Kamarul Imran Musa

Sociocultural and Dietary Practices Among Malay Subjects in the North-Eastern Region of Peninsular Malaysia: A Region of Low Prevalence of Helicobacter pylori Infection

Background and Aim:  The prevalence of Helicobacter pylori infection is exceptionally low among the Malays in the north‐eastern region of Peninsular Malaysia. The reasons are unknown. Our aim was to compare environmental factors that differed in relation to H. pylori prevalence among Malays born and residing in Kelantan.

Effect of Withania somnifera (Ashwagandha) on the Development of Chemotherapy-Induced Fatigue and Quality of Life in Breast Cancer Patients

Hypothesis. Withania somnifera is an herb with antioxidant, anti-inflammatory, anticancer, antistress, and adaptogenic properties. Previous studies have shown its antistress effects in animals. Traditional Indian medicine has used it for centuries to alleviate fatigue and improve general well-being. Methods. This is an open-label prospective nonrandomized comparative trial on 100 patients with breast cancer in all stages undergoing either a combination of chemotherapy with oral Withania somnifera or chemotherapy alone. The chemotherapy regimens were either taxotere, adriamycin, and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide. Withania somnifera root extract was administered to patients in the study group at a dose of 2 g every 8 hours, throughout the course of chemotherapy. The quality-of-life and fatigue scores were evaluated before, during, and on the last cycles of chemotherapy using the EORTC QLQ-C30 (Version 3), Piper Fatigue Scale (PFS), and Schwartz Cancer Fatigue Scale (SCFS-6). Results. The median age distributions in the study and control arm were 51 years (range = 36-70) and 50.5 years (range = 32-71), respectively. The majority (77%) of patients had stage II and III disease. Patients in the control arm experienced statistically significant higher estimated marginal means of fatigue score compared with the study group (P < .001 PFS, P < .003 SCFS-6). Furthermore, various symptom scales of the EORTC QLQ-C30 were statistically significant in 7 out of 18 symptoms in the intervention group compared with the control group (P < .001). The 24-month overall survival for all stages in study and control group patients were 72% versus 56%, respectively; however, the result was not significant (P = .176), at a median follow-up duration of 26 months. Conclusions. Withania somnifera has potential against cancer-related fatigue, in addition to improving the quality of life. However, further study with a larger sample size in a randomized trial is warranted to validate our findings.

Pulse Wave Velocity as a Marker of Severity of Coronary Artery Disease

To determine whether pulse wave velocity (PWV) as a measure of arterial stiffness is a marker of coronary artery diseases (CAD), the authors did a cross‐sectional study in 92 patients undergoing coronary angiography for suspected CAD. Arterial stiffness was assessed through recording PWV from the left carotid–right femoral arteries using an automated machine. The mean PWV was higher in patients with CAD than in those without CAD (11.13±0.91 vs 8.14±1.25 m/sec; P<.001). When the severity of CAD was expressed as 1‐, 2‐, and multiple‐vessel disease, there was a significant association between the severity of CAD and PWV. PWV differed significantly with different categorical severity of CAD even when age and total cholesterol were controlled for. In a univariable analysis, PWV was higher with higher systolic blood pressure (P<.004). The authors conclude that arterial stiffness measured through PWV is an independent and complementary cardiovascular risk marker.

Prognostic Factors in Patients With Colorectal Cancer at Hospital Universiti Sains Malaysia

OBJECTIVE To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. METHODS We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival. RESULTS We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95-7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37-9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92-15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26-11.21). CONCLUSION Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.

Prevalence of Abnormal Glucose Tolerance and Risk Factors in Urban and Rural Malaysia

OBJECTIVE To determine the prevalence of prediabetes and diabetes among rural and urban Malaysians. RESEARCH DESIGN AND METHODS This cross-sectional survey was conducted among 3,879 Malaysian adults (1,335 men and 2,544 women). All subjects underwent the 75-g oral glucose tolerance test (OGTT). RESULTS The overall prevalence of prediabetes was 22.1% (30.2% in men and 69.8% in women). Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were found in 3.4 and 16.1% of the study population, respectively, whereas 2.6% of the subjects had both IFG and IGT. Based on an OGTT, the prevalence of newly diagnosed type 2 diabetes was 12.6% (31.0% in men and 69.0% in women). The prediabetic subjects also had an increased prevalence of cardiovascular disease risk factors. CONCLUSIONS The large proportion of undiagnosed cases of prediabetes and diabetes reflects the lack of public awareness of the disease.

Prognostic Study of Using Different Monitoring Modalities in Treating Severe Traumatic Brain Injury

OBJECTIVE To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients. METHODS This was a prospective randomized study that included all adults with traumatic severe head injury who had a Glasgow Coma Score < 9 and computed tomography scan features that did not reveal significant infratentorial pathology. Subjects were randomized into a multimodality group where they received multiple cerebral monitoring or into a standard single modality group where they received only intracranial pressure monitoring. The outcome was analysed 6 months post treatment using the Barthel Index. RESULTS The outcome at 6 months post treatment between the two groups was not statistically significant (p < 0.48). However, the percentage of subjects who were independent at 6 months was higher in the multimodality group (21.2%) compared with the single modality group (17.3%). CONCLUSION Multimodality monitoring for severely head-injured patients has no effect on outcome. However, study with a larger sample size and improvement in groups comparison are required to ascertain the above findings.

An audit of diabetes-dependent quality of life in patients with type 2 diabetes mellitus in Malaysia

AbstractPurposeThe aim of this study was to evaluate and validate the ADDQoL and to assess the impact of diabetes on QoL among the type 2 diabetes mellitus patients in Malaysia.Methods The Malay and English versions of the ADDQoL questionnaire were administered to patients attending routine outpatient visits in three primary hospitals and a public clinic. The construct validity of the ADDQoL was validated using confirmatory factor analysis (CFA). The sample comprised 350 Malay respondents who rated the ADDQoL Malay version and 246 non-Malay respondents (Chinese or Indian) who answered using the ADDQoL original English version.ResultsCFA confirmed the presence of one-factor structure for both samples. The internal consistency was high with Cronbach’s alpha values of 0.945 and 0.907 for the ADDQoL Malay and English versions, respectively. Results showed that for all three ethnicities, the most important domain is ‘family life’. Overall, Malay patients stated their ‘living conditions’ is the most negatively affected, while for Chinese and Indians, diabetes has the greatest impact on their ‘freedom to eat’.ConclusionsThe ADDQoL was found to be culturally appropriate, valid and reliable among Malay- and English-speaking type 2 diabetes mellitus patients in Malaysia.

The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents

OBJECTIVE Traumatic brain injury due to road traffic accidents occurs mainly in the younger age group in which injury-related disability leads to long-term impact on employment and economic and social consequences across the lifespan. This study was designed to assign a monetary cost (in Malaysian ringgits [RM]) to the treatment of patients with surgically treated isolated traumatic head injury as determined up to 1 year after injury. METHODS Relevant resource items used were identified and valued using the direct measurement of costs method, cost accounting methods, standard unit costs method, fees, charges and/or market prices method. These values were then tabulated to generate the total costs for each patient, via a combination of macro-costing and micro-costing methods. Malaysian currency values were converted to US dollars according to the average conversion rate for the period from January to May 2016: RM1 = US

The Combination of Sonography and Physical Examination Improves the Patency and Suitability of Hemodialysis Arteriovenous Fistula in Vascular Access

0.2452. RESULTS This costing study analyzed data from 49 patients. The estimated cost for the 1st year of care for all patients was RM1,471,919.80 (US

Prevalence of metabolic syndrome and its risk factors in adult Malaysians: Results of a nationwide survey

360,914.735), with a mean (± SD) cost per case of RM30,039.18 ± 22,986.25 or