Pharmacotherapy for Essential Hypertension: A Brief Review

Hypertension is one of the leading causes of disability-adjusted life years and mortality, with approximately 15% prevalence worldwide. Most patients with hypertension from low- to high-income countries do not receive treatment. Among those who receive treatment, the majority remain undertreated and do not achieve their blood pressure goals. Therefore, new hypertension guidelines introduce more conscientious treatment strategies to maximize the probability of achieving the new strict blood pressure goals compared with the previous guidelines. Who should receive treatment for hypertension? Which antihypertensive medications have the strongest supporting data? Are generic and more affordable medications as effective as expensive brand medications? What are the different treatment strategies to maximize success in controlling blood pressure? Here, we briefly review pharmacotherapy for hypertension and provide answers to these questions as well as some other common questions regarding treatment of hypertension.     

Mechanical and Durability Evaluation of Metakaolin as Cement Replacement Material in Concrete

Due to the increasing prices of cement and its harmful effect on the environment, the use of cement has become highly unsustainable in concrete. There is a considerable need for promoting the use of cement replacement materials. This study investigates the effect of variable percentages of metakaolin (MK) on the mechanical and durability performance of concrete. Kaolin clay (KC) was used in the current research to prepare the MK by the calcination process; it was ground in a ball mill to its maximum achievable fineness value of 2550 m²/Kg. Four replacement levels of MK, i.e., 5%, 10%, 15%, and 20% by weight of cement, in addition to control samples, at a constant water-to-cement (w/c) ratio of 0.55 were used. For evaluating the mechanical and durability performance, 27 cubes (6 in. × 6 in. × 6 in.) and 6 cylinders (3.875 in. diameter, 2 in. height) were cast for each mix. These samples were tested for compressive strength under standard conditions and in an acidic environment, in addition to being subjected to water permeability, sorptivity, and water absorption tests. Chemical analysis revealed that MK could be used as pozzolana as per the American Society for Testing and Materials (ASTM C 618:2003). The results demonstrated an increased compressive strength of concrete owing to an increased percentage of MK in the mix with aging. In particular, the concrete having 20% MK after curing under standard conditions exhibited 33.43% higher compressive strength at 90 days as compared to similarly aged control concrete. However, with increasing MK, the workability of concrete decreased drastically. After being subjected to an acid attack (immersing concrete cubes in 2% sulfuric acid solution), the samples exhibited a significant decrease in compressive strength at 90 days in comparison to those without acid attack at the same age. The density of acid attack increased with increasing MK with a maximum corresponding to 5% MK concrete. The current findings suggest that the local MK has the potential to produce good-quality concrete in a normal environment.     

Multi-Objective Optimization of Process Parameters during Micro-Milling of Nickel-Based Alloy Inconel 718 Using Taguchi-Grey Relation Integrated Approach

This research investigates the machinability of Inconel 718 under conventional machining speeds using three different tool coatings in comparison with uncoated tool during milling operation. Cutting speed, feed rate and depth of cut were selected as variable machining parameters to analyze output responses including surface roughness, burr formation and tool wear. It was found that uncoated and AlTiN coated tools resulted in lower tool wear than nACo and TiSiN coated tools. On the other hand, TiSiN coated tools resulted in highest surface roughness and burr formation. Among the three machining parameters, feed was identified as the most influential parameter affecting burr formation. Grey relational analysis identified the most optimal experimental run with a speed of 14 m/min, feed of 1 μm/tooth, and depth of cut of 70 μm using an AlTiN coated tool. ANOVA of the regression model identified the tool coating parameter as most effective, with a contribution ratio of 41.64%, whereas cutting speed and depth of cut were found to have contribution ratios of 18.82% and 8.10%, respectively. Experimental run at response surface optimized conditions resulted in reduced surface roughness and tool wear by 18% and 20%, respectively.     

Development and evaluation of a hearing aid manual in the Malay language

Objective: This study aimed to (a) translate a hearing aid (HA) manual into Malay language and revise the translated manual based on best practice guidelines; (b) compare the effectiveness of the translated and the revised Malay HA manuals in helping individuals to perform HA management tasks.

Design: Cross-sectional, randomised, single-blinded study.

Study sample: An Oticon-Dynamo HA manual was translated and revised based on best practice guidelines. Ninety participants aged 55?years and above participated in this study. They were randomly assigned into the control group (received translated manual) and the experimental group (received the revised translated manual). The Hearing Aid Management (HAM) test, which was developed in a previous study, was conducted to evaluate participant’s ability to perform HA management tasks using the translated and the revised version of Malay HA manual.

Results: The revised Malay HA manual had a lower reading grade level relative to the initial translated Malay HA manual. The ability to perform HA management tasks was better in the experimental group (mean = 12.2, SD = 1.15) versus the control group (mean = 8.7, SD = 2.11).

Conclusion: Further revision of existing HA manuals based on best practice guidelines is recommended to help individuals better manage their HAs.     

The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

Clinical Autonomic Research - Comparison of hemodynamic profiles and pain scores in diabetic patients undergoing diabetic foot surgery receiving peripheral nerve block (PNB) or spinal anesthesia...     

p‐Synephrine,ephedrine, p‐octopamine and m‐synephrine: Comparative mechanistic,physiological and pharmacological properties

Confusion and misunderstanding exist regarding the lack of cardiovascular and other adverse health effects of p‐synephrine and p‐octopamine relative to ephedrine and m‐synephrine (phenylephrine) which are known for their effects on the cardiovascular system. These four molecules have some structural similarities. However, the structural and stereochemical differences of p‐synephrine and p‐octopamine as related to ephedrine and m‐synephrine result in markedly different adrenergic receptor binding characteristics as well as other mechanistic differences which are reviewed. p‐Synephrine and p‐octopamine exhibit little binding to α‐1, α‐2, β‐1 and β‐2 adrenergic receptors, nor are they known to exhibit indirect actions leading to an increase in available levels of endogenous norepinephrine and epinephrine at commonly used doses. The relative absence of these mechanistic actions provides an explanation for their lack of production of cardiovascular effects at commonly used oral doses as compared to ephedrine and m‐synephrine. As a consequence, the effects of ephedrine and m‐synephrine cannot be directly extrapolated to p‐synephrine and p‐octopamine which exhibit significantly different pharmacokinetic, and physiological/pharmacological properties. These conclusions are supported by human, animal and in vitro studies that are discussed.     

An Update on Vitamin D Deficiency Status in Malaysia

Vitamin D is essential for maintaining serum calcium levels, ensuring sufficient bone mineralization, immunomodulatory properties, and a protective effect on the cardiovascular system, renal disease, cancer, as well as in pregnancy. Vitamin D deficiency is prevalent worldwide, and it is not related to a country’s development index. However, the data on vitamin D deficiencies are primarily taken from out-of-date, small-scale studies on target age groups or specific diseases, rather than from large-scale, population-based surveys. In Malaysia, for the past 16 years, studies were conducted involving adult men and women, pregnant women, postmenopausal women, adolescent, and children especially with specific diseases such as spina bifida, epilepsy, chronic liver disease, and atopic dermatitis. Only a few large surveys were conducted involving children and adolescents. Across the specific target population studied, vitamin D deficiency and insufficiency were seen particularly among females, Indians, and those of Malay ethnicity. This is related to widely known causes of vitamin D deficiency such as skin type (melanin) and sun avoidant lifestyles that include covering clothes, largely practiced by Malay Muslims in Malaysia. Other related causes or the high-risk groups are breastfed infants, the elderly, the obese, those on medications, and those characterized by fat malabsorption and geophysical factors. Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches, depending on the severity. The objective is to raise serum vitamin D to a normal level, hence, relieving the symptoms and reducing the adverse health outcomes. Despite no clear guidelines in treating vitamin D deficiency in Malaysia, this condition can be prevented with taking adequate vitamin D in food resources, sun exposure, or supplementation. Special attention should be given to high-risk groups including infants, obese patients, and the elderly.     

The role of electronic medical records in improving health care quality: A quasi-experimental study

The Teleprimary Care—Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics.The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21.A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR.With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.