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Analysis of examinations in curriculum review

Rotem A, Barrand J, Azman A

Med Educ, 1982 Jan;16(1):3-6.
PMID: 7057721

This paper describes the analysis of the written professional examinations administered at the Medical School, Universiti Kebangsaan Malaysia (UKM), during the academic year 1979-80. It is a product of a collaborative activity involving medical teachers and two short-term consultants of the World Health Organization. The examination papers were analysed in order to identify content areas disproportionately emphasized in the examinations; to determine the quality and appropriateness of the examination items used; and to review the extent of continuity and integration across departments and courses. This paper is intended to introduce an approach to curriculum review which is based on analysis of the examination system. The procedures and sample outcomes are described and the implications for curriculum development and evaluation are discussed.
Electrolyte profile of Malaysian mothers' milk

Alaudeen S, Muslim N, Faridah K, Azman A, Arshat H

Malays J Reprod Health, 1988 Dec;6(2):102-7.
PMID: 12342169

PIP: The influence of socioeconomic status (ethnicity, income and parity) on electrolyte composition (sodium and potassium) in human milk is little known. We have thus quantitatively analyzed approximately 700 samples of milk (1-90 days postpartum) obtained from healthy Malaysian mothers' (Malay, Chinese and Indians) of full term infants. Results show that the mean concentration (mmol/l) of sodium is highest (48.2+or-1.7, Mean+or-SEM) in the Malaysian mothers' colostrum and this value decreased by 30% in their transitional milk and remained constant throughout subsequent days of lactation (mature milk). Ethnically, it is found that the level of sodium in colostrum of Malay and Chinese mothers were similar while the Indian mothers' colostrum showed apparently higher value (52.7+or-3.4 mmol/l) that is statistically insignificant. The transitional milk of all 3 ethnic groups studied exhibited similar levels of sodium. On subsequent days of lactation (mature milk) the Malay mothers exhibited lowest concentration (25.9+or-2.6 mmol/l) of sodium that is significantly (P0.05) different from that of Chinese and Indian mothers. Income and parity do not significantly affect the sodium level in Malaysian mothers' milk during all stages of lactation studied. The level of potassium, however did not change significantly with days of lactation. Like sodium, potassium too was not influenced by income and parity. (Author's).
Fulltext Iodine content in drinking water not an important determinant of endemic goitre

Osman A, Khalida M, Azman AB, Jamil R, Tan TT, Wu LL, et al.

Asia Pac J Clin Nutr, 1993 Sep;2(3):115-8.
PMID: 24352141

The prevalence of goitre was determined in several communities in rural parts of Pahang. Urine specimens were collected randomly among the participants. Drinking water from various sources such as river and spring, and water from gravity feed systems was also collected to determine the iodine content by using the ashing method. The results were compared to that of Kuala Lumpur City. lt was found that the prevalence of goitre in rural areas was between 20 and 70% depending on village, ethnic group, age and gender. The interior parts of the jungle where Aborigines lived was moderately endemic with goitre prevalence of goitre more than 20% and urinary iodine content 2.0-5.0 μg I/dl). A nearby Malay traditional village which was studied had mild endemia (prevalence 10-30% and urinary iodine content 5.0-10.0 μg I/dl) while a Felda Malay resettlement scheme and Kuala Lumpur City did not have endemic goitre. Endemic goitre in rural areas was associated with low iodine content in drinking water. Even though Kuala Lumpur had low iodine content in its drinking water there was no endemic goitre, indicating that other factors were more important.
Fulltext Racial differences in the fasting lipid profile of healthy Malaysians

Zaraihan S, Azman AB, Tariq AR

Med J Malaysia, 1994 Dec;49(4):355-63.
PMID: 7674971

The fasting lipid profile of a sample of Malays, Chinese and Indians in Peninsular Malaysia was studied to see whether these might explain differences in the rate of coronary heart disease mortality amongst the three ethnic groups. Fifty healthy subjects were studied from each of the three groups. They were matched for age, body mass index, gender and smoking habits, if any. The total cholesterol/HDL-cholesterol ratio and LDL-cholesterol/HDL-cholesterol ratio were found to be statistically higher in the Indians than in the Malays and the Chinese. The differences between the Indians and the Chinese were statistically more significant than the differences between the Indians and the Malays. Our findings may partially explain the higher predisposition of the Indian community in Malaysia to CHD mortality and are consistent with those of other studies performed on Indian communities living outside the Indian subcontinent.
Fulltext Ocular involvement in acute lymphoblastic leukaemia

Tan AK, Azman A, Hoe TS, Rohana T

Med J Malaysia, 1994 Dec;49(4):409-11.
PMID: 7674978

A six-year-old boy, a known case of acute lymphoblastic leukaemia (ALL) on remission since 1991 presented with leukocoria and poor vision of the left eye for two days' duration. Examination revealed endophthalmitis in the left eye with raised intraocular pressure. Anterior chamber paracentesis with vitreous biopsy confirmed a diagnosis of ocular involvement. Further investigation revealed that he also had bone marrow and central nervous system relapse. Clinical manifestation and treatment modalities of ocular involvement in leukaemia are discussed.
Fulltext Chondrosarcoma of the nasal septum

Indudharan R, Das PK, Azman AA, Suhaiza S

Singapore Med J, 1998 Aug;39(8):376-9.
PMID: 9844502

A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.
Fulltext Quality of life--how do Malaysian asthmatics fare?

Sararaks S, Rugayah B, Azman AB, Karuthan C, Low LL

Med J Malaysia, 2001 Sep;56(3):350-8.
PMID: 11732082

Asthma can place considerable restrictions on the physical, emotional and social aspects of the lives of patients. The assessment of quality of life aims to provide a means of measuring the impact of this disease on patients' lives, from the patients' perspective. A cross sectional multi-centre study was conducted in six government hospitals throughout the country. Self-administered SF-36 was used, and clinical information obtained through interviews and examination. 1612 asthmatics responded. Females constituted 63% of the respondents; mean age was 40.9 years; Malays were the majority ethnic group, while 70.8% had secondary level education and 53.7% were employed. Half had suffered from asthma for at least 13 years, while 46.8% and 23.6% have moderate and severe disease respectively. Quality of life was affected by severity of disease. Asthmatics, had a significantly poorer quality of life than the general US population. Severe asthma disease was associated with a compromised quality of life, similar to that of COPD.
Fulltext Cost analysis of cataract surgery with intraocular lens implantation: a single blind randomised clinical trial comparing extracapsular cataract extraction and phacoemulsification

Rizal AM, Aljunid SM, Normalina M, Hanom AF, Chuah KL, Suzainah Y, et al.

Med J Malaysia, 2003 Aug;58(3):380-6.
PMID: 14750378

A randomised single blinded clinical trial to compare the cost of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) between March and December 2000. A total of 60 patients were included in this study. The cost of a cataract surgery incurred by hospital, patients and households up to two months after discharge were included. The costs of training, loss of patients' income after discharge and intangible costs were excluded. Results showed that the average cost for one ECCE operation is RM1,664.46 (RM1,233.04-RM2,377.64) and for PEA is RM1,978.00 (RM1,557.87-RM3,334.50). During this short period of follow up, it can be concluded that ECCE is significantly cheaper than PEA by an average difference of RM 313.54 per patient (p < 0.001). Cost of equipment and low frequency of PEA technique done in HUKM were the two main reasons for the high unit cost of PEA as compared to ECCE.
Fulltext Quality of life of the Malaysian general population: results from a postal survey using the SF-36

Azman AB, Sararaks S, Rugayah B, Low LL, Azian AA, Geeta S, et al.

Med J Malaysia, 2003 Dec;58(5):694-711.
PMID: 15190656 MyJurnal

Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.
Fulltext Validity and reliability of the SF-36: the Malaysian context

Sararaks S, Azman AB, Low LL, Rugayah B, Aziah AM, Hooi LN, et al.

Med J Malaysia, 2005 Jun;60(2):163-79.
PMID: 16114157

Results of construct validity and reliability of the SF-36 are described, based on data from a multi-centre study on asthmatics and a population based survey. Questionnaire refinement was carried out between the two studies. Quality of data was good, with all items having less than 0.5% missing values. Floor and/or ceiling effects were observed for REE, REP, PF and SF. For scaling assumptions, correlations between each items and its hypothesized scale were all above 0.50, except for one item in PF. and for both items in SF. Item discriminant validity was an issue for items in VT, SF and MH scales. Cronbach's as for all scales exceeded the recommended 0.70 level, except for SF. Only one latent dimension was identified in principal component analysis, and only 52-53% of variance accounted for. As expected, PF shows high correlations with the physical component while MH was highly correlated with the mental component. Contrasting findings in the loadings of other scales were observed in the asthma data. Age, disease severity and presence of self-reported handicap/disability significantly affect PF, while MH demonstrates no obvious pattern with declining age. In essence, the Malay version of SF-36 could be used in Malaysia, with its generally acceptable internal consistency and validity. The caveat is in the call for additional domains of importance to Malaysians that is not covered by the instrument, and in the caution to be employed when using and construing the instrument.
Fulltext Health-related quality of life in patients with knee osteoarthritis attending two primary care clinics in Malaysia: a cross-sectional study

Zakaria ZF, Bakar AA, Hasmoni HM, Rani FA, Kadir SA

Asia Pac Fam Med, 2009 Dec 31;8(1):10.
PMID: 20084190 DOI: 10.1186/1447-056X-8-10

BACKGROUND: Measurement of health-related quality of life (HRQOL) among patients with osteoarthritis (OA) helps the health care provider to understand the impact of the disease in the patients' own perspective and make health services more patient-centered. The main aim of this study was to measure the quality of life among patients with symptomatic knee OA attending primary care clinic. We also aimed to ascertain the association between socio-demographic and medical status of patients with knee OA and their quality of life.
METHODS: A clinic based, cross sectional study using the Short Form-36 (SF-36) questionnaire was conducted in two primary care health clinics in Hulu Langat, Selangor, Malaysia over a period of 8 months. The nurses and medical assistants were involved in recruiting the patients while the family physicians conducted the interview.
RESULTS: A total 151 respondents were recruited. The mean age was 65.6 +/- 10.8 years with females constituted 119 (78.8%) of the patients. The mean duration of knee pain was 4.07 +/- 2.96 years. Half of the patients were overweight and majority, 138 (91.4%), had at least one co-morbidity, the commonest being hypertension. The physical health status showed lower score as compared to mental health component. The domain concerning mental health components showed positive correlation with age. There was a significant negative correlation between age and physical functioning (p < 0.0005) which indicated the deterioration of this domain as patients became older. Male respondents had better scores in most of the QOL dimensions especially in the physical functioning domain (p = 0.03). There was no significant association between QOL with different education levels, employment status and marital status. Patients with higher body mass index (BMI) and existence co-morbidities scored lower in most of the QOL domains.
CONCLUSIONS: This study has shown that patients with knee OA attending primary care clinics have relatively poor quality of life pertaining to the physical health components but less impact was seen on the patients' mental health.
Use of traditional and complementary medicine in Malaysia: a baseline study

Siti ZM, Tahir A, Farah AI, Fazlin SM, Sondi S, Azman AH, et al.

Complement Ther Med, 2009 Oct-Dec;17(5-6):292-9.
PMID: 19942109 DOI: 10.1016/j.ctim.2009.04.002

The increasing popularity and use of traditional and complementary medicine (TCAM) in both developed and developing countries, including Malaysia, have raised significant public health policy issues. However, currently, there is a paucity of baseline data on such usage by the Malaysian community.
Fulltext The Spetzler-Martin Grading System and management of patients with intracranial arteriovenous malformation in a tertiary referral hospital

Al-Edrus, S. A., Suhaimi, S. N., Noor Azman, A. R., Latif, A. Z., Sobri, M.

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):91-99.
MyJurnal

Introduction: An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. The Spetzler-Martin grading system has been widely accepted worldwide to estimate the pretreatment risks and predict the outcome of patients with intracranial AVM. In Malaysia, we still do not have the baseline data of this grading system. Methods: A total of 33 patients from a tertiary referral hospital diagnosed with intracranial AVM based on neuroimaging findings over a 4-year period were studied. Medical
records were traced and neuroimaging findings were analysed. The AVMs were graded according to the Spetzler-Martin grading system and Fisher’s exact test was used to assess statistical difference between the grades of the AVM and management plan for the patients. Results: Four patients were graded as Grade 1, 9 patients as Grade II, 10 patients as Grade III, 6 patients as Grade IV and 4 patients as Grade V. Ten patients were treated conservatively; six patients underwent surgery and embolisation respectively. Four patients underwent radiosurgery and a combination of embolisation while surgery and radiosurgery were given to 5 patients and 2 patients respectively. Statistically significant difference (p=0.016) was found between the Spetzler-Martin grading system and the management of intracranial AVMs. Conclusion: The management decision was not made based on the
grading of the AVMs. It is recommended that all AVM patients be routinely graded according to this system prior to treatment.
Fulltext Level of knowledge, attitude and practice of night market food outlet operators in Kuala Lumpur regarding the usage of repeatedly heated cooking oil

Azman A, Mohd Shahrul S, Chan SX, Noorhazliza AP, Khairunnisak M, Nur Azlina MF, et al.

Med J Malaysia, 2012 Feb;67(1):91-101.
PMID: 22582556 MyJurnal

Consumption of repeatedly heated oil can be detrimental to health. The objective of this study was to determine the level of knowledge, attitude and practice of night market food outlet operators in Kuala Lumpur regarding the usage of repeatedly heated cooking oil. The quality of cooking oil was also investigated. A cross-sectional study involving pretested questionnaire was undertaken in April 2009. The questionnaire was designed as a tool to collect data from the respondents (n=100) by face-to-face interview. The results showed that majority of respondents had only moderate (53.0%) or low (18.0%) level of knowledge regarding this issue. Most respondents (67.0%) agreed that it is not a good practice. The majority (69.0%) agreed that the usage of repeatedly heated cooking oil is detrimental to health. Despite that, most respondents (63.0%) admitted that they had used cooking oil repeatedly. Most (62.0%) of the cooking oil samples taken from the night market food outlets were considered fit for human consumption. In conclusion, the level of knowledge of night market food outlet operators in Kuala Lumpur regarding this issue needs to be improved in order to ensure the safety of fried food purchased from such establishments.
Deep-fried keropok lekors Increase Oxidative Instability in Cooking Oils

Kamisah Y, Shamil S, Nabillah MJ, Kong SY, Hamizah NA, Qodriyah HM, et al.

Malays J Med Sci, 2012 Oct;19(4):57-62.
PMID: 23613649

BACKGROUND: This study was performed to compare the oxidative quality of repeatedly heated palm and soybean oils, which were used to fry keropok lekors and potato chips.
METHODS: A kilogramme of keropok lekors or potato chips was fried in 2.5 L of palm or soybean oil at 180 °C for 10 minutes. The frying process was repeated once and four times to obtain twice-heated and five-times-heated oils. The peroxide value and fatty acid composition of the oils were measured.
RESULTS: Frequent heating significantly increased the peroxide values in both oils, with the five-times-heated oils having the highest peroxide values [five-times-heated palm: 14.26 ± 0.41 and 11.29 ± 0.58 meq/kg vs fresh: 2.13 ± 0.00, F (3,12) = 346.80, P < 0.001; five-times-heated soybean: 16.95 ± 0.39 and 12.90 ± 0.21 meq/kg vs fresh: 2.53 ± 0.00 oils, F (3,12) = 1755, P < 0.001, when used to fry keropok lekors and potato chips, respectively]. Overall, both oils showed significantly higher peroxide values when keropok lekors were fried in them compared with when potato chips were fried. In general, the heated soybean oil had significantly higher peroxide values than the heated palm oil. Fatty acid composition in the oils remained mostly unaltered by the heating frequency.
CONCLUSION: keropok lekors, when used as the frying material, increased the peroxide values of the palm and soybean oils. Fatty acid composition was not much affected by the frequency of frying or the fried item used.
Fulltext Development of an indoor air quality checklist for risk assessment of indoor air pollutants by semiquantitative score in nonindustrial workplaces

Syazwan A, Rafee BM, Hafizan J, Azman A, Nizar A, Izwyn Z, et al.

Risk Manag Healthc Policy, 2012;5:17-23.
PMID: 22570579 DOI: 10.2147/RMHP.S26567

To meet the current diversified health needs in workplaces, especially in nonindustrial workplaces in developing countries, an indoor air quality (IAQ) component of a participatory occupational safety and health survey should be included.
Fulltext Wavelet packet entropy for heart murmurs classification

Safara F, Doraisamy S, Azman A, Jantan A, Ranga S

Adv Bioinformatics, 2012;2012:327269.
PMID: 23227043 DOI: 10.1155/2012/327269

Heart murmurs are the first signs of cardiac valve disorders. Several studies have been conducted in recent years to automatically differentiate normal heart sounds, from heart sounds with murmurs using various types of audio features. Entropy was successfully used as a feature to distinguish different heart sounds. In this paper, new entropy was introduced to analyze heart sounds and the feasibility of using this entropy in classification of five types of heart sounds and murmurs was shown. The entropy was previously introduced to analyze mammograms. Four common murmurs were considered including aortic regurgitation, mitral regurgitation, aortic stenosis, and mitral stenosis. Wavelet packet transform was employed for heart sound analysis, and the entropy was calculated for deriving feature vectors. Five types of classification were performed to evaluate the discriminatory power of the generated features. The best results were achieved by BayesNet with 96.94% accuracy. The promising results substantiate the effectiveness of the proposed wavelet packet entropy for heart sounds classification.
A rare case of intussusception associated with metastasized small cell carcinoma of lung

Jarmin R, Azman A, Rahim R, Kosai NR, Das S

Acta Med Iran, 2012;50(11):782-4.
PMID: 23292632

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.
Fulltext Analysis of indoor air pollutants checklist using environmetric technique for health risk assessment of sick building complaint in nonindustrial workplace

Syazwan A, Rafee BM, Juahir H, Azman A, Nizar A, Izwyn Z, et al.

Drug Healthc Patient Saf, 2012;4:107-26.
PMID: 23055779 DOI: 10.2147/DHPS.S33400

To analyze and characterize a multidisciplinary, integrated indoor air quality checklist for evaluating the health risk of building occupants in a nonindustrial workplace setting.
Fulltext Multi-level basis selection of wavelet packet decomposition tree for heart sound classification

Safara F, Doraisamy S, Azman A, Jantan A, Abdullah Ramaiah AR

Comput Biol Med, 2013 Oct;43(10):1407-14.
PMID: 24034732 DOI: 10.1016/j.compbiomed.2013.06.016

Wavelet packet transform decomposes a signal into a set of orthonormal bases (nodes) and provides opportunities to select an appropriate set of these bases for feature extraction. In this paper, multi-level basis selection (MLBS) is proposed to preserve the most informative bases of a wavelet packet decomposition tree through removing less informative bases by applying three exclusion criteria: frequency range, noise frequency, and energy threshold. MLBS achieved an accuracy of 97.56% for classifying normal heart sound, aortic stenosis, mitral regurgitation, and aortic regurgitation. MLBS is a promising basis selection to be suggested for signals with a small range of frequencies.

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