Browse publications by year: 2017

  1. Fulltext QTc prolongation and antipsychotic medications in psychiatric patients – a review
    Zainuddin, Z., Zaini, S.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Background: Antipsychotic medications are the cornerstones of the acute and
    long-term treatment of schizophrenia. Despite their benefits in minimizing
    the schizophrenia symptoms, they have been associated with the risk of
    inducing QTc prolongation, which may lead to a serious life-threatening
    arrhythmia and cause sudden death. Objective: To review the QTc
    prolongation caused by antipsychotic medications used among psychiatric
    patients. Methods: Literature search was conducted using databases such as
    Scopus, Science Direct, Pubmed, and Springer link. The keywords used for
    the search were “QTc prolongation”, “antipsychotic medications” and
    “schizophrenia”. The inclusion criteria are articles from 2001 to 2014,
    articles written in English and articles related to the effects of antipsychotics
    in causing sudden cardiac death. The inclusion criteria are the articles
    written in other languages and the article about other adverse effect of
    antipsychotics. Results: Twenty-seven articles were found to be relevant to
    this study and twenty of them which discusses about antipsychotic-induced
    QT interval prolongation have been included in the table of evidence.
    Conclusion: Antipsychotics regardless of the generations have the potential of
    causing QT interval prolongation. The risk-to-benefit ratio that accounts for
    the danger of sudden cardiac death should be evaluated before prescribing
    an antipsychotic medicine and each individual patient should be assessed on
    the potential contributing factors to the prolongation of QTc.
  2. Fulltext Schizencephaly: psychosis, a rare manifestation
    Aloysius, A., Seed, H.F., Thong, K.S.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Schizencephaly is an uncommon congenital malformation of the central
    nervous system which affects the development of the cerebral cortex. It is
    defined as the gray matter lined filled cleft with cerebrospinal fluid that
    extends from the pial surface to the ventricle. There exists a paucity in
    scientific literature regarding the association between schizencephaly and
    psychosis. We report a case of a 36-year-old male, presented with worsening
    crisis of aggression, disorganized behavior and auditory hallucinations over
    20 years. CT brain scan revealed unilateral left open lip schizencephaly, a
    finding during his recent admission to the psychiatry ward.
    MeSH terms: Aggression; Cerebral Cortex; Hallucinations; Male; Psychiatry; Psychotic Disorders; Tomography, X-Ray Computed; Schizencephaly; Gray Matter
  3. Fulltext Dilemma of diagnosing OCD: a case report
    Ridzwan, H., Saifuddin, T.M.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Obsessive Compulsive Disorder (OCD) may present in the prodromal phase
    of schizophrenia. However at times it is difficult to distinguish between the
    pure obsession and psychotic obsessions that exist in patients. We present a
    case of a patient initially diagnosed as Schizophrenia due to the disorganized
    aspect of her behaviour, only to discover an extreme form of obsessions that
    explained her demeanor throughout.
    MeSH terms: Female; Humans; Obsessive Behavior; Obsessive-Compulsive Disorder; Schizophrenia
  4. Fulltext Haloperidol in treatment resistant schizophrenia: a case report
    Ridzwan, H., Saifuddin, T.M.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    A substantial percentage of patients will have an inadequate response to
    clozapine in treatment resistance schizophrenia. Therefore, different
    approaches need to be considered for managing this group of patients. We
    present a case of a treatment resistant schizophrenia patient who shows poor
    response toward clozapine. Later, he was started with haloperidol. Even
    though antipsychotic superiority of clozapine in relation to haloperidol is
    significant, this patient demonstrated otherwise.
    MeSH terms: Clozapine; Haloperidol; Humans; Male; Schizophrenia; Antipsychotic Agents; Educational Personnel
  5. Fulltext Psychosis associated with weight-loss product containing sibutramine: a case report
    Saifuddin, T.M., Rahim, N., Mansor, N.Z.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Sibutramine is a prohibited weight-reducing agent used in many weight-loss
    products, which has been banned in many countries since 2010 including
    Malaysia due to it toxicities and mortality effect. The widespread use of these
    sibutramine-containing products has raised concerns regarding their side
    effects, which include psychological symptoms. In this case report, we
    highlight a case of psychosis induced by the use of this product. We present a
    case of 36-year-old Burmese lady who has three admissions to psychiatry
    ward with psychotic presentation after on-going consumption of weight-loss
    product containing sibutramine.
    MeSH terms: Body Weight; Cyclobutanes; Malaysia; Psychiatry; Psychotic Disorders; Weight Loss; Reducing Agents
  6. Fulltext Mania secondary to hyponatremia in elderly patient: a case report
    Saifuddin, T.M., Harun, N.A.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Manic symptoms secondary to hyponatremia is rare or might be underreported.
    Awareness of this phenomenon is important for therapeutic
    considerations of patients. We present a case of late onset mania in an elderly
    gentleman who was previously diagnosed to have Major Depressive Disorder.
    His manic symptoms improved without medication after sodium level was
    corrected.
    MeSH terms: Aged; Awareness; Bipolar Disorder; Depressive Disorder, Major; Humans; Hyponatremia; Psychiatric Status Rating Scales; Sodium
  7. Fulltext The psychometric properties of the Malay version of the Demoralisation Scale (DS-M)
    Chin, H.L., Ng, C.G., Aili, H.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Objective: The objective of this study was study the psychometric properties
    the Malay Version of the Demoralisation Scale (DS-M) in cancer patients.

    Method: This was a cross sectional study where 178 subjects were recruited
    from Universiti Malaya Medical Centre (UMMC). The subjects answered
    both English and Malay versions of the Demoralisation Scales, Centre for
    Epidemiologic Studies Depression (CESD) Scale, Distress Thermometer and
    Positive Emotion Rating Scale (PERS). Principal component factor analysis
    was conducted. The internal consistency, convergent, divergent and
    discriminant validity were examined.

    Results: The mean score for the DS-M
    of the subjects was 18.79 + 15.30 where 37.6% of the cancer patients scored >
    23. The principal component analysis of DS-M yielded four-factor structures.
    The Cronbach’s alpha for the scale was 0.95, and the subscales ranged
    between 0.81-0.92. The Spearman’s correlation showed a good convergent
    validity between DS-M and CESD (r = 0.78, p < 0.01) and Distress
    Thermometer (r = 0.64, p < 0.01); and divergent validity between DS-M and
    PERS (r = -.69, p < 0.01). The AUC was 0.92 (SE: 0.02, p < 0.01, 95% CI 0.88-
    0.97).

    Conclusion: The DS-M has good psychometric properties as a
    screening tool for demoralisation in patients with cancer in Malaysia.
  8. Fulltext Cross-cultural adaptation of the reliable and valid Malay version of alcohol use disorder identification test
    Ali, N., Abdul Mutalip, M.H., Kamaruddin, R., Manickam, M.A., Ahmad, N.A.
    Malaysian Journal of Psychiatry, 2017;26(2):19-31.
    MyJurnal
    Background: Early detection of alcohol abuse and associated risk(s) is necessary. It requires easy and reliable screening tools that are culturally
    adapted to the local context.
    Objectives: The aims of this study were to cross culturally adapt, test for its reliability and validity of the Malay version of Alcohol Use Disorder Identification Testing (AUDIT-M).
    Methods: The cross-cultural adaptation process involved four stages: translation, synthesis, back translation and field pre-testing. The final version of AUDIT-M was pre-tested and post-tested within a 10-day interval among 37 respondents at the Tampin Health Clinic. Analysis of reliability and validity testing were done using SPSS version 21.
    Results: There were 37 participants in this study. The Intra-Class Correlation (ICC) with single measures of the test-retest scores was 0.93 (Cronbach alpha = 0.97), while the internal consistency reliability yielded (Cronbach alpha=0.92). Validity testing for the Pre-test and Post-test analysis with the Pearson correlation analysis was r=0.938.
    Conclusion: The translated Malay version of the AUDIT-M was found to be easy to understand and adaptable in the Malaysian context.
    MeSH terms: Alcoholism; Ambulatory Care Facilities; Cross-Cultural Comparison; Humans; Malaysia; Surveys and Questionnaires; Translations; Reproducibility of Results
  9. Fulltext Validation of the Malay version of Zarit Burden Interview (MZBI)
    Shim, V.K., Drahman, I., Ng, C.G.
    Malaysian Journal of Psychiatry, 2017;26(2):0-0.
    MyJurnal
    Background: Caregiver burden is an important outcome commonly
    investigated in both observational and interventional literatures associated
    with caregiving of patients. Zarit Burden Interview (ZBI) is the oldest and
    most widely used measure for assessment of caregiver burden. Since the
    publication of the original version in 1980, various translated and shorter
    revised versions of the ZBI in multiple languages have been produced.

    Objectives: This study aimed to evaluate the validity and reliability of the
    Malay version of Zarit Burden Interview (MZBI) for assessment of the
    caregiver burden among the local family caregivers of cancer patients.

    Methods: In total, 50 family caregivers of cancer patients in a government
    tertiary hospital in Sarawak were recruited in this cross-sectional study using
    non-random sampling method. The caregivers were given the MZBI scale,
    followed by the Malay version of Center for Epidemiologic Studies –
    Depression (MCES-D) scale and English version of Zarit Burden Interview
    (EZBI) scale. Statistical analyses were performed to assess the reliability and
    validity of the MZBI.

    Results: The MZBI demonstrated good reliability with
    high internal consistency (α = 0.898) and split-half correlation of 0.912, and
    significant positive correlation with MCES-D (rs = 0.58, p < 0.01) and EZBI
    (rs = 0.84, p < 0.01). A score of 22 was selected as the suitable cut-off score for
    MZBI scale in the local population based on ROC curve with the area under
    the curve of 0.786 (CI 0.658 – 0.914, p = 0.001). At the score of 22, the
    sensitivity and specificity of the MZBI were 70.8% and 69.2% respectively.

    Conclusion: The MZBI demonstrated fairly good psychometric properties in
    assessing the caregiver burden in local Malaysian population. Further study
    on the factorial structure of the MZBI would be useful to enhance the overall
    validity of the scale in the context of caregiver burden assessment.
  10. Fulltext A better mental health for all
    Jasraj, S., Viknesh, N.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Psychiatric services have progressed well throughout history, marked by a shift from heavily inpatient asylums to outpatient management via deinstitutionalization, and advances in psychopharmacology. An overview of important themes is discussed at public mental health level. Firstly, differences between sexes are touched upon from theoretical and societal perspectives. Next, among the disabled, the phenomenon of diagnostic overshadowing, attributing apparent mental health problems to learning disability, contributes to their overall poorer quality of life. Mental health at both extremes of age is another important theme, whereby dementia and depression are keenly observed in the older age group, while maternal risk factors and parenting play a role in the mental well-being of the younger age group. Fourthly, inequalities, stigma and discrimination, are rife among people living with mental illness, and thereby detrimental in their road to recovery. Deinstitutionalization is explained as being more than just downsizing the inpatient load, gaining prominence with the emergence of community psychiatry services, and found to be helpful in overcoming stigma. Demographically, it was demonstrated that developing countries, as opposed to developed countries, have advantages in their approaches to psychiatric services, including better integration of people living with mental illness into society. Lastly, the psychological well-being of mental health workers should not be discounted, with measures such as stress management and resilience training proving to be key in combating burnout.
    MeSH terms: Burnout, Professional; Community Psychiatry; Deinstitutionalization; Dementia; Depression; Depressive Disorder; Developing Countries; Humans; Inpatients; Mental Health; Outpatients; Psychopharmacology; Quality of Life; Socioeconomic Factors; Parenting; Developed Countries; Social Stigma
  11. Fulltext Clozapine-induced fatal bowel ischaemia - a neglected side effect?
    Razak, N.A., Mohd Nor, F., Shafie, M.S., Hwang, I.S.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    There have been previous reported deaths due to clozapine-induced
    constipation. In all these cases, patients have experienced prior abdominal
    symptoms over a period of weeks or months. Clozapine is an anti-psychotic
    drug, and it is widely used for treatment of schizophrenia. The important
    side-effects of clozapine include postural hypotension, weight gain,
    tachycardia, cardiomyopathy, cardiomyositis, seizures, hypersalivation and
    agranulocytosis. However, constipation induced by clozapine need to be
    addressed since it may cause fatal consequences. Constipation associated with
    clozapine is thought to be mediated by the drugs' pronounced dosedependent
    cholinergic and serotonergic antagonism. Hence, a clozapineinduced
    rapidly fatal bowel ischaemia is the highlight of this report and this
    risky side-effect should be aware by the psychiatrist or physician before
    commencing the treatment.
    MeSH terms: Agranulocytosis; Clozapine; Constipation; Humans; Hypotension, Orthostatic; Cardiomyopathies; Psychiatry; Schizophrenia; Seizures; Sialorrhea; Tachycardia; Weight Gain; Cholinergic Agents
  12. Fulltext Organic disorder with neuropsychiatric symptoms - case report of anti-NMDA receptor encephalitis with neuropsychiatric manifestations
    Sivarooban, V., Yogitagavari, Y., Che, C.K., Lee, C.W.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Neuropsychiatric symptoms are symptoms that caused by organic brain
    disorders. Multiple neuropsychiatric symptoms can occur concurrently in the
    course of brain related organic disorders. Two main components of
    neuropsychiatric symptoms are cognitive impairment and disturbance of
    consciousness while other neuropsychiatric symptoms, such as hallucinations,
    delusions, mood disorders, anxiety, apathy, behavioural and personality
    changes also commonly occur. Some of the mild neuropsychiatric symptoms
    could possibly be the earliest manifestations of brain related organic
    disorders. Clinicians should carefully evaluate organic factors in the
    treatment of psychosis, especially in patients of very young age or older age.
    They should have enough knowledge and experience in the integrating
    neuroscience, that is, neuropsychiatry. The present report illustrates a case of
    organic disorder with neuropsychiatric manifestations. It is about a young
    male patient who was diagnosed with anti-NMDA receptor encephalitis and
    subsequently developed acute delirium secondary to the illness.
    MeSH terms: Anxiety; Brain; Consciousness; Delirium; Delusions; Hallucinations; Humans; Male; Personality; Psychotic Disorders; Mood Disorders; Apathy; Neuropsychiatry; Anti-N-Methyl-D-Aspartate Receptor Encephalitis
  13. Fulltext A diagnostic dilemma: catatonia, serotonin syndrome and Parkinsonism
    Mohd Miharbeim M.F., Ahmad Zafri, A.B., Suhaila, M.Z.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Catatonia may concomitantly occur with other psychiatric diagnoses such as
    Major Depressive Disorder, however problem in diagnosis may arise due to
    the overlapping features with other problems such as serotonin syndromes,
    neuroleptic malignant syndromes and Parkinsonism. Despite the diagnostic
    dilemma and lack of diagnostic tools, the clinical correlation between the
    carbon monoxide poisoning and the late-onset development of the
    Parkinsonian features is the highlight of this report.
    MeSH terms: Carbon Monoxide Poisoning; Catatonia; Depressive Disorder, Major; Neuroleptic Malignant Syndrome; Serotonin Syndrome; Parkinsonian Disorders
  14. Fulltext Interlocking doctor-patient trust in patient-hood: a gender perspective among mental health care users
    Kamarunzaman, N.Z., Selamat, N.H.
    Malaysian Journal of Psychiatry, 2017;26(1):15-29.
    MyJurnal
    This article aims at exploring the trust establishment among patients with depression during their journey to psychiatric patient-hood. This study was undertaken in government hospital involving 29 psychiatric outpatient users in Kedah and Pulau Pinang respectively using phenomenological study and gender lens. Semi-structured in-depth interview and non-participant observation were the tools used in data collection. The data explicated with the aid of a qualitative data analysis tool, Atlas.ti., version 7.5. Through the findings, the study identified “Trust” appears critical in the accounts of the patients in shaping the doctor-patient relationship. Five interlocking subthemes describing the health professional’s characteristic while giving the service include doctor’s integrity, concern, competencies, empathy, and autonomy enabler. The findings had highlighted that both female and male physicians had different approach to their patients, where the female physician had better chances in getting the mandate of trust. This research is useful to health professionals and governance of mental health care to fulfil the patients’ needs based on their genders.

    Study site: government hospital involving 29 psychiatric outpatient users
    in Kedah and Pulau Pinang
    MeSH terms: Mental Disorders; Hospitals; Humans; Malaysia; Outpatient Clinics, Hospital; Physician-Patient Relations*; Sex Factors; Qualitative Research
  15. Fulltext The Malay version of the mental health knowledge schedule: a preliminary study
    Pheh. K.S., Anna Ong. W.H., Low, S.K., Tan, C.S., Kok, J.K.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Background of Study: Mental Health Knowledge Schedule (MAKS) is an instrument to assess knowledge about mental health issues commonly used in English-speaking countries.
    Objectives: The present study translated the MAKS into Malay language (MAKS-M) and investigate its reliability in the Malaysian context among secondary school teachers.
    Methods: A total of 77 secondary school teachers answered the back-translated MAKS-M before and after attending a mental health literacy program. Cronbach’s alpha and
    Lin’s concordance statistics of the data were computed.
    Results: Test-retest reliability was below the satisfactory level. Specifically, internal consistency was low for Time 1 but improvement was observed in Time 2.
    Conclusion: The findings suggest that fundamental knowledge about mental health may be required for individuals to understand the items. Recommendations were provided for future studies to explore the usability of the MAKS-M.
    MeSH terms: Adult; Cross-Sectional Studies; Faculty; Humans; Malaysia; Mental Health; Psychometrics; Schools
  16. Fulltext Depression symptoms level among thyroid disorders patients at Central region of Peninsular Malaysia
    Siti Nur Illiani, J., Azlina, D., Sanisah, S., Ramli, M., Nik Noor Fatnoon, N.A.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Background of Study: Patients with thyroid disorders were found to have
    continued to experience symptoms of depression despite the great of treatment has
    been given to the patient to balance the thyroid hormones. Objective: The aim of
    this study is to determine the level of depression symptoms among various types
    of thyroid disorders patients.

    Methods: A cross sectional study was carried out at
    one of the government hospital at central region of Peninsular Malaysia from
    August to October 2016. Patients were diagnosed as thyroid disorders, Malaysian
    citizen, above 18 years old and did not have any psychiatric disorders were
    included in this study.Depression Anxiety Stress Scale-42 (DASS-42) was
    selected to determine the severity of depression symptoms and interpreted as
    follow: less than 9-no depression, between 10 and 13-mild depression, between
    14-20-moderate depression, between 21 and 27- severe depression and more than
    28-extreme severe depression. Descriptive statistic was analysed by IBM
    Statistical Package for the Social Sciences (SPSS) version 21.0.

    Results: About
    15% (23) out of 153 thyroid patients had varies degree of depression symptoms
    from mild to severe extremely depression. Patients who had hyperthyroid were
    found to have more depressed, followed by hypothyroid and thyroid cancer group.

    Conclusion: These findings would suggest that the depression score was higher in
    the patients who have hyperthyroid. A more detail and thorough study is
    recommended to be done, in order to confirm these findings.
    MeSH terms: Anxiety; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Government; Humans; Hyperthyroidism; Malaysia; Social Sciences; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones; Thyroid Neoplasms
  17. Fulltext Rats and leptospirosis, a unique tropical experience
    Bahaman, A.R.
    Jurnal Veterinar Malaysia, 2017;29(1):26-27.
    MyJurnal
    Rats are the maintenance host for leptospirosis and are the source of the infection to humans and animals. To eradicate leptospirosis, then the maintenance hosts should be eliminated. This is not possible, particularly when it involved wildlife like rats. A good alternative then is to impose biological control on the rat population which is a safe and pragmatic approach. The environment is the indirect source of infection and in tropical countries; recreational areas are often the place foroutbreaks of leptospirosis. Claims that leptospires survive for months in the environment probably is not true. The “top up” or daily excretion of leptospires from the maintenance hosts particularly rats make it appears that the leptospires survived for months in the environment. The good news is that although there are many infected rats in the cities, there were hardly any reports of outbreaks of leptospirosis in urban areas. Outbreaks of leptospirosis tend to be in the countryside particularly in recreational areas, where infection is easily transmitted through the conjunctiva or mucous membrane of the upper respiratory or gastro-intestinal tract through water activities.
  18. The Pattern of Uveitis among Chinese, Malays, and Indians in Singapore
    Siak J, Jansen A, Waduthantri S, Teoh CS, Jap A, Chee SP
    Ocul Immunol Inflamm, 2017;25(sup1):S81-S93.
    PMID: 27419535 DOI: 10.1080/09273948.2016.1188968
    PURPOSE: To describe the pattern of uveitis among Chinese, Malays, and Indians at a tertiary referral institution in Singapore.

    METHODS: Charts between January 1997 and December 2010 were retrospectively reviewed. Charts between January 2014 and December 2014 were prospectively reviewed.

    RESULTS: A total of 1249 and 148 charts were retrospectively and prospectively reviewed, respectively. The top causes of anterior uveitis (AU) were HLA-B27, idiopathic, and CMV AU. The top known causes of intermediate uveitis were tuberculosis, primary intraocular lymphoma, and sarcoidosis. The top causes of posterior uveitis were CMV retinitis, toxoplasmosis, and dengue maculopathy. The top causes of panuveitis were VKH, idiopathic panuveitis, tuberculosis, and Behçet disease. HLA-B27 and CMV AU were more frequent among Chinese (21% vs 9% (non-Chinese); p<0.001; 10% vs 5% (non-Chinese); p<0.001, respectively). Tuberculous uveitis was more frequent among Malays and Indians (12% (non-Chinese) vs 5% (Chinese), p<0.001).

    CONCLUSIONS: Different uveitis patterns were encountered among patients of different races.

    MeSH terms: Adolescent; Adult; Aged; Child; Child, Preschool; China/ethnology; Female; Humans; India/ethnology; Infant; Infant, Newborn; Malaysia/ethnology; Male; Middle Aged; Retrospective Studies; Singapore/epidemiology; Uveitis/classification; Uveitis/ethnology*; Uveitis/etiology; Age Distribution; Sex Distribution; Asian Continental Ancestry Group/ethnology*; Tertiary Care Centers/statistics & numerical data
  19. When water is thicker than blood: recognising a systemic cause of haemoptysis
    Wedge E, Abrahamson E, Tudor-Williams G, Nadel S, Deal J
    Arch Dis Child Educ Pract Ed, 2017 Aug;102(4):210-219.
    PMID: 27780827 DOI: 10.1136/archdischild-2015-308957
    The case of an 11-year-old child presenting with acute haemoptysis and breathlessness is described. The girl was Malaysian and had recently arrived in the UK. She subsequently deteriorated, developing respiratory failure. The course of the illness is described, with reference to the diagnostic process at each stage. The case demonstrates the importance of having a broad investigatory approach in acute haemoptysis.
    MeSH terms: Child; Diagnosis, Differential; Female; Glomerulonephritis/complications; Glomerulonephritis/diagnosis*; Glomerulonephritis/therapy*; Great Britain; Hemoptysis/diagnosis*; Hemoptysis/etiology; Hemoptysis/therapy*; Humans; Malaysia; Pediatrics/standards*; Treatment Outcome; Practice Guidelines as Topic*
  20. Fulltext Effect of x-radiation on biomechanical properties of bovine ligamentum nuchae
    Faizal Mohamed
    Journal of Nuclear and Related Technologies, 2017;14(2):33-40.
    MyJurnal
    The extracellular matrix (ECM) is a complex structural entity surrounding and supporting cells that
    are found within mammalian tissue. This study presents the effect of ionizing radiation on the physical
    properties of elastin which is usually found within arteries, lung, skin, ligantum nuchae, vocal chords
    and elastic cartilage as a function of their composition and organization or architecture. X-ray from
    an electron linac were used to give doses of 10-50Gy to cover the range of irradiation exposure during
    radiotherapy. A uniaxial mechanical testing protocol was used to characterize the fibrous protein. For
    pericardial the major change was an increase in the elastic modulus in the toe region of the curve (≤
    20% strain), from 23±18 kPa for controls to 57±22 kPa at a dose of 10 Gy (p=0.01, α=0.05). At a
    larger strain (≤ 20%), the elastic modulus in the region decreased from 1.92±0.70 MPa for control
    pericardium tissue to 1.31±0.56 MPa (p=0.01, α=0.05) for 10 Gy X-irradiated sample. For elastin,
    the stress-strain relationship was linear up to 30% strain, but the elastic modulus decreased
    significantly with irradiation (controls 626±65 kPa, irradiated 474±121 kPa (p=0.02, α=0.05). The
    results suggest that for elastin chain scissions are the primary effect of irradiation. The Raman
    microspectrometry was employed to characterize these changes on ECM conformation.
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