Geriatric Medicine , Department of Medicine, Faculty of Medicine , Kuala Lumpur , Malaysia.,d University of Malaya, Ageing and Age-Associated Disorders Research Group, Wellness Research Cluster , Kuala Lumpur , Malaysia
| | - M C Chong
- a University of Malaya , Department of Nursing Science, Faculty of Medicine , Kuala Lumpur , Malaysia
| | - Y P Chua
- e Institute of Educational Leadership, University of Malaya , Kuala Lumpur , Malaysia
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Gan SY, Saedon NI, Sukanya S, Fairuz NHA, Sakinah SMN, Fatin NIAH, Imran ZA, Chee KH, Teo JYL, Tan MP. Experience of a rapid access falls and syncope service at a teaching hospital in Kuala Lumpur. Med J Malaysia 2017; 72:203-208. [PMID: 28889130] [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: 06/07/2023]
Abstract
No abstract available.
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Affiliation(s)
- S Y Gan
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia.
| | - N I Saedon
- University of Malaya Medical Centre, Faculty of Medicine, Division of Geriatric Medicine, Kuala Lumpur, Malaysia
| | - S Sukanya
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia
| | - N H A Fairuz
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia
| | - S M N Sakinah
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia
| | - N I A H Fatin
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia
| | - Z A Imran
- University of Malaya Medical Centre, Faculty of Medicine, Division of Cardiology, Kuala Lumpur, Malaysia
| | - K H Chee
- University of Malaya Medical Centre, Faculty of Medicine, Division of Geriatric Medicine, Kuala Lumpur, Malaysia
| | - J Y L Teo
- University of Malaya Medical Centre, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - M P Tan
- University of Malaya Medical Centre, Cardiorespiratory Laboratory, Kuala Lumpur, Malaysia
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Rosli R, Loh DA, Choo WY, MohdHairi F, Peramalah D, Kandiben S, Lee PL, Gani N, Madzlan MF, Abd Hamid MAI, Akram Z, Chu AS, Bulgiba A, Cumming RG, Tan MP, Chin AV, Hairi NN. 26EFFECTS OF MULTICOMPONENT EXERCISE AND THERAPEUTICLIFESTYLE (CERGAS) INTERVENTION ON COGNITIVE FUNCTION IN LOWER INCOME ELDERLY POPULATION: A CLUSTER RANDOMISED CONTROLLED TRIAL. Age Ageing 2017. [DOI: 10.1093/ageing/afx118.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Strassheim V, Newton JL, Tan MP, Frith J. 31DROXIDOPA FOR ORTHOSTATIC HYPOTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS. Age Ageing 2017. [DOI: 10.1093/ageing/afx107.31] [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: 11/13/2022] Open
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Tan PJ, Khoo EM, Hill KD, MacKenzie L, Kamaruzzaman SB, Khor HM, Saedon NI, Tan MP. 44THE EFFECTS OF A TAILORED MULTIFACTORIAL INTERVENTION ON RATE OF FALL AND TIME-TO-FIRST FALL IN MALAYSIA. Age Ageing 2017. [DOI: 10.1093/ageing/afx120.44] [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: 11/14/2022] Open
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Khor HM, Tan PJ, Saedon NI, Kamaruzzaman SB, Tan MP. 43DOES A MULTIFACTORIAL INTERVENTIONAL PROGRAMME ON FALLS PREVENTION IN OLDER FALLERS IMPROVE FRAILTY OUTCOMES? PRELIMINARY RESULTS FROM THE MALAYSIAN FALLS ASSESSMENT INTERVENTION TRIAL (MYFAIT). Age Ageing 2017. [DOI: 10.1093/ageing/afx120.43] [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: 11/14/2022] Open
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Roshaslina R, Tan MP, Gray WK, Subramanian P, Chin AV. 27PICTURE-BASED MEMORY IMPAIRMENT SCREEN FOR DEMENTIA: INFLUENCE OF ETHNICITY AND EDUCATION LEVEL AMONG THE ELDERLY IN MALAYSIA. Age Ageing 2017. [DOI: 10.1093/ageing/afx118.27] [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: 11/13/2022] Open
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Mat S, Jaafar MH, Tan MP. 29VITAMIN D DEFICIENCY IS ASSOCIATED WITH ETHNICITY AND KNEE PAIN SEVERITY IN A MULTI-ETHNIC SOUTH EAST ASIAN NATION. Age Ageing 2017. [DOI: 10.1093/ageing/afx117.29] [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: 11/13/2022] Open
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Izzati N, Khor HM, Tan PJ, Sumaiyah M, Nemala N, Tan MP. 120POTENTIAL RISK FACTORS AMONG INDIVIDUALS WITH RECURRENT AND INJURIOUS FALLS RECRUITED TO THE MALAYSIAN FALLS ASSESSMENT AND INTERVENTION TRIAL (MYFAIT). Age Ageing 2017. [DOI: 10.1093/ageing/afx072.120] [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: 11/14/2022] Open
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Tan PJ, Tan MP. 119CHARACTERISTICS OF FALL RECURRENCE: RESULTS OF THE MALAYSIAN FALLS ASSESSMENT AND INTERVENTION TRIAL (MYFAIT). Age Ageing 2017. [DOI: 10.1093/ageing/afx072.119] [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: 11/12/2022] Open
Affiliation(s)
- P J Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya
| | - M P Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya
- Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya
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Goh CH, Ng SC, Tan MP. 102THE INFLUENCE OF AGE AND SYSTOLIC BLOOD PRESSURE ON BLOOD PRESSURE VARIABILITY AMONG HEALTHY OLDER INDIVIDUALS. Age Ageing 2017. [DOI: 10.1093/ageing/afx059.102] [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: 11/12/2022] Open
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Romli MH, Tan MP, Mackenzie L, Lovarini M, Suttanon P, Clemson L. Falls amongst older people in Southeast Asia: a scoping review. Public Health 2017; 145:96-112. [PMID: 28359399 DOI: 10.1016/j.puhe.2016.12.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 07/08/2016] [Revised: 11/07/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The older population in the Southeast Asian region is accelerating and is expected to surpass the proportion of the ageing population in North America and Europe in the future. This study aims to identify the research literature related to falls among older people in Southeast Asia, to examine current practice and discuss the future direction on falls prevention and interventions in the region. STUDY DESIGN A scoping review design was used. METHODS A systematic literature search was conducted using the Medline, CINAHL, AMED, Ageline, PsycINFO, Web of Sciences, Scopus, Thai-Journal Citation Index, MyCite and trial registries databases. RESULTS Thirty-seven studies and six study protocols were included, from Thailand, Malaysia, Singapore, Vietnam, Indonesia and the Philippines. One-sixth of the studies involved interventions, while the remainder were observational studies. The observational studies mainly determined the falls risk factors. The intervention studies comprised multifactorial interventions and single interventions such as exercises, educational materials and visual correction. Many of the studies replicated international studies and may not have taken into account features unique to Southeast Asia. CONCLUSION Our review has revealed studies evaluating falls and management of falls in the Southeast Asian context. More research is required from all Southeast Asian countries to prepare for the future challenges of managing falls as the population ages.
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Affiliation(s)
- M H Romli
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia; Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - M P Tan
- Ageing and Age Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - L Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - M Lovarini
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - P Suttanon
- Faculty of Allied Health Sciences, Thammasat University, 99 Moo 18 Paholyothin Road, Klong Luang, Rangsit, Prathumthani 12120, Thailand.
| | - L Clemson
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
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Jaafar MH, Mahadeva S, Subramanian P, Tan MP. Perceptions of Healthcare Professionals on the Usage of Percutaneous Endoscopic Gastrostomy in a Teaching Hospital from a Middle-Income South East Asian Country. J Nutr Health Aging 2017; 21:473-479. [PMID: 28346575 DOI: 10.1007/s12603-016-0774-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/27/2022]
Abstract
OBJECTIVE To explore the perceptions of healthcare professionals' (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding. DESIGN Semi-structured, qualitative interviews. SETTINGS A teaching hospital in Kuala Lumpur, Malaysia. PARTICIPANTS A total of 17 healthcare professionals aged 23-43 years, 82% women. RESULTS Thematic analysis revealed five themes that represent HCPs' perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability. CONCLUSION The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.
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Affiliation(s)
- M H Jaafar
- Maw Pin Tan, MBBS, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia, Telephone: +6016-3328600 / +603-79493200, Email :
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Tan MP, Dolton GM, Gerry AB, Brewer JE, Bennett AD, Pumphrey NJ, Jakobsen BK, Sewell AK. Human leucocyte antigen class I-redirected anti-tumour CD4 + T cells require a higher T cell receptor binding affinity for optimal activity than CD8 + T cells. Clin Exp Immunol 2016; 187:124-137. [PMID: 27324616 PMCID: PMC5167017 DOI: 10.1111/cei.12828] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/12/2022] Open
Abstract
CD4+ T helper cells are a valuable component of the immune response towards cancer. Unfortunately, natural tumour‐specific CD4+ T cells occur in low frequency, express relatively low‐affinity T cell receptors (TCRs) and show poor reactivity towards cognate antigen. In addition, the lack of human leucocyte antigen (HLA) class II expression on most cancers dictates that these cells are often unable to respond to tumour cells directly. These deficiencies can be overcome by transducing primary CD4+ T cells with tumour‐specific HLA class I‐restricted TCRs prior to adoptive transfer. The lack of help from the co‐receptor CD8 glycoprotein in CD4+ cells might result in these cells requiring a different optimal TCR binding affinity. Here we compared primary CD4+ and CD8+ T cells expressing wild‐type and a range of affinity‐enhanced TCRs specific for the HLA A*0201‐restricted NY‐ESO‐1‐ and gp100 tumour antigens. Our major findings are: (i) redirected primary CD4+ T cells expressing TCRs of sufficiently high affinity exhibit a wide range of effector functions, including cytotoxicity, in response to cognate peptide; and (ii) optimal TCR binding affinity is higher in CD4+ T cells than CD8+ T cells. These results indicate that the CD4+ T cell component of current adoptive therapies using TCRs optimized for CD8+ T cells is below par and that there is room for substantial improvement.
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Affiliation(s)
- M P Tan
- Cardiff University School of Medicine, Cardiff, UK
| | - G M Dolton
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | | | | | - A K Sewell
- Cardiff University School of Medicine, Cardiff, UK
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Tan MP, Jamsari AFJ, Siti Azizah MN. Genotyping of microsatellite markers to study genetic structure of the wild striped snakehead Channa striata in Malaysia. J Fish Biol 2016; 88:1932-1948. [PMID: 27027270 DOI: 10.1111/jfb.12956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
Genetic variability and differences in wild striped snakehead Channa striata from Malaysia were analysed by genotyping nine novel nuclear microsatellite loci. Analysis revealed moderate-to-high genetic diversity in most of the populations, indicative of large effective population sizes. The highly diversified populations are admixed populations and, therefore, can be recommended as potential candidates for selective breeding and conservation since they each contain most of the alleles found in their particular region. Three homogenous groups of the wild populations were identified, apparently separated by effective barriers, in accordance with contemporary drainage patterns. The highest population pairwise FST found between members of the same group reflects the ancient population connectivity; yet prolonged geographical isolation resulted in adaptation of alleles to local contemporary environmental change. A significant relationship between genetic distance and geographical isolation was observed (r = 0·644, P < 0·01). Anthropogenic perturbations indicated apparent genetic proximity between distant populations.
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Affiliation(s)
- M P Tan
- School of Fisheries and Aquaculture Sciences, Universiti Malaysia Terengganu, 21030, Kuala Terengganu, Terengganu, Malaysia
- Institut Akuakultur Tropika (AKUATROP), Universiti Malaysia Terengganu, 21030, Kuala Terengganu, Terengganu, Malaysia
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - A F J Jamsari
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - M N Siti Azizah
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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Zia A, Kamaruzzaman S, Myint PK, Tan MP. Anticholinergic burden is associated with recurrent and injurious falls in older individuals. Maturitas 2015; 84:32-7. [PMID: 26531071 DOI: 10.1016/j.maturitas.2015.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 06/21/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE While the anticholinergic activity of medications has been linked to cognitive decline, few studies have linked anticholinergic burden with falls in older people. We evaluated the relationship between anticholinergic burden and recurrent and injurious falls among community-dwelling older adults. STUDY DESIGN This case-control study was performed on 428 participants aged ≥65 years, 263 cases with two or more falls or one injurious fall in the preceding 12 months, and 165 controls with no falls in the preceding 12 months. Anticholinergic burden was determined using the anticholinergic cognitive burden (ACB) scale. Upper and lower limb functional abilities were assessed with timed up and go (TUG), functional reach (FR) and grip strength (GS). Logistic regression analysis was employed to calculate the mediation effect of TUG, FR and GS on ACB associated falls. RESULTS Univariate analysis revealed a significant association between an ACB score of ≥1 with falls (OR, 1.8; 95% CI; 1.1-3.0; p=0.01) and significantly poorer TUG and FR. The association between ACB≥1 and falls was no longer significant after adjustment for either TUG (OR for ACB associated falls, 1.4; 95% CI, 0.88-2.4; p=0.14) or FR (OR for ACB associated falls, 1.4; 95% CI, 0.89-2.4, p=0.12) but remained significant with GS. CONCLUSION The association between recurrent and injurious falls and the use of any medications listed in the ACB scale was mediated through gait and balance impairment but not by muscular weakness, providing a novel insight into the potential mechanistic link between ACB and falls. Future studies should determine whether TUG and FR measurements could help inform risk to benefit decisions where ACB medications are being considered.
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Affiliation(s)
- Anam Zia
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
| | - S Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Phyo Kyaw Myint
- AGEING, Epidemiology Group, School of Medicine & Dentistry, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - M P Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre of Innovation in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia.
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Tan MP, Gerry AB, Brewer JE, Melchiori L, Bridgeman JS, Bennett AD, Pumphrey NJ, Jakobsen BK, Price DA, Ladell K, Sewell AK. T cell receptor binding affinity governs the functional profile of cancer-specific CD8+ T cells. Clin Exp Immunol 2015; 180:255-70. [PMID: 25496365 PMCID: PMC4408161 DOI: 10.1111/cei.12570] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 12/17/2022] Open
Abstract
Antigen-specific T cell receptor (TCR) gene transfer via patient-derived T cells is an attractive approach to cancer therapy, with the potential to circumvent immune regulatory networks. However, high-affinity tumour-specific TCR clonotypes are typically deleted from the available repertoire during thymic selection because the vast majority of targeted epitopes are derived from autologous proteins. This process places intrinsic constraints on the efficacy of T cell-based cancer vaccines and therapeutic strategies that employ naturally generated tumour-specific TCRs. In this study, we used altered peptide ligands and lentivirus-mediated transduction of affinity-enhanced TCRs selected by phage display to study the functional properties of CD8(+) T cells specific for three different tumour-associated peptide antigens across a range of binding parameters. The key findings were: (i) TCR affinity controls T cell antigen sensitivity and polyfunctionality; (ii) supraphysiological affinity thresholds exist, above which T cell function cannot be improved; and (iii) T cells transduced with very high-affinity TCRs exhibit cross-reactivity with self-derived peptides presented by the restricting human leucocyte antigen. Optimal system-defined affinity windows above the range established for natural tumour-specific TCRs therefore allow the enhancement of T cell effector function without off-target effects. These findings have major implications for the rational design of novel TCR-based biologics underpinned by rigorous preclinical evaluation.
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Affiliation(s)
- M P Tan
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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Jaafar MH, Mahadeva S, Morgan K, Tan MP. Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review. J Nutr Health Aging 2015; 19:190-7. [PMID: 25651445 DOI: 10.1007/s12603-014-0527-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 10/24/2022]
Abstract
OBJECTIVE The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia. METHODS We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia. RESULTS 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective. CONCLUSIONS Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.
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Affiliation(s)
- M H Jaafar
- M.P. Tan, Department of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia,
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Nordin N, Tiwari D, Tan MP. 123 * FRAILTY PREDICTORS AND OUTCOMES FOR GERIATRIC IN-PATIENTS. Age Ageing 2014. [DOI: 10.1093/ageing/afu046.6] [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: 11/12/2022] Open
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Saedon NI, Tan MP, Abidin IZ, Kamaruzzaman SB, Poi PJH. 92 * A CASE CONTROL STUDY OF CARDIOVASCULAR ASPECTS OF FALLS IN URBAN OLDER POPULATION IN MALAYSIA. Age Ageing 2014. [DOI: 10.1093/ageing/afu039.6] [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: 11/12/2022] Open
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Dayana SMH, Lim SM, Tan MP, Chin AV, Poi PJH, Kamaruzzaman SB, Majeed ABA, Ramasamy K. 115 * IP-10 AND IL-13 AS POTENTIALLY NEW, NON-CLASSICAL BLOOD-BASED CYTOKINE BIOMARKERS FOR ALZHEIMER'S DISEASE. Age Ageing 2014. [DOI: 10.1093/ageing/afu045.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tan MP, Kenny RAM, Chadwick TJ, Kerr SRJ, Parry SW. Carotid sinus hypersensitivity: disease state or clinical sign of ageing? Insights from a controlled study of autonomic function in symptomatic and asymptomatic subjects. Europace 2010; 12:1630-6. [DOI: 10.1093/europace/euq317] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Sutcliffe K, Gray J, Tan MP, Pairman J, Wilton K, Parry SW, Newton JL. Home orthostatic training in chronic fatigue syndrome--a randomized, placebo-controlled feasibility study. Eur J Clin Invest 2010; 40:18-24. [PMID: 19912315 DOI: 10.1111/j.1365-2362.2009.02225.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Orthostatic (Tilt)-training is an effective treatment for neurally mediated hypotension (NMH). NMH is a frequent finding in chronic fatigue syndrome (CFS). We evaluated home orthostatic training (HOT) in CFS in a randomized placebo-controlled feasibility study. METHODS Thirty-eight patients with CFS (Fukuda Criteria) were randomly allocated to daily tilt training (n = 19) or sham training (n = 19) for 6 months. Haemodynamic responses to standing were performed in all subjects using continuous technology (Taskforce) at enrolment, week 1, 4 and 24. Symptom response and compliance were assessed using diaries. RESULTS Two patients (one from each arm) withdrew from the study. Fourteen patients in each group complied completely or partially, and patients found the training manageable and achievable. Compared to the sham group, blood pressure while standing dropped to 8.0 mmHg less in the HOT group at 4 weeks (95% CI: 1.0 to 15.0, P = 0.03). At 4 weeks, the HOT group had higher total peripheral resistance compared to the sham group; mean difference 70.2, 95% CI: -371.4 to 511.8. Changes were maintained at 6 months. There was no significant difference in fatigue between groups at 4 weeks (mean difference 1.4, 95% CI: -13.5 to 16.2), but there was a trend towards improvement in fatigue at 6 months. Compliers had lower fatigue compared to non-compliers. CONCLUSIONS A placebo-controlled study of HOT in CFS is feasible. HOT is well tolerated and generally complied with. A likely physiological rationale for HOT in CFS is related to reductions in orthostatic intolerance. An adequately powered study including strategies to enhance compliance is warranted.
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Affiliation(s)
- K Sutcliffe
- UK NIHR Biomedical Research Centre in Ageing - Cardiovascular Theme, Newcastle, UK
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Tan MP, Newton JL, Chadwick TJ, Gray JC, Nath S, Parry SW. Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study. Europace 2009; 12:240-6. [DOI: 10.1093/europace/eup368] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tan MP, Duncan GW, Parry SW. Head-up Tilt Table Testing: a state-of-the-art review. Minerva Med 2009; 100:329-338. [PMID: 19749686] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Vasovagal syncope (VVS) is the commonest cause of syncope accounting for up to 60% of all cases. The head-up tilt-table test (HUTT) was first described as a diagnostic test for VVS in 1986 and is now in widespread use as a research and diagnostic tool. Vasovagal syncope was previously thought to be confined to younger patients but with the introduction of HUTT, it is now being diagnosed with greater frequency in the elderly. Research into the physiological changes in susceptible individuals during HUTT has greatly increased our understanding of the pathophysiological processes underlying VVS; in particular, the hypotensive response during VVS is associated with sympathetic withdrawal rather than bradycardia alone. Various provocation agents, including nitrates, isoprotenerol and lower body negative pressure have been described to improve the diagnostic yield of the HUTT. Glyceryl trinitrate is now routinely administered during HUTTs. Individuals with typical presentations and infrequent episodes do not require investigation with HUTT as history alone is often diagnostic. The head-up tilt-table test is, however, required with atypical features, seizure activity, occupational issues, and is more likely to be required in older patients. The practicalities of conducting the HUTT and limitations of HUTTs are also discussed.
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Affiliation(s)
- M P Tan
- Institute for Ageing and Health, Newcastle University, Newcastle, UK
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Tan MP, Newton JL, Chadwick TJ, Parry SW. The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study. Europace 2008; 10:1400-5. [DOI: 10.1093/europace/eun278] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tan MP. Re: Langer's axillary arch: Anatomy, embryological features and surgical implications. Surgeon 2005;3(5):325-27. Surgeon 2006; 4:252; author reply 252. [PMID: 16892847] [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: 05/11/2023]
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Abstract
BACKGROUND It has been stated that completion thyroidectomy for thyroid malignancy should be performed either within 10 days of the primary operation or after 3 months, to reduce the incidence of complications. The aim of this study was to review the impact of timing on the rate of complications following completion thyroidectomy. METHODS Data were obtained retrospectively from the Endocrine Surgery Thyroid Data Base, to which the records of all patients have been entered since 1957. The patients who had the last 100 consecutive completion thyroidectomies for thyroid cancer comprised the study group. RESULTS Sixty-three patients had the second operation performed within 10 days or more than 90 days after the initial operation (group 1). Thirty-seven patients had reoperation between 10 and 90 days after the first procedure (group 2). One patient (2 per cent) in group 1 and one patient (3 per cent) in group 2 suffered a permanent complication (P not significant). CONCLUSION There was no definite impact of the timing of surgery on the rate of complications after completion thyroidectomy.
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Affiliation(s)
- M P Tan
- Endocrine Surgical Unit, Department of Surgery, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
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Tan MP, Cheong DM. Life-threatening perineal gangrene from rectal perforation following colonic hydrotherapy: a case report. Ann Acad Med Singap 1999; 28:583-5. [PMID: 10561777] [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: 02/14/2023]
Abstract
Alternative medicine is widely publicized in Singapore. To date there are few reports of complications arising as a result of such treatments. However, there is no legislation as yet governing alternative medicine practitioners. We present an unusual case of a patient who developed life-threatening perineal gangrene as a result of rectal perforation following colonic hydrotherapy.
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Affiliation(s)
- M P Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Abstract
An 11-day-old male infant presented with subarachnoid and intraventricular haemorrhage caused by a ruptured intracranial aneurysm. Magnetic resonance (MR) angiogram and digital subtraction angiography (DSA) revealed a fusiform aneurysm 10 mm in diameter supplied by the proximal segment of the anterior cerebral artery (A1), with both distal segments (A2) arising from the aneurysm. The right A1 was aplastic. There have been 13 previous case reports of neonatal cerebral artery aneurysms, but only 1 of these has been fusiform. None of the earlier reports has mentioned dysplastic segments or other anomalies of the circle of Willis.
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Affiliation(s)
- M P Tan
- Department of Paediatric Neurosurgery, Queen's Medical Centre, Nottingham, UK
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