Putrajaya, Malaysia
Putrajaya, Malaysia

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Latif Z.A.,Bangladesh Institute of Research and Rehabilitation for Diabetes | Hussein Z.,Hospital Putrajaya | Litwak L.,Hospital Italiano Of Buenos Aires | Naggar N.E.,Hai Aljamea Hospital | And 2 more authors.
Diabetes Therapy | Year: 2013

Introduction: Hypoglycemia is a complication in the management of type 2 diabetes, and elderly people are at greater risk of experiencing hypoglycemia events than younger patients. Insulin analogs achieve glycemic control with minimal risk of hypoglycemia and may therefore be a good treatment option for all patients. Methods: A1chieve was an international, multicenter, prospective, open-label, noninterventional, 24-week study in people with type 2 diabetes who started/switched to therapy with biphasic insulin aspart 30, insulin detemir or insulin aspart (alone/in combination) in routine clinical practice. This sub-analysis evaluated clinical safety and effectiveness of insulin aspart as part of a basal-bolus regimen (±oral glucose-lowering drugs) in three agegroups (B40,[40-65, and[65 years) of insulinexperienced and insulin-naive people with type 2 diabetes. Results: In total, 4,032 patients were included in the sub-analysis. After 24 weeks of insulin aspart treatment, significant improvements versus baseline were observed in all age-groups for: proportion of people with C1 hypoglycemia events (18.3-27.1% and 11.0-12.7%, at baseline and 24 weeks, respectively), C1 major hypoglycemia events (3.3-6.7% and 0-0.2%), and C1 nocturnal hypoglycemia events (9.2-13.7% and 2.9-4.9%); glycated hemoglobin (9.6-9.8% and 7.4%); fasting plasma glucose (change from baseline ranged from -3.6 to -4.4mmol/l); and post-breakfast post-prandial plasma glucose (change from baseline ranged from -5.5 to -5.9mmol/l). Fourteen serious adverse drug reactions were reported. Healthrelated quality of life was significantly improved for all age-groups (all, p\0.001). Conclusion: All age-groups showed improved glycemic control and reduced risk of hypoglycemia when starting/switching to insulin aspart therapy within a basal-bolus regimen; this may be particularly important for elderly patients given their greater risk of hypoglycemia versus younger patients. © The Author(s) 2013.

Abdul Muizz A.M.,Hospital Seremban | Mohd Shahrir M.S.,National University of Malaysia | Sazliyana S.,National University of Malaysia | Oteh M.,National University of Malaysia | And 2 more authors.
International Journal of Rheumatic Diseases | Year: 2011

Aims: The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction. Methods: The study was a cross-sectional study involving 53 patients (47 female and 6 male) with RA without clinically evident heart disease and 53 healthy subjects (47 female and 6 male) who served as a control group. Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. Results: Of 17 cardiac parameters assessed, only two were abnormal. None of the specific cardiac diastolic dysfunction parameters were significantly different in RA patients compared to the control group. There was no significant correlation between diastolic function values in RA patients and value of Disease Activity Score 28 (DAS-28) and value of Health Assessment Questionnaires Disability Index (HAQDI). Atrial (A) wave velocity was greater in RA patients compared to the control group (0.71 [0.58-0.83] vs. 0.61 [0.51-0.71]; P<0.04). However, interventricular relaxation time (IVRT) ([73.08±9.92 vs. 70.74±9.02], P=0.207), lower E/A ratio (1.27 [1.02-1.56] vs. 1.42 [1.20-1.68], P=0.102), diastolic dysfunction parameters according to Redfield Classification (25 [47.2%] vs. 27 [50.9%] P=0.56), diastolic dysfunction using E/A (P=0.321) and tissue doppler imaging (E/E') (P=0.148) were not different. Conclusion: Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

Tan T.H.,National Cancer Institute | Hussein Z.,Hospital Putrajaya | Saad F.F.A.,Serdang Hospital | Shuaib I.L.,Universiti Sains Malaysia
Nuclear Medicine and Molecular Imaging | Year: 2015

Purpose: To evaluate the diagnostic performance of 68Ga-DOTATATE 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT), 18F-FDG PET/CT and 131I-MIBG scintigraphy in the mapping of metastatic pheochromocytoma and paraganglioma. Materials and Methods: Seventeen patients (male = 8, female = 9; age range, 13–68 years) with clinically proven or suspicious metastatic pheochromocytoma or paraganglioma were included in this prospective study. Twelve patients underwent all three modalities, whereas five patients underwent 68Ga-DOTATATE and 131I-MIBG without 18F-FDG. A composite reference standard derived from anatomical and functional imaging findings, along with histopathological information, was used to validate the findings. Results were analysed on a per-patient and on per-lesion basis. Sensitivity and accuracy were assessed using McNemar’s test. Results: On a per-patient basis, 14/17 patients were detected in 68Ga-DOTATATE, 7/17 patients in 131I-MIBG, and 10/12 patients in 18F-FDG. The sensitivity and accuracy of 68Ga-DOTATATE, 131I-MIBG and 18F-FDG were (93.3 %, 94.1 %), (46.7 %, 52.9 %) and (90.9 %, 91.7 %) respectively. On a per-lesion basis, an overall of 472 positive lesions were detected; of which 432/472 were identified by 68Ga-DOTATATE, 74/472 by 131I-MIBG, and 154/300 (patient, n = 12) by 18F-FDG. The sensitivity and accuracy of 68Ga-DOTATATE, 131I-MIBG and 18F-FDG were (91.5 %, 92.6 % p < 0.0001), (15.7 %, 26.0 % p < 0.0001) and (51.3 %, 57.8 % p < 0.0001) respectively. Discordant lesions were demonstrated on 68Ga-DOTATATE, 131I-MIBG and 18F-FDG. Conclusions: Ga-DOTATATE PET/CT shows high diagnostic accuracy than 131I-MIBG scintigraphy and 18F-FDG PET/ CT in mapping metastatic pheochromocytoma and paraganglioma. © 2015, Korean Society of Nuclear Medicine.

Ramadas A.,Monash University | Chan C.K.Y.,Monash University | Chan C.K.Y.,Australian Catholic University | Oldenburg B.,Monash University | And 2 more authors.
International Journal of Behavioral Medicine | Year: 2015

Background: Diabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries. Although e-health is an emerging theme, only a few successful web-based studies on diabetes self-management have been reported. Purpose: We describe the development, implementation, and process evaluation of an Internet-delivered dietary intervention program (myDIDeA) for diabetic patients in a developing country. Method: Specific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines. The lesson plans and the study website were then developed based on the evidence, Transtheoretical Model’s Stages of Change and user-centered design approach. Finally, the effectiveness of the website was tested through a randomized-controlled trial to promote dietary change in patients with type 2 diabetes. The participants in the intervention group (n = 66) were given access to myDIDeA for 6 months. Process evaluation in form of intervention adherence and program reception were conducted at post intervention. Results: The response rate for the process evaluation was 89 %. On average, each participant logged in at least once for each lesson plan and spent almost 12 min on the site. The participants’ content satisfaction, acceptability, and usability scores were satisfactory. The primary outcome of the trial, Dietary Knowledge, Attitude, and Behavior score was strongly correlated with content satisfaction (r = 0.826, p < 0.001), acceptability (r = 0.793, p < 0.001) and usability of the website (r = 0.724, p < 0.001), and moderately correlated with frequency of log-in (r = 0.501, p < 0.05) and duration spent in the website (r = 0.399, p < 0.05). Conclusion: The process evaluation of myDIDeA demonstrates its feasibility, and future studies should identify the possibility of extending the use of Internet-based intervention programs to other health behaviors and issues related to self-management of chronic conditions. In addition, interactivity, peer support via social media, and other means to stimulate the interest of participants can be explored. © 2014, International Society of Behavioral Medicine.

Shahar M.A.,International Islamic University Malaysia | Hussein H.,Hospital Putrajaya | Sidi H.,National University of Malaysia | Shah S.A.,National University of Malaysia | Mohamed Said M.S.,National University of Malaysia
International Journal of Rheumatic Diseases | Year: 2012

Aim: To determine the prevalence of sexual dysfunction (FSD) among women with rheumatoid arthritis attending the Rheumatology Clinic in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Hospital Putrajaya, Malaysia, and to determine its associations with potential clinical and disease activity factors. Method: This was a cross-sectional study involving women with rheumatoid arthritis between the ages of 20 and 60 years. A validated Malay Version Female Sexual Function Index (MVFSFI) was administered to diagnose FSD. Sociodemographic and disease activity profiles were obtained and those who had and did not have FSD were compared. Results: Among 63 respondents, 51 patients were included in the analysis for FSD. The prevalence of FSD in women with rheumatoid arthritis attending UKMMC and Hospital Putrajaya Rheumatology Clinic was 29.4%. Erythrocyte sedimentation rate (ESR) and Disease Activity Score in 28 joints (DAS28-ESR) correlates with MVFSFI score with r = -0.364 (P = 0.009) and r = -0.268 (P = 0.057), respectively. Sociodemographic factors that correlate with MVFSFI score were: patient's age (r = 0.520, P < 0.001); duration of marriage (r = -0.355, P = 0.001); husband's age (r = -0.460, P = 0.001); age of oldest child (r = -0.449, P = 0.001); and age of youngest child (r = -0.627, P < 0.001). Conclusion: We found in this study that the prevalence of FSD in rheumatoid arthritis in our centers was 29.4%. Age and family dynamics appear to be more important predictors compared to disease activity. © 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Litwak L.,Hospital Italiano Of Buenos Aires | Goh S.-Y.,Singapore General Hospital | Hussein Z.,Hospital Putrajaya | Malek R.,CHU Setif | And 2 more authors.
Diabetology and Metabolic Syndrome | Year: 2013

Background: Current International Diabetes Federation guidelines recommend a target HbA1c <7.0%, but many people with diabetes worldwide find this difficult to achieve, increasing their risk of developing complications. This publication examines the prevalence of diabetes complications and its association with baseline characteristics in people with type 2 diabetes who participated in the A1chieve study. Methods. A1chieve was a 24-week, multinational, open-label, observational study of 66,726 people with type 2 diabetes who had begun using biphasic insulin aspart 30, insulin aspart, or insulin detemir in routine clinical care. Participants were enrolled from 28 countries across four continents (Asia, Africa, Europe and South America). Baseline measurements of disease characteristics included: glycated haemoglobin (HbA1c), fasting (FPG) and post-prandial plasma glucose (PPG), high- and low-density lipoprotein cholesterol (H- or LDL-C), systolic blood pressure (SBP), and body mass index (BMI). Data on complications and use of vascular disease preventative drugs were collected. Results: Complication rates were high (27.2% had macrovascular complications and 53.5% had microvascular complications), particularly in Russia, and use of vascular disease preventative drugs was lower than expected. Age, BMI, diabetes duration, LDL-C, and SBP were positively associated, and HDL-C negatively associated, with macro- and microvascular complications (all p < 0.05). HbA1c and FPG were negatively associated with macrovascular complications (both p < 0.05), which may be linked to the cross-sectional study design. Conclusions: These results suggest a worldwide failure to achieve glycaemic targets. Better diabetes management with earlier initiation and optimisation of insulin regimens (e.g., with insulin analogues in the A1chieve population) may reduce the prevalence of vascular complications, improve the lives of people with diabetes and reduce the burden on healthcare systems. © 2013 Litwak et al.; licensee BioMed Central Ltd.

Jamaluddin F.A.,University of Malaya | Sthaneshwar P.,University of Malaya | Hussein Z.,University of Malaya | Othman N.,Hospital Putrajaya | Chan S.P.,University of Malaya
Malaysian Journal of Pathology | Year: 2013

Introduction: Prolactin (PRL) exists in different forms in human serum. The predominant form is monomeric PRL (molecular mass 23 kDa) with smaller amounts of big PRL (molecular mass 50-60 kDa) and at times macroprolactin (molecular mass 150-170 kDa). Macroprolactin, generally considered to be biologically inactive, accounts for the major part of prolactin in some patients. Different immunoassays for prolactin differ in reactivity with this macromolecular complex. Aim: The present study was undertaken to assess the incidence of macroprolactinaemia in our cohort of hyperprolactinemic patients. Method: 204 samples with hyperprolactinemia were evaluated for macroprolactinemia by polyethylene glycol (PEG) precipitation and gel filtration chromatography (GFC). Recoveries ≤60% after PEG precipitation were considered to have macroprolactinaemia. Results: A total of 43 (21%) of these patients had less than 60% recovery after PEG precipitation. GFC confirmed that in seven of these patients macroprolactin was the major part of the prolactin. Recoveries were < 40% PEG precipitation in these samples. Combined macro and hyperprolactinemia was observed in two samples and the recovery after PEG precipitation was >40% but ≤50%. The incidence of macroprolactinemia in our cohort of hyperprolactinaemic patients was noted to be 4.4%. Conclusion: Macroprolactin is a significant cause of misdiagnosis, unnecessary investigation, and inappropriate treatment and hence it is useful to screen all patients with high PRL levels with PEG precipitation and to apply GFC to samples with recoveries <50%.

Sarinah B.,Hospital Putrajaya | Hisham A.-N.,Hospital Putrajaya
Asian Journal of Surgery | Year: 2010

Background: Primary thyroid lymphoma is uncommon and accounts for less than 2-5% of all thyroid malignancies. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations. Methods: Eleven women and six men with primary thyroid lymphoma were diagnosed and managed in our department between October 1998 and March 2006. The clinical course and pathological spectrum of this disorder affecting the thyroid gland were reviewed. Results: Twelve patients had a prior history of thyroid disease. Clinical symptoms included a rapidly enlarging neck mass (88%), dyspnoea (65%), dysphagia (53%) and hoarseness of voice (35%). Five patients were hypothyroid at the time of diagnosis. Fifteen patients underwent fine-needle aspiration cytology (FNAC). Six patients had an initial diagnosis of lymphocytic thyroiditis. FNAC results were highly suggestive of thyroid lymphoma in only five patients. In the remaining patients, FNAC results showed a follicular lesion in two patients and were inconclusive in the other two patients. A further incisional biopsy was performed in five patients, and a diagnosis of non-Hodgkin's lymphoma (NHL) was confirmed in four patients and inconclusive in one. Five patients had a core biopsy. Four revealed NHL and one had lymphocytic thyroiditis. Nine patients underwent surgery; three of whom had emergency debulking of the tumour for acute airway obstruction. A final diagnosis of thyroid lymphoma was confirmed in all these patients. Sixteen patients had B-cell and one had T-cell NHL. Fifteen patients received combination chemotherapy with or without irradiation. All tumours dramatically decreased in size soon after initiation of treatment. Overall survival was 82%, with a mean follow-up of 19 months. Conclusion: The diagnosis of primary thyroid lymphoma should be considered when dealing with rapidly growing goitres. The role of FNAC in diagnosing thyroid lymphoma is limited but it is still useful in the initial work-up. Nevertheless, surgical intervention is often required to establish the diagnosis and relieve critical airway compression. A combination of chemotherapy and irradiation is the mainstay of management. © 2010 Asian Surgical Association.

Nik Jaafar N.R.,National University of Malaysia | Selamat Din S.H.,Hospital Tuanku Jaafar | Mohamed Saini S.,National University of Malaysia | Ahmad S.N.A.,Hospital Putrajaya | And 4 more authors.
Comprehensive Psychiatry | Year: 2014

Introduction The period of the cancer patients undergoing treatment is also the most stressful time for their family caregivers. This study aimed to determine the rates of major depressive disorder and dysthymia; and their associated factors in the caregivers during this time. Methods One hundred and thirty caregiver-patient dyads attending the oncology centre for breast cancer treatment participated in this cross-sectional study. While the data on the patients' socio-demographic and illness characteristics were obtained from their medical record, the caregivers completed three self-report measures: 1) socio-demography and the caregiving factor questionnaire, 2) Multi-dimensional Perceived Social Support (MSPSS) and 3) Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those with "probable depression" identified from the DASS-21 score were interviewed using The Mini-International Neuropsychiatric Interview (MINI) to obtain the diagnoses of depressive disorders. Results Twenty-three of the 130 caregivers (17.69%) were diagnosed to have depressive disorders, where 12.31% (n = 16) had major depressive disorder and 5.38% (n = 7) had dysthymic disorder. Factors associated with depression include ethnicity, duration of caregiving, the patients' functional status and the caregivers' education level. Logistic regression analysis showed that the patients' functional status (p < 0.05, OR = 0.23, CI = 0.06-0.86) and the caregivers' education level (p < 0.05, CI = 9.30, CI = 1.82-47.57) were significantly associated with depression in the caregivers attending to breast cancer patients on oncology treatment. Conclusions A significant proportion of family caregivers were clinically depressed while caring for their loved ones. Depression in this population is a complex interplay between the patients' factors and the caregivers' factors. © 2014 Elsevier Inc. All rights reserved.

Tan T.H.,Hospital Putrajaya | Lee B.N.,Hospital Putrajaya | Hassan S.Z.A.,Hospital Putrajaya
Nuclear Medicine and Molecular Imaging | Year: 2014

Purpose: In neuroendocrine liver metastases of unknown primary, a multimodality approach is usually adopted and consists of transabdominal ultrasound, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine techniques, endoscopy and exploratory surgery. The purpose of the study is to evaluate the diagnostic value of 68Ga-DOTATATE positron emission tomography (PET)/CT as part of a multimodality approach in neuroendocrine liver metastases of unknown primary. Materials and Methods: Six patients (M:F = 5:1, age range 28-56 years) with immunohistochemically proven neuroendocrine liver metastases but inconclusive initial CT work-up were retrospectively analysed. Clinical finding, histopathology, comparative imaging and follow-up were used to validate the results when ethically justified. Results: 68Ga-DOTATATE PET/CT identified the primary tumour in five out of six (83.3 %) patients: pancreas (n = 4) and stomach (n = 1). Out of three patients with indeterminate primary on initial CT, two patients were confirmed by 68Ga-DOTATATE PET/CT. Absence of uptake in indeterminate primary of one patient was later confirmed negative by histopathology. In another three patients with undetected primary on initial CT, primary site was demonstrated in all patients with unsuspected metastases in two patients on 68Ga-DOTATATE PET/ CT. No further work-up was done to confirm the primary in patients with distant metastases. Change of management was observed in three out of six (50 %) patients. Conclusion: Our small study indicates that 68Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin. © 2013 Korean Society of Nuclear Medicine.

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