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  1. Rohana AG, Norasyikin AW, Suehazlyn Z, Ming W, Norlela S, Norazmi MK
    Med J Malaysia, 2006 Dec;61(5):638-40.
    PMID: 17623970 MyJurnal
    We report a case of a 65 year old Malay lady with long-standing diabetes mellitus, who presented to our institution with a one month history of worsening neck pain and progressive upper and lower limb weakness. She was stable despite severe hyponatraemia which was initially treated as syndrome of inappropriate anti-diuretic hormone (SIADH). This was consistent with her underlying illness which was concluded as cervical tuberculosis (TB) with spinal cord compression. She underwent decompression and bone grafting. Despite continuous treatment her serum sodium levels remained low. There were no other problems with her adrenals or thyroid. A water loading and hypertonic saline perfusion test was performed and supported the diagnosis of reset osmostat. Her serum sodium remained below the normal range and she was discharged well.
  2. Norasyikin AW, Norlela S, Rozita M, Masliza M, Shamsul AS, Nor Azmi K
    Singapore Med J, 2009 Oct;50(10):962-6.
    PMID: 19907885
    Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date no known study done to determine its prevalence in patients with ACS.
  3. Adawiyah J, Norasyikin AW, Mat NH, Shamsul AS, Azmi KN
    Heart Asia, 2010;2(1):11-4.
    PMID: 27325934 DOI: 10.1136/ha.2009.001503
    The non-thyroidal illness syndrome (NTIS) or the sick euthyroid syndrome refers to abnormal changes in circulating thyroid hormones due to systemic illnesses. Thyroid hormones are pivotal in the regulation of normal cardiac functions. However, the effects of the NTIS on the heart in acute coronary syndrome (ACS) are still unclear.
  4. Sangeetha-Shyam, Fatimah A, Rohana AG, Norasyikin AW, Karuthan C, Nik SS, et al.
    Malays J Nutr, 2013 Apr;19(1):9-23.
    PMID: 24800381 MyJurnal
    Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2
    diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve
    cardio-metabolic outcomes in insulin-resistant individuals. We examined the
    feasibility of lowering GI through GI-based-education among Asian post-GDM
    women. Methods: A 3-month investigation was carried out on 60 Malaysian
    women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were
    randomised into two groups: LGIE and CHDR. The CHDR group received
    conventional healthy dietary recommendations only. The LGIE group received
    GI based-education in addition to conventional healthy dietary recommendations.
    At baseline and after 3-months, dietary intake of energy and macronutrient
    intakes including GI diet and glycaemic load was assessed using 3-day food
    records. Diabetes-Diet and GI-concept scores and physical activity levels were
    assessed using a questionnaire. Adherence to dietary instructions was measured
    at the end of 3 months. Results: At the end of 3 months, the LGIE group had
    significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total
    carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and
    GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g,
    0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant
    reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in
    GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores
    correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary
    adherence was comparable in both groups. Conclusion: GI-education improves
    GI-concept knowledge and helps lower dietary glycaemic index among women
    with a history of GDM.
    Keywords: Diet, gestational diabetes mellitus, glycaemic index, glycaemic load,
    prevention, type 2 diabetes
  5. Norasyikin AW, Rozita M, Mohd Johan MJ, Suehazlyn Z
    Med Princ Pract, 2014;23(4):387-9.
    PMID: 24401542 DOI: 10.1159/000357645
    OBJECTIVE: To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in an elderly woman.
    CLINICAL PRESENTATION AND INTERVENTION: A 62-year-old woman presented with anaemic symptoms and jaundice. Blood tests showed macrocytic anaemia due to vitamin B12 deficiency with Coombs negative haemolysis. A thyroid function test was consistent with hypothyroidism. Autoimmune antibody assays were positive for anti-parietal cell, anti-intrinsic factor and anti-thyroid peroxidase antibodies. A final diagnosis of autoimmune thyroiditis with pernicious anaemia, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B12 injection and a blood transfusion. She was discharged uneventfully after a week of hospitalization.
    CONCLUSION: This case showed that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic despite positive autoantibodies.
  6. Wan Asyraf WA, Mohd Shahrir MS, Asrul W, Norasyikin AW, Hanita O, Kong WY, et al.
    Reumatismo, 2018 Dec 20;70(4):241-250.
    PMID: 30570242 DOI: 10.4081/reumatismo.2018.1075
    Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.
  7. Nurain MN, Marmuji LZ, Mastura I, Michael FH, Barakatun-Nisak MY, Yusof M, et al.
    Malays Fam Physician, 2019;14(3):55-59.
    PMID: 32175041
    Diabetes in pregnancy is associated with risks to the woman and her developing fetus. Management of the condition at the primary care level includes pre-conception care, screening, diagnosis, as well as antenatal and postpartum care. A multidisciplinary approach is essential in ensuring its holistic management.
  8. Sulaiman S, Leelavathi M, Norasyikin AW
    Med J Malaysia, 2020 11;75(6):655-659.
    PMID: 33219173
    INTRODUCTION: The rapid increase in Type 2 Diabetes Mellitus (T2DM) among the younger age groups is a growing concern worldwide. Thus, assessing the perception of risk and knowledge among those at risk may provide an opportunity for early intervention, delay or even prevent the onset.
    OBJECTIVE: The aim of this study was to determine the perceived risk of developing T2DM and its knowledge among the offspring of diabetic patients.
    METHODS: A cross sectional study using a self-administered questionnaire was conducted among university students whose parents had type 2 diabetes to determine their perceived risk and knowledge on T2DM.
    RESULTS: A total of 336 university students participated in this study and 56.5% of them correctly identified themselves at risk of developing T2DM. About half of them (52.7%) had higher knowledge of T2DM. Male students appeared to have better risk perception (p=0.024) compared to females while those with mothers affected by T2DM appear to have higher knowledge regarding diabetes (p=0.007). Most of their information regarding T2DM was obtained from the internet (87.5%) and other family members (77.9%).
    CONCLUSION: The students whose mothers had T2DM appear to have better knowledge and information regarding T2DM and this was mostly obtained from the internet and family members. Awareness regarding diabetes and healthy lifestyles advice through primary patients may be beneficial for their offspring.
    Study site: Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  9. Ameen SA, Norasyikin AW, Dina HN, Zara MNF, Tyler R, Asma A
    Int Tinnitus J, 2022 Dec 01;26(2):89-94.
    PMID: 36724354 DOI: 10.5935/0946-5448.20220013
    OBJECTIVES: To determine the prevalence of tinnitus in Type 1 Diabetes Mellitus (T1DM) patients, to evaluate its severity and to correlate it with estimated Glomerular Filtration Rate (eGFR) as well as glycaemia control (HbA1c).

    MATERIAL AND METHODS: We performed a questionnaire-based cross-sectional study at Hospital Canselor Tuanku Muhriz (HCTM) from a period of 15 months. A total of 133 T1DM patients who fulfilled our study's criteria were subjected to otoscopy examination, tuning fork test and free field voice test. The mini-Tinnitus Questionnaire (TQ) was used to assess the severity of tinnitus. We were careful to categorize the perceived duration of tinnitus.

    RESULTS: The prevalence of tinnitus among T1DM patients was 24.1% (32/133 patients). Out of 32 patients, approximately 78.1% (25 patients) had a compensated level of tinnitus distress and the remaining 21.9% (7/32) had moderate tinnitus. The duration of tinnitus ranged from 2 seconds to 2 minutes, whıch was ringing and intermittent in nature. The HbA1c and estimated Glomerular Filtration Rate (eGFR) were higher in tinnitus compared to the non-tinnitus group. There was no significant correlation between the severity of tinnitus and HbA1c level or eGFR.

    CONCLUSIONS: Our study concluded that tinnitus amongst T1DM patients was likely to be non-pathological in view of its short duration with minimal to no distress to the sufferers. An elevated HbA1c may increase the risk of developıng tinnitus.

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