National Clinical Research Center

Havana, Cuba

National Clinical Research Center

Havana, Cuba
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PubMed | Washington University in St. Louis, George Washington University, Cleveland Clinic, University of Malaya and National Clinical Research Center
Type: Journal Article | Journal: BMJ open | Year: 2016

The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush (Just for Me; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting ones own sample.Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87).Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.

News Article | December 17, 2016

LUGANO-SINGAPORE, Dec. 18, 2016 - Cancer has a major impact on mental and physical wellbeing, researchers report at the ESMO Asia 2016 Congress in Singapore. Results from a Malaysian study (1) of 1,362 patients found more than four in five survivors were suffering from anxiety and a similar number had depression a year after diagnosis. Lead author Shridevi Subramaniam, a research officer at the National Clinical Research Center, Ministry of Health Malaysia, Kuala Lumpur, Malaysia, said: "We urgently need new ways of supporting cancer survivors and addressing wider aspects of wellbeing. "Instead of just focusing on clinical outcome, doctors must focus equally on quality of life for cancer patients especially psychologically, financially and socially." Researchers included Malaysian patients from the ACTION study (ASEAN Cost in Oncology Study) and nearly a third (33%) had breast cancer. They filled in questionnaires to assess health-related quality of life (HRQoL). Anxiety and depression levels were also included in the survey. A patient's satisfaction with their physical health and mental wellbeing- or health-related quality of life -- is an important end result in cancer care. But the study showed that patients' mental and physical wellbeing was low overall 12 months after diagnosis. The more advanced the cancer, the lower the HRQoL. The type of cancer was also a factor because disease severity differs. Women with reproductive system cancers, for example, had higher wellbeing scores than lymphoma patients. This could be explained by the fact that lymphoma is often aggressive and progresses quickly while reproductive system cancers, such as cervical, can spread slowly over a number of years. "The key message is to focus more on supporting patients throughout their whole cancer 'journey' especially in their lives after treatment," added Subramanian. Cancer also has a significant impact on the lives and wellbeing of adolescents and young adults, as reported in a separate ongoing study (2). Researchers set out to identify the extent of wellbeing issues and other problems in this group who not only are at major milestones in their lives but also do not expect to develop the disease. The study included patients who were newly diagnosed with cancer (n=56) and with an average age of 28. They completed a survey including questions on occupation and lifestyle, and were also asked about problems around physical symptoms, mental wellbeing and financial issues Results showed more than a third (37%) were suffering distress at diagnosis of cancer. Nearly half identified the top cause as treatment decisions, followed by family health issues, sleep and worry. Senior author Associate Professor Alexandre Chan, Department of Pharmacy, National University of Singapore and Specialist Pharmacist, National Cancer Center, Singapore, said: "The young differ from older people because they don't expect to be ill, and certainly not with cancer. They're also at a stage when they're facing many social responsibilities and family burdens. "That's why they need effective supportive care and help in managing the physical, psychological and emotional side-effects that come with both cancer diagnosis and treatment." Commenting on these studies, Ravindran Kanesvaran, assistant professor, Duke-NUS Medical School, and Consultant Medical Oncologist, National Cancer Center, Singapore, said: "There is a critical need to find ways of addressing the high levels of distress among cancer survivors in general as highlighted by the Malaysian study. "The psycho-social impact of cancer on adolescents and young adults also clearly needs further evaluation. This is to assess the impact on quality of life at the time of diagnosis as well as throughout and after treatment. "What's required are specific interventions to meet the needs of this age group, as well as specially tailored survivorship programmes and supportive care. "While it's not surprising that the young adult cancer population has a higher risk of suicide, conducting studies like this help us find new ways to address this issue effectively."

Pena Quian Y.,National Clinical Research Center | Fernandez-Britto J.E.,Atherosclerosis Research and Reference Center | Bacallao J.,Atherosclerosis Research and Reference Center | Batista J.F.,National Clinical Research Center | De Leon M.L.,Primero de Enero Polyclinic
MEDICC Review | Year: 2012

INTRODUCTION: Silent myocardial ischemia is frequent in type 2 diabetics, therefore, symptoms cannot be relied upon for diagnosis and followup in these patients. Various studies relate blood lipid levels to cardiovascular diseases, and several authors describe certain lipoproteins as independent predictors of ischemia. OBJECTIVE: Identify blood lipid levels that predict silent myocardial ischemia in a type 2 diabetic population in Havana. METHODS: From May 2005 through May 2009, assessment was done of 220 asymptomatic type 2 diabetics in ten polyclinics in Havana using laboratory tests and Single-Photon Emission-Computed Tomography, synchronized with electrocardiogram, known as gated SPECT (gSPECT). Coronary angiography was used for confirmation when gSPECT detected ischemia. Patients were classified into two groups: gSPECT positive and gSPECT negative. Descriptive statistics (mean and standard deviation) were calculated for all variables and mean comparison tests were conducted. Classification trees were developed relating lipid values to gSPECT results, identifying optimal cutoff points for their use as indicators of silent myocardial ischemia in the total study population and for each sex separately. RESULTS: GSPECT found silent myocardial ischemia in 29.1% of those examined, and 68.4% of angiograms found multivessel disease. gSPECT-positive diabetics had higher levels of total cholesterol, LDL, and triglycerides (p < 0.05). HDL levels were lower in this group (p <0.05). Classification trees showed optimal cutoff points, indicators for silent ischemia, for: HDL ≤44 mg/dL, LDL >119.9 mg/dL, and triglycerides >107.2 mg/d; 80.4% of diabetics with these HDL and triglyceride values had ischemia. HDL was the most important normalized variable when the entire population was analyzed. Analysis by sex showed a greater percentage of silent ischemia in men (33.3%) than in women (24.8%). The most important normalized variables were LDL of >100.8 mg/dL for men and HDL of ≤44 mg/dL for women. CONCLUSIONS: A considerable percentage of the study population had silent myocardial ischemia. Type 2 diabetics with ischemia had higher levels of total cholesterol, LDL and triglycerides. HDL levels were significantly lower in these patients. The association of low HDL with high triglycerides was a strong indicator of myocardial ischemia in type 2 diabetics without clinical cardiovascular signs.

Woon Y.L.,Clinical Epidemiology Unit | Hor C.P.,Kepala Batas Hospital | Hor C.P.,Seberang Jaya Hospital | Hussin N.,Taiping Hospital | And 3 more authors.
PLoS Neglected Tropical Diseases | Year: 2016

Background: Dengue infection is the fastest spreading mosquito-borne viral disease, which affects people living in the tropical and subtropical countries. Malaysia had large dengue outbreaks in recent years. We aimed to study the demographics and clinical characteristics associated with dengue deaths in Malaysia. Methods: We conducted a retrospective review on all dengue deaths that occurred nationwide between 1stJanuary 2013 and 31stDecember 2014. Relevant data were extracted from mortality review reports and investigational forms. These cases were categorized into children (<15 years), adults (15–59 years) and elderly (≥60 years) to compare their clinical characteristics. Results: A total of 322 dengue deaths were reviewed. Their mean age was 40.7±19.30 years, half were females and 72.5% were adults. The median durations of first medical contact, and hospitalization were 1 and 3 days, respectively. Diabetes and hypertension were common co-morbidities among adults and elderly. The most common warning signs reported were lethargy and vomiting, with lethargy (p = 0.038) being more common in children, while abdominal pain was observed more often in the adults (p = 0.040). But 22.4% did not have any warning signs. Only 34% were suspected of dengue illness at their initial presentation. More adults developed severe plasma leakage (p = 0.018). More than half (54%) suffered from multi-organ involvement, and 20.2% were free from any organ involvement. Dengue deaths occurred at the median of 3 days post-admission. Dengue shock syndrome (DSS) contributed to more than 70% of dengue deaths, followed by severe organ involvement (69%) and severe bleeding (29.7%). Conclusion: In Malaysia, dengue deaths occurred primarily in adult patients. DSS was the leading cause of death, regardless of age groups. The atypical presentation and dynamic progression of severe dengue in this cohort prompts early recognition and aggressive intervention to prevent deaths. Trial Registration: National Medical Research Registry (NMRR, NMRR-14-1374-23352) © 2016 Woon et al.

Yang Z.-F.,Guangzhou University | Yang Z.-F.,National Clinical Research Center | Bai L.-P.,Macau University of Science and Technology | Huang W.-B.,Guangzhou University | And 5 more authors.
Fitoterapia | Year: 2014

Influenza poses a particular risk of severe outcomes in the elderly, the very young and those with underlying diseases. Tea polyphenols are the natural phenolic compounds in teas, and principally consist of catechins, proanthocyanidins, flavonols, and theaflavins, which antiviral activities have been reported recently. This study is to gain a further insight into potential of various tea polyphenols for inhibiting influenza virus infection. Five tea polyphenols exhibited inhibitory activity against influenza A virus in the trend of theaflavin > procyanidin B-2 > procyanidin B-2 digallate > (-)-epigallocatechin(EGC) > (-)-epigallocatechingallate(EGCG) with IC 50 values in the range of 16.2-56.5 μg/ml. Six of the tested compounds showed anti-influenza B virus activity in the order of kaempferol > EGCG > procyanidin B-2 > (-)-EGC ~ methylated EGC > theaflavin with IC50 values in the range of 9.0-49.7 μg/ml. Based on these results, the structure-activity relationship (SAR) was explained as follows. First, the dimeric molecules, such as theaflavin and procyanidin B-2, generally displayed more potent antiviral activity against both influenza A and B viruses than the catechin monomers. Second, the kaempferol for inhibition of influenza B virus indicated that the more planar flavonol structure with only one C-4′ phenolic hydroxyl group in the B ring is necessary for the anti-influenza B virus activity. A similar SAR can be drawn from the assays of another enveloped RNA virus, such as respiratory syncytial virus. These results are expected to provide guides for rational design of antiviral drugs based on polyphenols. © 2013 Published by Elsevier B.V.

PubMed | Hospital Kuala Lumpur, Hospital Melaka, University of Malaya and National Clinical Research Center
Type: Journal Article | Journal: The Medical journal of Malaysia | Year: 2015

Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia.This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality.A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%).Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.

Foo C.Y.,National Clinical Research Center | Lim K.K.,National Clinical Research Center | Sivasampu S.,National Clinical Research Center | Dahian K.B.,National Clinical Research Center | Goh P.P.,National Clinical Research Center
BMC Health Services Research | Year: 2015

Background: Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Methods: Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. Results: In 2011, 33 % of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10 % (SE ± 2.92), 7.4 % (SE ± 2.06), 6.9 % (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Conclusions: Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy makers and service managers to intuitively visualise the overall performance of resource use in an otherwise difficult to assess scenario. The considerable potential output gain estimated indicates that effort should be invested to understand what drove the performance variation and optimise them. Similar performance assessment should be undertaken for other healthcare services in the country in order to work towards a sustainable health system. © 2015 Foo et al.

Liu J.,Central South University | Song C.,Central South University | Song C.,Huazhong University of Science and Technology | Xiao Q.,Central South University | And 4 more authors.
Shock | Year: 2015

Caveolin-1 plays an important role in the pathogenesis of idiopathic pulmonary fibrosis. We previously showed that fluorofenidone (FD), a novel pyridine agent, can attenuate bleomycin-induced experimental pulmonary fibrosis and restore the production of caveolin-1. In this study, we explore mainly whether caveolin-1 plays a critical role in the anti-pulmonary fibrosis effects of FD in vitro. The normal human lung fibroblasts (NHLFs) were cultured with transforming growth factor-β1 (TGF-β1) and then were treated with FD. Subsequently, NHLFs transfected with cav-1-siRNA were treated with TGF-β1 and/or FD. The expressions of α-smooth muscle actin (α-SMA), fibronectin, collagen I, caveolin-1, phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated c-Jun N-terminal kinase (p-JNK), and phosphorylated P38 were measured by Western blot and/or real-time polymerase chain reaction. Fluorofenidone attenuated TGF-β1-induced expressions of α-SMA, fibronectin, and collagen I; inhibited phosphorylation of ERK, JNK, and P38; and restored caveolin-1 protein expression but cannot increase caveolin-1 mRNA level in vitro. After caveolin-1 was silenced, FD could not downregulate TGF-β1-induced expressions of α-SMA, fibronectin, and collagen I or phosphorylation of ERK, JNK, and P38. These studies demonstrate that FD, a potential antifibrotic agent, may attenuate TGF-β1-induced activation of NHLFs by restoring the expression of caveolin-1. © 2014 by the Shock Society.

Ng C.H.,University of Malaya | Bhoo Pathy N.,National Clinical Research Center | Taib N.A.,University of Malaya | Teh Y.C.,University of Malaya | And 5 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2011

Introduction: The age standardised incidence rate (ASR) of breast cancer in Malaysia which is a high middle-income country is similar to Indonesia, a low middle-income country. (Globocan 2008) It is however unknown whether the presentation of breast cancer differs between these two countries. Objective: We compared the stage, age at presentation, and pathological characteristics of breast cancer between two tertiary hospitals in Indonesia and Malaysia; Dharmais Cancer Centre (DCC), which is the national cancer referral centre in Indonesia, and University Malaya Medical Centre (UMMC), which is an academic hospital with established breast oncology services in Kuala Lumpur. One thousand, one hundred and fourteen consecutive women (477 in UMMC: 637 in DCC) who were newly diagnosed with breast cancer between January and December, 2010 were included. Patient's age, TNM stage at presentation, and pathological characteristics were compared. Estrogen receptor (ER) and progesterone receptor (PR) were considered positive if 10% or greater of invasive cell nuclei were stained while HER2 was considered positive with an immunohistochemostry staining intensity of 3+. Logistic regression analyses were performed to identify differences. Results: Median age at diagnosis was 52 years in UMMC and 47 years in DCC, whereby patients in DCC were more likely to be very young at diagnosis (aged < 35 years) compared to their counterparts in UMMC (Odds ratio (OR): 2.09; 95%CI: 1.32-3.31). Approximately one third of patients in UMMC presented with TNM stage III or IV, compared to 63% in DCC. Patients in DCC were three times more likely to present with metastatic breast cancer compared to patients in UMMC (OR: 3.01; 95% CI: 2.02-4.48). The percentage of low grade tumours in DCC was higher than in UMMC (28% vs 11% respectively), and the difference persisted even after multivariate adjustment. Although the frequency of ER and PR positivity appeared to be higher in UMMC (65% and 55% respectively) compared to DCC (48% and 40% respectively), these differences were not statistically significant following adjustment for age, stage, HER2 status and grade. The frequency of HER2 positivity was 45% in DCC compared to 26% in UMMC, and remained significantly higher even after multivariate adjustment (multivarite OR:1.76; 95%CI:1.25-2.47, in DCC compared to UMMC). The proportion of triple negative breast cancer was however similar in the two centres (19% in UMMC vs 21% in DCC). Conclusion: Indonesian women with breast cancer seem to present at a younger age and at later stages compared to Malaysian women. Their tumors were more likely to be of low grade and HER2 positive, even after adjustment for other factors, while hormone receptor positivity proved similar in the two groups. The higher HER2 positivity rate in Indonesian patients warrants further study.

PubMed | National Clinical Research Center and Kuala Lumpur General Hospital
Type: | Journal: BMJ case reports | Year: 2017

An infant, who was born preterm at 36weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37days, and currently the patient is doing well.

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