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Are predictors of future suicide attempts and the transition from suicidal ideation to suicide attempts shared or distinct: a 12-month prospective study among patients with depressive disorders

Chan LF, Shamsul AS, Maniam T

Psychiatry Res, 2014 Dec 30;220(3):867-73.
PMID: 25240940 DOI: 10.1016/j.psychres.2014.08.055

Our study aimed to examine the interplay between clinical and social predictors of future suicide attempt and the transition from suicidal ideation to suicide attempt in depressive disorders. Sixty-six Malaysian inpatients with a depressive disorder were assessed at index admission and within 1 year for suicide attempt, suicidal ideation, depression severity, life event changes, treatment history and relevant clinical and socio-demographic factors. One-fifth of suicidal ideators transitioned to a future suicide attempt. All future attempters (12/66) had prior ideation and 83% of attempters had a prior attempt. The highest risk for transitioning from ideation to attempt was 5 months post-discharge. Single predictor models showed that previous psychiatric hospitalization and ideation severity were shared predictors of future attempt and ideation to attempt transition. Substance use disorders (especially alcohol) predicted future attempt and approached significance for the transition process. Low socio-economic status predicted the transition process while major personal injury/illness predicted future suicide attempt. Past suicide attempt, subjective depression severity and medication compliance predicted only future suicide attempt. The absence of prior suicide attempt did not eliminate the risk of future attempt. Given the limited sample, future larger studies on mechanisms underlying the interactions of such predictors are needed.
Fulltext Health-related quality of life in patients with diabetic foot problems in Malaysia

Mazlina M, Shamsul AS, Jeffery FA

Med J Malaysia, 2011 Aug;66(3):234-8.
PMID: 22111447 MyJurnal

This study aimed to evaluate the impact of foot problems on health-related quality of life (HRQoL) in patients with diabetes in Malaysia. Short-Form 36 (SF-36) questionnaire was used to assess the HRQoL of 140 diabetic patients with foot problems attending outpatient diabetic foot clinic in a tertiary hospital, University Malaya Medical Centre. Their HRQoL were compared with 134 diabetic patients without foot problems attending the same clinic. The median score of all the eight SF-36 domains differed significantly between the two groups, where patients with foot problems having statistically significant lower scores. The two domains that were most severely compromised were components of the physical health: Physical Functioning and Role Physical domains. The SF-36 scale scores in diabetic patients with foot problems were also lower than those of the SF-36 norms for the Malaysian population. In conclusion, the results showed that diabetic foot problems negatively affect the patients' HRQoL in both physical and mental health aspects based on the SF-36.
Study site: Diabetic Foot clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Suicide attempts among depressed inpatients with depressive disorder in a Malaysian sample. Psychosocial and clinical risk factors

Chan LF, Maniam T, Shamsul AS

Crisis, 2011;32(5):283-7.
PMID: 21940256 DOI: 10.1027/0227-5910/a000088

Depressed inpatients constitute a high-risk population for suicide attempts.
Fulltext Predictors of mortality in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI): Insights from National Cardiovascular Disease Database (NCVD), Malaysia

Ponniah JP, Shamsul AS, Adam BM

Med J Malaysia, 2012 Dec;67(6):601-5.
PMID: 23770953 MyJurnal

The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary intervention. Estimation of post operative mortality risk factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data extracted from the National Cardiovascular Disease Database (NCVD-ACS and NCVD PCI). Both these registries were interlinked and was further matched to JPN (Jabatan Pendaftaran Negara/National registration Department) to assess mortality among the patients who underwent PCI and all death which occurred in between 2007, 2008 and 2009. There were 630 patients in this studied. Age, history of diabetes mellitus, peripheral vascular, renal failure and previous percutaneous coronary intervention were univariately associated with mortality. However based on logistics stepwise method, only age and history of renal failure had showed statistically significant and sizeable odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.
Fulltext Parental concerns and control in feeding of 9 to 12-year-old children in a primary school in Kuala Lumpur, Malaysia

Noor AM, Muthupalaniappen L, Shamsul AS, Hizlinda T, Khairani O, Fatimah A

Malays J Nutr, 2012 Apr;18(1):47-55.
PMID: 23713229 MyJurnal

Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding.
Fulltext A cross sectional study was conducted among married women in Kg. Sasapan Kelubi, Hulu Langat, Selangor, Malaysia. [Amalan calitan pap dan faktor hubungkait di kalangan wanita berkahwin di Kg. Sesapan Kelubi , Daerah Hulu Langat, Selangor D.E. Malaysia]

Jamsiah M, Shamsul AS, Aniza I, Rozhan S, Sharifah Ezat WP

Malaysian Journal of Community Health, 2008;14(1):52-61.
MyJurnal

Introduction : A cross sectional study was conducted among married women in Kg. Sasapan Kelubi, Hulu Langat, Selangor, Malaysia. The objective of the study was to identify the prevalence of Pap Smear practice and it`s influencing factors.
Methodology : Universal sampling was conducted from door to door to all married women who agreed to be involved in this study. Guided questionnaire was used as the main instrument in this study. The data was analyzed using SPSS version 12.0.
Result : A total of 154 respondents gave their feedback. Mean age in this study was 23.3±4.4.years. Only 66 respondents (42.9%) have had the pap smear with only 6 respondents (3.9%) practiced as per recommended schedule. The reasons for the respondents never practicing pap smear were no knowledge (n=46,52.3%), scared (n=22, 42.5%), shyness (n=21,23.9%), no free time(n-6,6.8%), unconcerned (n=3,3.4%), no female doctors (n= 6,6.8%), not bother, health clinic too far and high cost (n=1,1.1%). The only factor that showed significant association with pap smear practice was the score of knowledge about smear whereby respondents who underwent pap smear showed higher score compared to those respondents who never underwent pap smear.
Conclusion : The study showed that more efforts is required to improve knowledge and awareness among married women in rural area in order to overcome the knowledge gap, wrong perception and other reasons that prevent acceptance pap smear practice among them.
Keywords : married women, pap smear practice, rural area, Malaysia
Fulltext Patient satisfaction on waiting time and duration of consultation at Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre

Raja Lexshimi RG, Zaleha MI, Shamsul AS, Suriawati G

Medicine & Health, 2009;4(1):35-49.
MyJurnal

Patients are increasingly dissatisfied with the “waiting time” and “duration of consultation” at outpatient clinics. A cross sectional study was carried out to measure waiting time and duration of consultation and to examine patients’ level of satisfaction towards waiting time and duration of consultation at the Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also examined patient’s satisfaction towards the overall clinic services. Data was collected using a self-administered questionnaire. A total of 81 patients participated in this study with a response rate of 100 percent. Findings indicated a significant difference in the mean between expected waiting time level II (from the time the patient is given the calling number till the time patient is called into the doctor’s room) and the actual waiting time level II experienced. A significant difference in the mean between the expected duration of consultation and the actual duration of consultation experienced was also noted. However, no significant difference was found between the mean of expected waiting time level I (the time patient register at the counter till the patient is given the calling number) and the actual waiting time (p>0.05). Overall, patient satisfaction towards waiting time was low (29.6%) and duration of consultation was of moderate level (41.9%). The overall satisfaction towards the clinic services were of average level (56.8%). Findings also indicated that patient satisfaction was not influenced by socio-demographic factors of respondents such as age, ethnic, education level, occupation and income level. Important findings from this study may help staff managing the clinic in addressing patients’ complaint on waiting time and improve patients’ satisfaction on the overall services of the Orthopedic clinic in UKMMC.
Study site: Orthopedic clinc, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext The non-thyroidal illness syndrome in acute coronary syndrome is associated with increased cardiac morbidity and mortality

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.
Fulltext Adrenal insufficiency in acute coronary syndrome

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.
Fulltext Interleukin-23 and its correlation with disease activity, joint damage, and functional disability in rheumatoid arthritis

Dalila AS, Mohd Said MS, Shaharir SS, Asrul AW, Low SF, Shamsul AS, et al.

Kaohsiung J. Med. Sci., 2014 Jul;30(7):337-42.
PMID: 24924839 DOI: 10.1016/j.kjms.2014.02.010

The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage.

Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review

Tan GH, Azrif M, Shamsul AS, Ho CC, Praveen S, Goh EH, et al.

Asian Pac J Cancer Prev, 2011;12(10):2727-30.
PMID: 22320982

INTRODUCTION: Testicular cancer mainly affects young men worldwide. There is lack of published data on patients with this malignant condition from the Southeast Asian region. The aim of this study was therefore to determine the clinicopathologic features of testicular cancer patients treated in a Southeast Asian university hospital and their overall survival rate.
MATERIALS AND METHODS: This was a retrospective study of testicular cancer patients treated between January 2001 and February 2011. Their epidemiological data, clinical presentation, pathologic diagnosis, stage of disease and treatment were gathered and the overall survival rate of this cohort was analyzed.
RESULTS: Thirty-one patients were included in this study. The majority of them were of Malay ethnicity. The average age at presentation was 33.7 years. The commonest testicular cancer was non-seminomatous germ cell tumour, followed by seminoma, lymphoma and rhabdomyosarcoma. More than half of all testicular germ cell tumour (GCT) patients had some form of metastasis at diagnosis. All the patients were treated with radical orchidectomy. Adjuvant chemotherapy was given to those with metastatic disease. Four seminoma patients received radiotherapy to the para-aortic lymph nodes. The 5-year survival rate for all testicular cancers in this cohort was 83.9%. The survival rate was 88.9% in 5 years when GCT were analyzed separately.
CONCLUSION: GCT affects patients in their third and fourth decades of life while lymphoma patients are generally older. Most of the patients treated for GCT are of Malay ethnicity. The majority have late presentation for treatment. The survival rate of GCT patients treated here is comparable to other published series in other parts of the world.
Fulltext Diagnostic value of the C methacetin breath test in various stages of chronic liver disease

Razlan H, Marzuki NM, Tai ML, Shamsul AS, Ong TZ, Mahadeva S

Gastroenterol Res Pract, 2011;2011:235796.
PMID: 21687605 DOI: 10.1155/2011/235796

The accuracy of the (13)C-methacetin breath test ((13)C-MBT) in differentiating between various stages of liver disease is not clear. A cross-sectional study of Asian patients was conducted to examine the predictive value of the (13)C-MBT in various stages of chronic liver diseases. Diagnostic accuracy of the breath test was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve analysis. Seventy-seven patients (47 men/30 women, mean age 50 ± 16 years) were recruited. Forty-seven patients had liver cirrhosis (Child Pugh A = 11, Child Pugh B = 15, and Child Pugh C = 21), 21 had fibrosis, and 9 had chronic inflammation. The sensitivity and positive predictive value for liver fibrosis, cirrhosis (all stages), Child-Pugh A, Child-Pugh B, and Child-Pugh C were 65% and 56%, 89% and 89%, 67% and 42%, 40% and 40%, and 50% and 77%, respectively. Area under curve values for fibrosis was 0.62 (0.39-0.86), whilst that for cirrhosis (all stages) was 0.95 (0.91-0.99). The (13)C-methacetin breath test has a poor predictive value for liver fibrosis but accurately determines advanced cirrhosis.
A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity

Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, Oteh M, Shamsul AS, Hussein H

Int J Rheum Dis, 2011 Feb;14(1):18-30.
PMID: 21303478 DOI: 10.1111/j.1756-185X.2010.01593.x

AIMS: The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction.
METHODS: The study was a cross-sectional study involving 53 patients (47 female and 6 male) with RA without clinically evident heart disease and 53 healthy subjects (47 female and 6 male) who served as a control group. Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects.
RESULTS: Of 17 cardiac parameters assessed, only two were abnormal. None of the specific cardiac diastolic dysfunction parameters were significantly different in RA patients compared to the control group. There was no significant correlation between diastolic function values in RA patients and value of Disease Activity Score 28 (DAS-28) and value of Health Assessment Questionnaires Disability Index (HAQDI). Atrial (A) wave velocity was greater in RA patients compared to the control group (0.71 [0.58-0.83] vs. 0.61 [0.51-0.71]; P < 0.04). However, interventricular relaxation time (IVRT) ([73.08 ± 9.92 vs. 70.74 ± 9.02], P = 0.207), lower E/A ratio (1.27 [1.02-1.56] vs. 1.42 [1.20-1.68], P = 0.102), diastolic dysfunction parameters according to Redfield Classification (25 [47.2%] vs. 27 [50.9%] P = 0.56), diastolic dysfunction using E/A (P = 0.321) and tissue doppler imaging (E/E') (P = 0.148) were not different.
CONCLUSION: Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease.
Sleep disturbances in Malaysian patients with Parkinson's disease using polysomnography and PDSS

Norlinah MI, Afidah KN, Noradina AT, Shamsul AS, Hamidon BB, Sahathevan R, et al.

Parkinsonism Relat Disord, 2009 Nov;15(9):670-4.
PMID: 19362875 DOI: 10.1016/j.parkreldis.2009.02.012

Sleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson's disease (PD). However, studies in the Asian population are limited.
Fulltext Biochemical aspirin resistance in stroke patients - a cross-sectional single centre study

Azmin S, Sahathevan R, Rabani R, Nafisah WY, Tan HJ, Raymond AA, et al.

EXCLI J, 2013;12:907-15.
PMID: 27092036

BACKGROUND: Aspirin use is known to reduce the recurrence of stroke. However, the clinical response to aspirin has been mixed. The rate of stroke recurrence whilst on aspirin treatment is still unacceptably high. A plausible explanation for this may be resistance to the effects of aspirin. The causes of aspirin resistance are manifold and multi-factorial. We conducted a study to investigate the prevalence rate of biochemical aspirin resistance in a cohort of aspirin-naïve stroke patients. We also sought to determine the inherent factors that may predispose towards the development of aspirin resistance.
METHOD: This was a cross-sectional, observational study conducted on patients admitted to our centre with an acute stroke who were aspirin-naïve. The diagnosis of an acute stroke was confirmed by clinical history and brain imaging. Fifty consecutive patients were prospectively enrolled. Socio-demographic data were collected and baseline blood investigations were performed. Patients were tested for biochemical aspirin resistance using Multiplate platelet analyser (Dynabyte, Munich, Germany) after 5 doses of aspirin, corresponding to a total dose of 900 mg.
RESULTS: The median age of patients was 65.5 years and 54 % of patients were female. There were 11 smokers; of these 10 were male. Twenty-six (52 %) patients were Chinese, 21 (41 %) were Malay and 3 (6.0 %) were Indian. Aspirin resistance was present in 14 % of our patients. There was an inverse relationship between the presence of aspirin resistance and plasma HDL levels (r = -0.394; p = 0.005). There was no relationship observed between aspirin resistance and total cholesterol, triglycerides, LDL, HbA1c, ALT, ALP, urea and creatinine levels. There were no significant differences in demographic profiles or smoking status between the aspirin resistant and non-aspirin resistant groups. We did not find any link between ethnicity and aspirin resistance.
CONCLUSIONS: Our results indicate that a lower HDL level is associated with biochemical aspirin resistance. This may increase platelet aggregation and consequently increase the risk of a recurrent stroke. The clinical implications for aspirin resistance are far reaching. Any evidence that correctable factors may negatively influence the action of aspirin warrants further investigation. The prevalence rate of biochemical aspirin resistance in our study is comparable to the findings in other studies performed in an Asian population. Further research is required to determine how our findings translate into clinical aspirin resistance and stroke recurrence.
KEYWORDS: Asia; antiplatelet therapy; aspirin; aspirin resistance; developing countries; ischaemic stroke; risk factors
Fulltext The effects of angiotensin-converting enzyme gene polymorphism on the progression of immunoglobulin A nephropathy in Malaysian patients

Draman CR, Kong NC, Gafor AH, Rahman AF, Zainuddin S, Mustaffa WM, et al.

Singapore Med J, 2008 Nov;49(11):924-9.
PMID: 19037561

Angiotensin-converting enzyme (ACE) gene polymorphism, especially the deletion/deletion (DD) genotype, is associated with the disease progression of immunoglobulin A (IgA) nephropathy patients in various studies from both Asia Pacific and European populations. However, recent studies within the same populations were unable to reproduce the same results. Hence, we had studied the distribution of the DD genotype, the association between ACE gene polymorphism and the disease progression, and the factors (other than ACE gene polymorphism) which were involved in the disease progression of our local patients.
Suicidal ideation in systemic lupus erythematosus: NR2A gene polymorphism, clinical and psychosocial factors

Buji RI, Abdul Murad NA, Chan LF, Maniam T, Mohd Shahrir MS, Rozita M, et al.

Lupus, 2018 Apr;27(5):744-752.
PMID: 29161964 DOI: 10.1177/0961203317742711

Background Systemic lupus erythematosus (SLE) patients are a high-risk population for suicide. Glutamatergic neurosystem genes have been implicated in the neurobiology of depression in SLE and suicidal behaviour in general. However, the role of glutamate receptor gene polymorphisms in suicidal behaviour among SLE patients remains unclear in the context of established clinical and psychosocial factors. We aimed to investigate the association of NR2A gene polymorphism with suicidal ideation in SLE while accounting for the interaction between clinical and psychosocial factors. Methods A total of 130 SLE patients were assessed for mood disorders (MINI International Neuropsychiatric Interview), severity of depression (Patient Health Questionnaire-9), suicidal behaviour (Columbia-Suicide Severity Rating Scale), socio-occupational functioning (Work and Social Adjustment Scale), recent life events (Social Readjustment Rating Scale) and lupus disease activity (SELENA-SLE Disease Activity Index). Eighty-six out of the 130 study participants consented for NR2A genotyping. Results Multivariable logistic regression showed nominal significance for the interaction effect between the NR2A rs2072450 AC genotype and higher severity of socio-occupational impairment with lifetime suicidal ideation in SLE patients ( p = 0.038, odds ratio = 1.364, 95% confidence interval = 1.018-1.827). However, only the association between lifetime mood disorder and lifetime suicidal ideation remained significant after Bonferroni correction ( p

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