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  1. Yoon SY, Wong SW, Lim J, Ahmad S, Mariapun S, Padmanabhan H, et al.
    J Med Genet, 2022 Mar;59(3):220-229.
    PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416
    BACKGROUND: Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming.

    METHODS: The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer.

    RESULTS: Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms.

    CONCLUSION: The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.

  2. Nasir SNS, Ludin NA, Radzi AASM, Junedi MM, Ramli N, Marsan A, et al.
    Environ Dev Sustain, 2022 Jul 01.
    PMID: 35791324 DOI: 10.1007/s10668-022-02507-z
    COVID-19 has had a significant impact on the global demand and consumption of energy. In particular, the effect of the lockdown measures due to the COVID-19 pandemic can be seen directly in the reduced energy consumption in educational buildings. Therefore, the objective of this study is to assess the impact of COVID-19 on the electricity use in university buildings. The Research Complex Building of the National University of Malaysia was selected as a case study. An energy audit analysis was conducted based on the data collection via walk-through field audits and data loggers during the normal year (2019) to establish a baseline of data. The comparison of the electricity pattern during the normal year with the lockdown period of 2020 shows that the Building Energy Index (BEI) during a pandemic decreased by approximately 11% from the BEI in the normal year. In this regard, the energy audit verified that the main factors of electricity consumption are occupant presence and energy use in buildings. Hence, on the basis of the energy audit results, three appropriate energy conservation measures (ECMs) were detected and subsequently proposed to minimise the waste of energy. Results show that the implementation of ECMs can improve the energy consumption of buildings and reduce energy consumption by 21.81% or approximately 19% from the normal year. Hence, efficient energy use in buildings in the post-pandemic period can be achieved by the implementation of all the ECMs proposed.
  3. Thuhairah Rahman, Radzi Ahmad, Suhaila Muid, Tengku Saifudin Tengku Ismail, Buravkova, Ludmila B., Hapizah Nawawi
    MyJurnal
    Inflammation and endothelial dysfunction are key components in atherogenesis. Should the status of these pro-atherogenesis factors be enhanced during prolonged confined space travel, specific countermeasures need to be instituted to prevent these processes to ensure safe outcome for astronauts during space expeditions. Six crew members were exposed to prolonged, confined isolation for 520 days. Standard exercise and diet regime were instituted throughout isolation phase. Age and gender-matched healthy, free living controls were recruited in parallel. Serial serum and whole blood were analysed for biomarkers of inflammation (hsCRP and IL-6) and endothelial activation (sICAM-1, sVCAM-1 and E-selectin). Flow-mediated dilatation (FMD) of the artery was performed following the standard protocols set by the International Brachial Artery Reactivity Task Force by trained personnel. There was decreased sVCAM-1 concentration in crew members compared to baseline. However, there was significant decrease in percentage dilatation from baseline in FMD of the brachial artery in the crew members. Percent change increment was observed in hsCRP while percent change reduction was seen in sVCAM-1. The enhanced inflammation and reduced endothelial function could possibly be attributed to the rigorous exercise instituted throughout the confinement period. Furthermore, possible haemoconcentration as a result of psychosocial stress and/ or exercise-induced physiological response could further explain elevations in hsCRP, and unlikely pathological. Furthermore, endothelial activation was attenuated during isolation, suggesting that the diet and exercise program instated throughout the period improved endothelial function.
  4. Chua YA, Nazli SA, Rosman A, Kasim SS, Ibrahim KS, Md Radzi AB, et al.
    J Atheroscler Thromb, 2023 Oct 01;30(10):1317-1326.
    PMID: 36567112 DOI: 10.5551/jat.63389
    AIMS: Patients with familial hypercholesterolemia (FH) are known to have higher exposure to coronary risk than those without FH with similar low-density lipoprotein cholesterol (LDL-C) level. Lipid-lowering medications (LLMs) are the mainstay treatments to lower the risk of premature coronary artery disease in patients with hypercholesterolemia. However, the LLM prescription pattern and its effectiveness among Malaysian patients with FH are not yet reported. The aim of this study was to report the LLM prescribing pattern and its effectiveness in lowering LDL-C level among Malaysian patients with FH treated in specialist hospitals.

    METHODS: Subjects were recruited from lipid and cardiac specialist hospitals. FH was clinically diagnosed using the Dutch Lipid Clinic Network Criteria. Patients' medical history was recorded using a standardized questionnaire. LLM prescription history and baseline LDL-C were acquired from the hospitals' database. Blood samples were acquired for the latest lipid profile assay.

    RESULTS: A total of 206 patients with FH were recruited. Almost all of them were on LLMs (97.6%). Only 2.9% and 7.8% of the patients achieved the target LDL-C of <1.4 and <1.8 mmol/L, respectively. The majority of patients who achieved the target LDL-C were prescribed with statin-ezetimibe combination medications and high-intensity or moderate-intensity statins. All patients who were prescribed with ezetimibe monotherapy did not achieve the target LDL-C.

    CONCLUSION: The majority of Malaysian patients with FH received LLMs, but only a small fraction achieved the therapeutic target LDL-C level. Further investigation has to be conducted to identify the cause of the suboptimal treatment target attainment, be it the factors of patients or the prescription practice.

  5. Md Radzi AB, Kasim SS
    Medicine (Baltimore), 2023 Jan 27;102(4):e32822.
    PMID: 36705376 DOI: 10.1097/MD.0000000000032822
    RATIONALE: We report a rare case of paraneoplastic bullous pemphigoid associated with mantle cell lymphoma.

    PATIENTS CONCERNS: The patient presented with 5 months' history of generalized skin itchiness, night sweat and loss of weight. The skin manifestations started over the foot and hand area. However, he started to developed tense blisters over the face, trunk and limbs 3 days prior to this admission.

    DIAGNOSES: The skin biopsy report showed subepidermal bullae, in which the immunofluorescence findings in keeping with bullous pemphigoid. The peripheral blood immunophenotyping was suggestive of mantle cell lymphoma. Hence, a diagnosis of paraneoplastic bullous pemphigoid associated with mantle cell lymphoma was made.

    INTERVENTIONS: The patient was initiated with a cytoreduction chemotherapy.

    OUTCOMES: Unfortunately, patient's condition deteriorated further due to neutropenic sepsis and he succumbed after 2 weeks of intensive care.

    LESSONS: Bullous pemphigoid associated with mantle cell lymphoma are very rare. The presentation of bullous pemphigoid led to the detection of mantle cell lymphoma. Early diagnosis and appropriate treatment is crucial in managing this aggressive type of the disease. Both, bullous pemphigoid and mantle cell lymphoma had a parallel clinical course which suggests a paraneoplastic phenomenon in this reported case.

  6. Md Radzi AB, Tan SS
    Medicine (Baltimore), 2018 Jan;97(4):e8884.
    PMID: 29369168 DOI: 10.1097/MD.0000000000008884
    RATIONALE: We report a rare case of hepatocellular carcinoma (HCC) with metastases to the mandible and coracoid process of scapula without evidence of lung involvement.

    PATIENTS CONCERNS: The patient was diagnosed with HCC, presented 5 months later with right lower tooth pain, swelling over the right mandible area and right shoulder pain.

    DIAGNOSES: Histopathological examination of mandible showed findings suggestive of metastatic HCC. Magnetic resonance imaging (MRI) of the right shoulder revealed findings of irregular enhancing lesion at the right coracoid process causing erosion of the coracoid process.

    INTERVENTIONS: Patient was subsequently referred for palliative medicine care.

    OUTCOMES: He received adequate analgesia.

    LESSONS: Oral cavity and scapula metastases from HCC are very rare. Most oral metastases are associated with lung metastases, and they possibly occur by hematogenous route. In our case, the possible pathway of metastasis is an anastomotic network of paravertebral veins that bypasses the pulmonary, inferior caval, and portal venous circulations.

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