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  1. Ngah NF, Muhamad NA, Mohamed SO, Abdul Aziz RA, Ma'amor NH, Ahmad Tarmidzi NA, et al.
    Int J Ophthalmol, 2023;16(5):712-720.
    PMID: 37206185 DOI: 10.18240/ijo.2023.05.07
    AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.

    METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it.

    RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created.

    CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

  2. Ngah NF, Muhamad NA, Abdul Aziz RA, Mohamed SO, Ahmad Tarmizi NA, Adnan A, et al.
    Int J Ophthalmol, 2022;15(12):2001-2008.
    PMID: 36536974 DOI: 10.18240/ijo.2022.12.16
    The prevalence of diabetic retinopathy (DR), and associated morbidity is high in the Asia-Pacific region. Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR, especially in patients with cardiovascular risk, and pre-existing mild-to-moderate DR. Fenofibrate has also been found to reduce maculopathy, and the need for laser treatment in these patients. Considering these benefits of fenofibrate, a group of experts from the fields of endocrinology and ophthalmology convened in May 2017, to discuss on the the mechanism of action, and clinical efficacy of fenofibrate in DR. The findings from key clinical studies on fenofibrate in DR were reviewed by the experts, and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR. The statements were rated based on the GRADE criteria. An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes (T2D), and the place of fenofibrate was defined in the algorithm. The expert recommendations, and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.
  3. Ahmad Tarmizi NN, Bastion MC, Abdul Aziz RA, Md Din N, Mohd Khialdin S
    Cureus, 2021 Aug;13(8):e17620.
    PMID: 34646671 DOI: 10.7759/cureus.17620
    The aim of this study is to report an unusual case of retinal racemose haemangioma (RRH) in a child resulting in optic neuropathy and its optical coherence tomography angiography (OCT-A) findings. This is a retrospective case report. For almost a year, a 13-year-old girl experienced gradual, painless, generalized blurred vision in her right eye. Visual acuity was 6/60 with a positive relative afferent pupillary defect (RAPD) in her right eye. The right-eye fundus showed enlarged and tortuous retinal vessels extending from the optic disc to all four quadrants, including the juxta foveal region. OCT analysis revealed distortion in the region of enlarged vessels with minimal retinal fluid while OCT-A of the macula area demonstrated dilated and tortuous vessels in the superficial layers of the retina. Right intra-orbital vascular channels surrounding the optic nerve with optic nerve atrophy and gliosis were detected on magnetic resonance imaging angiography/venography (MRA/MRV). The cerebral angiogram reported an abnormal tangle of small vessels within the right orbit that received supply from a dilated right ophthalmic artery indicating the presence of retro-orbital arteriovenous malformation (AVM). She was then referred to the neurosurgeon and a decision was made not to embolize or resect the dilated vessel as this might lead to occlusion of the ophthalmic artery and thus worsen her vision. RRH may present in the paediatric age group, and optic nerve atrophy is one of the disease manifestations. OCT-A is a less invasive diagnostic option compared to fundus fluorescein angiography (FFA) for diagnosis and monitoring of disease progression.
  4. Ghoshal R, Sharanjeet-Kaur S, Mohamad Fadzil N, Mutalib HA, Ghosh S, Ngah NF, et al.
    PMID: 32887214 DOI: 10.3390/ijerph17176379
    In early and intermediate age related macular degeneration (ARMD), visual acuity alone has failed to explain the complete variation of vision. The aim of the present study was to determine correlation between different visual functions and retinal morphology in eyes with early and intermediate ARMD. In this single center cross sectional study, patients diagnosed as early or intermediate ARMD in at least one eye were recruited. Visual functions measured were best- corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS). Parameters such as thickness (RT) and volume (RV) of the retina, outer retinal layer thickness (ORLT) and volume (ORLV), outer nuclear layer thickness (ONLT) and volume (ONLV), retinal pigment epithelium layer-Bruch's membrane complex thickness (RPET) and volume (RPEV) were assessed employing semi-auto segmentation method of Spectralis optical coherence tomography (OCT). Twenty-six eyes were evaluated. DVA, CS, and RS showed significantly good correlation with RPET, ONLT, and ONLV, whereas NVA showed good correlation with ONLV and RPET. The present study concluded that RS, CS, NVA, and DVA represent the morphological alteration in early stages and should be tested in clinical settings. ONLT, ONLV, and RPET morphological parameters can be employed as important biomarkers in diagnosis of early to intermediate ARMD.
  5. Ngah NF, Muhamad NA, Asnir ZZ, Abdul Aziz RA, Mhad Kassim Z, Sahar SA, et al.
    Int J Ophthalmol, 2020;13(11):1808-1813.
    PMID: 33215014 DOI: 10.18240/ijo.2020.11.19
    AIM: To determine the prevalence of diabetic retinopathy (DR) among diabetic patients at the primary health clinics in Selangor, Malaysia.

    METHODS: All diabetic patients were screened in Retinal Disease Awareness Programme (RDAP) and those who had significant DR changes were referred to the hospital for further management. Descriptive analyses were done to determine the prevalence of DR and sociodemographic characteristics among patients with diabetic. Univariate and multivariable analysis using Logistic regression were performed to find association and predictor factors in this screening.

    RESULTS: A total of 3305 patients aged 40y and above were screened for DR. Of the patients screened, 9% patients were found to have DR and other visual complication such as maculopathy (0.9%), cataract (4.8%) and glaucoma (0.4%). The mean age of patients without retinopathy was 57.82±8.470y and the mean age of patients with DR was 63.93±9.857y. About 61.5% of the patients screened were aged below 60y and 38.5% were aged 60y and above. Majority of the patients screened were women 58.5% and Malay in the age group of 50-59y, while 27% were aged 60-69y. Significant association were found between age, sex, race, visual loss and DR.

    CONCLUSION: Although the prevalence of DR among patients is not alarming, effective interventions need to be implemented soon to avert a large burden of visual loss from DR.

  6. Teichmann J, Suwarganda EK, Beaven CM, Hébert-Losier K, Lee JW, Tenllado Vallejo F, et al.
    J Sport Rehabil, 2016 Dec 19.
    PMID: 27992260 DOI: 10.1123/jsr.2016-0082
    CONTEXT: Sensorimotor training is commonly used in a rehabilitative setting; however, the effectiveness of an unexpected disturbance program (UDP) to enhance performance measures in uninjured elite athletes is unknown.

    OBJECTIVE: To assess the impact of a three-week UDP program onstrength, power, and proprioceptive measures.

    DESIGN: Matched-group, pre- post design.

    SETTING: National Sports Institute.

    PARTICIPANTS: Twenty-one international-level female field hockey athletes.

    INTERVENTIONS: Two 45 min UDP sessions were incorporated into each week of a three week training program (total 6 sessions).

    MAIN OUTCOME MEASURES: One-repetition maximum strength, lower limb power, 20 m running speed, and proprioception tests were performed before and after the experimental period.

    RESULTS: Substantial improvements in running sprint speed at 5- (4.4 ± 2.6%; Effect Size [ES]: 0.88), 10- (2.1 ± 1.9%; ES: 0.51), and 20-m (1.0 ± 1.6%; ES: 0.23) were observed in the UDP group. Squat jump performance was also clearly enhanced when compared to the control group (3.1 ± 6.1%; ES: 0.23). Small but clear improvements in maximal strength were observed in both groups.

    CONCLUSION: A three week UDP can elicit clear enhancements in running sprint speed and concentric-only jump performance. These improvements are suggestive of enhanced explosive strength and are particularly notable given the elite training status of the cohort and relatively short duration of the intervention. Thus, we would reiterate the statement by Gruber and colleagues (2004) that sensorimotor training is a "highly efficient" modality for improving explosive strength.

  7. Teichmann J, Suwarganda EK, Lendewig C, Wilson BD, Yeo WK, Aziz RA, et al.
    J Sport Rehabil, 2016 May;25(2):126-32.
    PMID: 27269799 DOI: 10.1123/jsr.2014-0280
    The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.
  8. Teichmann J, Suwarganda EK, Lendewig C, Wilson BD, Yeo WK, Aziz RA, et al.
    J Sport Rehabil, 2016 May;25(2):126-32.
    PMID: 25658597 DOI: 10-1123/jsr.2014-0280
    CONTEXT: The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.

    OBJECTIVE: This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation.

    DESIGN: Pre-post study with 2-tailed paired t tests for limited a priori comparisons to examine differences.

    SETTING: National Sports Institute of Malaysia.

    PARTICIPANTS: 24 Malaysian national athletes.

    INTERVENTIONS: 7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises.

    MAIN OUTCOMES: Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire.

    RESULTS: For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb.

    CONCLUSION: The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.

  9. Yusoff MS, Esa AR, Mat Pa MN, Mey SC, Aziz RA, Abdul Rahim AF
    Educ Health (Abingdon), 2013 Jan-Apr;26(1):39-47.
    PMID: 23823672 DOI: 10.4103/1357-6283.112800
    CONTEXT: There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods.
    METHODS: A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations.
    RESULTS: At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism.
    CONCLUSIONS: This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.
  10. Chua LS, Amin NA, Neo JC, Lee TH, Lee CT, Sarmidi MR, et al.
    J Chromatogr B Analyt Technol Biomed Life Sci, 2011 Dec 15;879(32):3909-19.
    PMID: 22119436 DOI: 10.1016/j.jchromb.2011.11.002
    A number of three LC-MS/MS hybrid systems (QTof, TripleTof and QTrap) has been used to profile small metabolites (m/z 100-1000) and to detect the targeted metabolites such as quassinoids, alkaloids, triterpene and biphenylneolignans from the aqueous extracts of Eurycoma longifolia. The metabolite profiles of small molecules showed four significant clusters in the principle component analysis for the aqueous extracts of E. longifolia, which had been collected from different geographical terrains (Perak and Pahang) and processed at different extraction temperatures (35°C and 100°C). A small peptide of leucine (m/z 679) and a new hydroxyl methyl β-carboline propionic acid have been identified to differentiate E. longifolia extracts that prepared at 35°C and 100°C, respectively. From the targeted metabolites identification, it was found that 3,4ɛ-dihydroeurycomanone (quassinoids) and eurylene (squalene-type triterpene) could only be detected in the Pahang extract, whereas canthin-6-one-3N-oxide could only be detected in the Perak extract. Overall, quassinoids were present in the highest concentration, particularly eurycomanone and its derivatives compared to the other groups of metabolites. However, the concentration of canthin-6-one and β-carboline alkaloids was significantly increased when the roots of the plant samples were extracted at 100°C.
  11. Chua LS, Latiff NA, Lee SY, Lee CT, Sarmidi MR, Aziz RA
    Food Chem, 2011 Aug 1;127(3):1186-92.
    PMID: 25214112 DOI: 10.1016/j.foodchem.2011.01.122
    Both total phenolic content (TPC) and total flavonoid content (TFC) of Labisia pumila extracts were determined spectrophotometrically. L. pumila leaves extracted in 60% methanol (MeOH) were fractionated on C18 cartridge and the antioxidant property of each fraction was determined by measuring free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH) scavenging activity. The 40% MeOH fraction exhibited the highest scavenging activity. Nine flavonols (quercetin, myricetin and kaempferol), two flavanols (catechin and epigallocatechin) and nine phenolic acids were identified from this active fraction by UPLC-ESI-MS/MS, and confirmed by comparison with the mass spectra of standard aglycones, theoretical fragments generated from MS Fragmenter software, and literature values.
  12. Chew YH, Shia YL, Lee CT, Majid FA, Chua LS, Sarmidi MR, et al.
    Mol Cell Endocrinol, 2009 Aug 13;307(1-2):57-67.
    PMID: 19524127 DOI: 10.1016/j.mce.2009.03.005
    A mathematical model to describe the oscillatory bursting activity of pancreatic beta-cells is combined with a model of glucose regulation system in this work to study the bursting pattern under regulated extracellular glucose stimulation. The bursting electrical activity in beta-cells is crucial for the release of insulin, which acts to regulate the blood glucose level. Different types of bursting pattern have been observed experimentally in glucose-stimulated islets both in vivo and in vitro, and the variations in these patterns have been linked to changes in glucose level. The combined model in this study enables us to have a deeper understanding on the regime change of bursting pattern when glucose level changes due to hormonal regulation, especially in the postprandial state. This is especially important as the oscillatory components of electrical activity play significant physiological roles in insulin secretion and some components have been found to be lost in type 2 diabetic patients.
  13. Chew YH, Shia YL, Lee CT, Majid FA, Chua LS, Sarmidi MR, et al.
    Mol Cell Endocrinol, 2009 May 6;303(1-2):13-24.
    PMID: 19428987 DOI: 10.1016/j.mce.2009.01.018
    A model of glucose regulation system was combined with a model of insulin-signaling pathways in this study. A feedback loop was added to link the transportation of glucose into cells (by GLUT4 in the insulin-signaling pathways) and the insulin-dependent glucose uptake in the glucose regulation model using the Michaelis-Menten kinetic model. A value of K(m) for GLUT4 was estimated using Genetic Algorithm. The estimated value was found to be 25.3 mM, which was in the range of K(m) values found experimentally from in vivo and in vitro human studies. Based on the results of this study, the combined model enables us to understand the overall dynamics of glucose at the systemic level, monitor the time profile of components in the insulin-signaling pathways at the cellular level and gives a good estimate of the K(m) value of glucose transportation by GLUT4. In conclusion, metabolic modeling such as displayed in this study provides a good predictive method to study the step-by-step reactions in an organism at different levels and should be used in combination with experimental approach to increase our understanding of metabolic disorders such as type 2 diabetes.
  14. Noordin R, Aziz RA, Ravindran B
    Filaria journal, 2004 Dec 31;3(1):10.
    PMID: 15627400
    BACKGROUND: The recombinant antigen BmR1 has been extensively employed in both ELISA and immunochromatographic rapid dipstick (Brugia Rapid) formats for the specific and sensitive detection of IgG4 antibodies against the lymphatic filarial parasites Brugia malayi and Brugia timori. In sera of individuals infected with Wuchereria bancrofti the IgG4 reactivity to BmR1 is variable, and cross-reactivity of sera from individuals infected with Onchocerca volvulus or Loa loa was observed only in single cases. In order to characterize the homologs of the BmR1 antigen in W. bancrofti (Wb-BmR1), O. volvulus (Ov-BmR1) and L. loa (Ll-BmR1) the cDNA sequences were identified, the protein expressed and the antibody reactivity of patients' sera was studied. METHODS: PCR methodology was used to identify the cDNA sequences from cDNA libraries and/or genomic DNA of W. bancrofti, O. volvulus and L. loa. The clones obtained were sequenced and compared to the cDNA sequence of BmR1. Ov-BmR1 and Ll-BmR1 were expressed in E. coli and tested using an IgG4-ELISA with 262 serum samples from individuals with or without B. malayi, W. bancrofti, O. volvulus and L. loa infections or various other parasitic infections. BmR1, Ov-BmR1 and Ll-BmR1 were also tested for reactivity with the other three IgG subclasses in patients' sera. RESULTS: Wb-BmR1 was found to be identical to BmR1. Ov-BmR1 and Ll-BmR1 were found to be identical to each other and share 99.7% homology with BmR1. The pattern of IgG4 recognition of all serum samples to BmR1, Ov-BmR1 and Ll-BmR1 were identical. This included weak IgG4 reactivities demonstrated by L. loa- and O. volvulus-infected patients tested with Ov-BmR1 and Ll-BmR1 (or BmR1). With respect to reactivity to other IgG subclasses, sera from O. volvulus- and L. loa-infected patients showed positive reactions (when tested with BmR1, Ov-BmR1 or Ll-BmR1 antigens) only with IgG1. No reactivity was observed with IgG2 or with IgG3. Similarly, ELISAs to detect reactivity to other anti-filarial IgG subclasses antibodies showed that sera from individuals infected with B. malayi or W. bancrofti (active infections as well as patients with chronic disease) were positive with BmR1 only for IgG1 and were negative when tested with IgG2 and with IgG3 subclasses. CONCLUSIONS: This study demonstrates that homologs of the BmR1 antigen are present in W. bancrofti, O. volvulus and L. loa and that these antigens are highly conserved. Recognition of this antigen by patients' sera is similar with regard to IgG1, IgG2 and IgG3, but different for IgG4 antibodies. We conclude that the BmR1 antigen is suitable for detection of IgG4 antibodies in brugian filariasis. However, its homologs are not suitable for IgG4-based diagnosis of other filarial infections.
  15. Sulong MZ, Aziz RA
    J Prosthet Dent, 1990 Mar;63(3):342-9.
    PMID: 2407832
    This is a review of the literature concerning wear related to the following materials used in dentistry: dental amalgam, composite resins, and glass-ionomer cements, as well as natural tooth substance. Discussions are included on both in vivo and in vitro studies in which various methods were used to help determine wear resistance.
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