Azad Hassan Razack

Reliability and validity of the Malay version of the International Index of Erectile Function (IIEF-15) in the Malaysian population.

The objective of this study was to validate the Malay version of the International Index of Erectile Function (IIEF-15) in patients with lower urinary tract symptoms. Reliability and validity was assessed by using the test–retest while Cronbachs alpha was used to assess internal consistency. Effect size 5was evaluated to assess the sensitivity to change in the pre-transurethral resection of the prostate (TURP) vs post-TURP. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 15 items and five domains (Cronbachs alpha value=0.56 and higher and 0.74 and higher, respectively). Test–retest correlation coefficient for the 15 items and domains scores showed no significant changes. Intraclass correlation coefficient for 15 items and domains were high (ICC=0.59 and above). It can be concluded that the Mal-IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Identification of potential complementary serum biomarkers to differentiate prostate cancer from benign prostatic hyperplasia using gel- and lectin-based proteomics analyses.

Diagnosis of prostate cancer (PCa) is currently much reliant on the invasive and time‐consuming transrectal ultrasound‐guided biopsy of the prostate gland, particularly in light of the inefficient use of prostate‐specific antigen as its biomarker. In the present study, we have profiled the sera of patients with PCa and benign prostatic hyperplasia (BPH) using the gel‐ and lectin‐based proteomics methods and demonstrated the significant differential expression of apolipoprotein AII, complement C3 beta chain fragment, inter‐alpha‐trypsin inhibitor heavy chain 4 fragment, transthyretin, alpha‐1‐antitrypsin, and high molecular weight kininogen (light chain) between the two groups of patients’ samples. Our data are suggestive of the potential use of the serum proteins as complementary biomarkers to effectively discriminate PCa from BPH, although this requires further extensive validation on clinically representative populations.

Bacillus Calmette-Guerin and bladder cancer.

Bladder cancer is the second most common cancer of the urinary tract, and overall it is among the top 10 cancers in men. Transitional cell carcinoma (TCC) is the most common type, with the majority being superficial disease, i.e. the tumour has not gone beyond the lamina propria. The main problem with superficial TCC is the high recurrence rate. Various forms of treatment methods have been attempted to reduce the recurrence rate, with intravesical bacillus Calmette-Guerin (BCG) being the most successful to date. In fact, intravesical BCG is one of the most successful forms of immunotherapy in the treatment of any form of cancer. This article is a general review of BCG in bladder cancer with an emphasis on the indication and mechanism of action in reducing recurrence and progression.

Urine of patients with early prostate cancer contains lower levels of light chain fragments of inter‐alpha‐trypsin inhibitor and saposin B but increased expression of an inter‐alpha‐trypsin inhibitor heavy chain 4 fragment

The present study was aimed at the identification of proteins that are differentially expressed in the urine of patients with prostate cancer (PCa), those with benign prostatic hyperplasia (BPH) and age‐matched healthy male control subjects. Using a combination of 2DE and MS/MS, significantly lower expression of urinary saposin B and two different fragments of inter‐alpha‐trypsin inhibitor light chain (ITIL) was demonstrated in the PCa patients compared to the controls. However, only one of the ITIL fragments was significantly different between the PCa and BPH patients. When image analysis was performed on urinary proteins that were transferred onto NC membranes and detected using a lectin that binds to O‐glycans, a truncated fragment of inter‐alpha‐trypsin inhibitor heavy chain 4 was the sole protein found to be significantly enhanced in the PCa patients compared to the controls. Together, these urinary peptide fragments might be useful complementary biomarkers to indicate PCa as well as to distinguish it from BPH, although further epidemiological evidence on the specificity and sensitivity of the protein candidates is required.

Review Paper: Organ Transplants: Ethical, Social, and Religious Issues in a Multicultural Society

Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia.

Cardiovascular risk factors and ethnicity are independent factors associated with lower urinary tract symptoms.

Objectives To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting. Materials and Methods We conducted a cross-sectional study of 1021 men aged 40–79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses. Results There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity. Conclusion Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.

Ethnicity is an independent determinant of age-specific PSA level: findings from a multiethnic Asian setting.

Objectives To study the baseline PSA profile and determine the factors influencing the PSA levels within a multiethnic Asian setting. Materials and Methods We conducted a cross-sectional study of 1054 men with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The serum PSA concentration of each subject was assayed. Potential factors associated with PSA level including age, ethnicity, height, weight, family history of prostate cancer, lower urinary tract voiding symptoms (LUTS), prostate volume and digital rectal examination (DRE) were evaluated using univariable and multivariable analysis. Results There were 38 men (3.6%) found to have a PSA level above 4 ng/ml and 1016 (96.4%) with a healthy PSA (≤4 ng/ml). The median PSA level of Malay, Chinese and Indian men was 1.00 ng/ml, 1.16 ng/ml and 0.83 ng/ml, respectively. Indians had a relatively lower median PSA level and prostate volume than Malays and Chinese, who shared a comparable median PSA value across all 10-years age groups. The PSA density was fairly similar amongst all ethnicities. Further analysis showed that ethnicity, weight and prostate volume were independent factors associated with age specific PSA level in the multivariable analysis (p<0.05). Conclusion These findings support the concept that the baseline PSA level varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity may also need to be taken into account when investigating serum PSA concentrations in the multiethnic Asian population.

Impact of applied progressive deep muscle relaxation training on the level of depression, anxiety and stress among prostate cancer patients: A quasi-experimental study

BACKGROUND The aim of this study was to determine the impact of applied progressive muscle relaxation training on the levels of depression, anxiety and stress among prostate cancer patients. MATERIALS AND METHODS A quasi-experimental study was conducted at the University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over six months. Prostate cancer patients from UMMC received the intervention and patients from UKMMC were taken as controls. The level of depression, anxiety and stress were measured using Depression, Anxiety Stress Scales - 21 (DASS-21). RESULTS A total of 77 patients from the UMMC and 78 patients from the UKMMC participated. At the end of the study, 90.9% and 87.2% of patients from the UMMC and UKMMC groups completed the study respectively. There were significant improvements in anxiety (p<0.001, partial ?2=0.198) and stress (p<0.001, partial ?2=0.103) at the end of the study in those receiving muscle training. However, there was no improvement in depression (p=0.956). CONCLUSIONS The improvement in anxiety and stress showed the potential of APMRT in the management of prostate cancer patients. Future studies should be carried out over a longer duration to provide stronger evidence for the introduction of relaxation therapy among prostate cancer patients as a coping strategy to improve their anxiety and stress.

Effect of treating lower urinary tract symptoms on anxiety, depression and psychiatric morbidity: a one-year study.

Background:  The present study aimed to evaluate the effects of treating lower urinary tract symptoms (LUTS) on anxiety, depression and psychiatric morbidity following one year of follow‐up.

Quality of life assessment before and after transurethral resection of the prostate in patients with lower urinary tract symptoms.

Objectives: The aim of this study was to determine the effects of surgical treatment of lower urinary tract symptoms (LUTS) in a Malaysian population by evaluating the quality of life before and after treatment. Patients and methods: The study group comprised 111 LUTS patients (age 69.56 ± 7.94 years, mean ± SD ) who were assessed 1 week before and at 3, 6 and 12 months after treatment using the health-related quality of life (HRQOL-20) questionnaire, a visual analogue scale (VAS), the present pain intensity (PPI) scale and the international prostate symptom score (I-PSS). Results: Preoperatively the patients suffered more pain, severe prostatic symptoms, impaired disease-specific quality of life and a reduction in health-related quality of life. Postoperatively the patients showed a significant reduction and improvement in pain, prostatic symptoms, and disease-specific and health-related quality of life. Conclusions: The results showed that the operative procedure significantly improved the overall quality of life of patients with LUTS.