Displaying publications 1 - 20 of 73 in total

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  1. Idris N, Aznal SS, Chin SP, Wan Ahmad WA, Rosman A, Jeyaindran S, et al.
    Int J Womens Health, 2011;3:375-80.
    PMID: 22140324 DOI: 10.2147/IJWH.S15825
    There is scarce or no data on prevalence and presentation of acute coronary syndrome (ACS) among women of reproductive age. Furthermore, whether women of reproductive age presenting with ACS have the same risk factors as men and older women is not known.
  2. Yaakob ZH, Undok AW, Abidin IZ, Wan Ahmad WA
    Ann Saudi Med, 2012 6 19;32(4):433-6.
    PMID: 22705620
    Massive pulmonary embolism (PE) is not an uncommon condition, and it usually carries a high risk of mortality. It is one of the fatal conditions that commonly affect young patients. A definitive treatment for patients with massive PE is still lacking, and surgical intervention carries a substantial mortality risk. Thus, percutaneous intervention (clot fragmentation and/or aspiration) remains an option in some patients, specifically in those with a risk of bleeding, contraindicating the use of thrombolysis. There have been no randomized trials to validate percutaneous intervention in massive PE. A sufficient level of evidence is still lacking, and its use depends upon the expert committee's opinion and study of previous case reports. We present a 23-year-old man with first onset massive PE secondary to protein C deficiency, who was treated successfully with the combination of systemic thrombolysis and percutaneous interventions.
  3. Loch A, Lwin T, Zakaria IM, Abidin IZ, Wan Ahmad WA, Hautmann O
    Postgrad Med J, 2013 Jun;89(1052):335-9.
    PMID: 23524989 DOI: 10.1136/postgradmedj-2012-131174
    INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
    OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
    METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
    RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
    CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
    KEYWORDS: Accident & Emergency Medicine; Quality improvement
    Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur
  4. Lee CY, Hairi NN, Wan Ahmad WA, Ismail O, Liew HB, Zambahari R, et al.
    PLoS One, 2013;8(8):e72382.
    PMID: 24015238 DOI: 10.1371/journal.pone.0072382
    To assess whether gender differences exist in the clinical presentation, angiographic severity, management and outcomes in patients with coronary artery disease (CAD).
  5. Syed Ikmal SI, Zaman Huri H, Vethakkan SR, Wan Ahmad WA
    Int J Endocrinol, 2013;2013:698567.
    PMID: 24282409 DOI: 10.1155/2013/698567
    Type 2 diabetes mellitus patients with coronary artery disease have become a major public health concern. The occurrence of insulin resistance accompanied with endothelial dysfunction worsens the state of atherosclerosis in type 2 diabetes mellitus patients. The combination of insulin resistance and endothelial dysfunction leads to coronary artery disease and ischemic heart disease complications. A recognized biological marker, high-sensitivity C-reactive protein, has been used widely to assess the progression of atherosclerosis and inflammation. Along with coronary arterial damage and inflammatory processes, high-sensitivity C-reactive protein is considered as an essential atherosclerosis marker in patients with cardiovascular disease, but not as an insulin resistance marker in type 2 diabetes mellitus patients. A new biological marker that can act as a reliable indicator of both the exact state of insulin resistance and atherosclerosis is required to facilitate optimal health management of diabetic patients. Malfunctioning of insulin mechanism and endothelial dysfunction leads to innate immune activation and released several biological markers into circulation. This review examines potential biological markers, YKL-40, alpha-hydroxybutyrate, soluble CD36, leptin, resistin, interleukin-18, retinol binding protein-4, and chemerin, as they may play significant roles in insulin resistance and atherosclerosis in type 2 diabetes mellitus patients with coronary artery disease.
  6. Zuhdi AS, Mariapun J, Mohd Hairi NN, Wan Ahmad WA, Abidin IZ, Undok AW, et al.
    Ann Saudi Med, 2014 1 15;33(6):572-8.
    PMID: 24413861 DOI: 10.5144/0256-4947.2013.572
    BACKGROUND AND OBJECTIVES: Understanding the nature and pattern of young coronary artery disease (CAD) is important due to the tremendous impact on these patients' socio-economic and physical aspect. Data on young CAD in the southeast Asian region is rather patchy and limited. Hence we utilized our National Cardiovascular Disease Database (NCVD)-Percutaneous Coronary Intervention (PCI) Registry to analyze young patients who underwent PCI in the year 2007 to 2009.

    DESIGN AND SETTINGS: This is a retrospective study of all patients who had undergone coronary angioplasty from 2007 to 2009 in 11 hospitals across Malaysia.

    METHODS: Data were obtained from the NCVD-PCI Registry, 2007 to 2009. Patients were categorized into 2 groups-young and old, where young was defined as less than 45 years for men and less than 55 years for women and old was defined as more than or equals to 45 years for men and more than or equals to 55 years for women. Patients' baseline characteristics, risk factor profile, extent of coronary disease and outcome on dis.charge, and 30-day and 1-year follow-up were compared between the 2 groups.

    RESULTS: We analyzed 10268 patients, and the prevalence of young CAD was 16% (1595 patients). There was a significantly low prevalence of Chinese patients compared to other major ethnic groups. Active smoking (30.2% vs 17.7%) and obesity (20.9% vs 17.3%) were the 2 risk factors more associated with young CAD. There is a preponderance toward single vessel disease in the young CAD group, and they had a favorable clinical outcome in terms of all-cause mortality at discharge (RR 0.49 [CI 0.26-0.94]) and 1-year follow-up (RR 0.47 [CI 0.19-1.15]).

    CONCLUSION: We observed distinctive features of young CAD that would serve as a framework in the primary and secondary prevention of the early onset CAD.

  7. Reid CM, Yan B, Wan Ahmad WA, Bang LH, Hian SK, Chua T, et al.
    Int J Cardiol, 2014 Mar 1;172(1):72-5.
    PMID: 24480180 DOI: 10.1016/j.ijcard.2013.12.030
    Clinicians and other stakeholders recognize the need for clinical registries to monitor data in order to improve the outcome and quality of care in the delivery of medical interventions. The establishment of a collaboration across the Asia Pacific Region to inform on variations in patient and procedural characteristics and associated clinical outcomes would enable regional benchmarking of quality.
  8. Ahmad F, Sadiq MA, Chee KH, Mahmood Zuhdi AS, Wan Ahmad WA
    J Coll Physicians Surg Pak, 2014 Jun;24(6):441-3.
    PMID: 24953923 DOI: 06.2014/JCPSP.441443
    Pulmonary hypertension is frequently associated with atrial septal defect and various connective tissue disorders. This case describes a 74-year-old woman who presented with symptoms of heart failure and concomitant involvement of salivary glands and keratoconjunctivitis. An echocardiogram demonstrated ostium secundum atrial septal defect with left to right shunt and severe pulmonary hypertension. Laboratory investigations confirmed the diagnosis of Sjögren's syndrome (SS) with positive anti-nuclear factor and centromere SS-A/Ro pattern. Anti-Ro (SS-A) was found positive. Atrial septal defect was closed through transcatheter route with significant improvement in clinical outcome. This case report suggests a possible association of atrial septal defect with primary Sjögren's syndrome in an adult patient.
  9. Doufesh H, Ibrahim F, Ismail NA, Wan Ahmad WA
    J Altern Complement Med, 2014 Jul;20(7):558-62.
    PMID: 24827587 DOI: 10.1089/acm.2013.0426
    OBJECTIVES: This study investigated the effect of Muslim prayer (salat) on the α relative power (RPα) of electroencephalography (EEG) and autonomic nervous activity and the relationship between them by using spectral analysis of EEG and heart rate variability (HRV).

    METHODS: Thirty healthy Muslim men participated in the study. Their electrocardiograms and EEGs were continuously recorded before, during, and after salat practice with a computer-based data acquisition system (MP150, BIOPAC Systems Inc., Camino Goleta, California). Power spectral analysis was conducted to extract the RPα and HRV components.

    RESULTS: During salat, a significant increase (p

  10. Lu HT, Nordin R, Wan Ahmad WA, Lee CY, Zambahari R, Ismail O, et al.
    Glob Heart, 2014 Dec;9(4):381-90.
    PMID: 25592791 DOI: 10.1016/j.gheart.2014.06.001
    Sex differences in acute coronary syndrome (ACS) have been well studied in major registries and clinical trials in Western populations. Limited studies have examined the sex differences in ACS using a large number of Asian women as the subjects.
  11. Prasad M, Wan Ahmad WA, Sukmawan R, Magsombol EB, Cassar A, Vinshtok Y, et al.
    Coron Artery Dis, 2015 May;26(3):194-200.
    PMID: 25734606 DOI: 10.1097/MCA.0000000000000218
    OBJECTIVE: Medically refractory angina remains a significant health concern despite major advances in revascularization techniques and emerging medical therapies. We aimed to determine the safety and efficacy of extracorporeal shockwave myocardial therapy (ESMT) in managing angina pectoris.

    METHODS: A single-arm multicenter prospective study was designed aiming to determine the safety and efficacy of ESMT. Patients of functional Canadian Cardiovascular Society class II-IV, despite stable and optimal medical management, with documented myocardial segments with reversible ischemia and/or hibernation on the basis of echocardiography/single-photon emission computerized tomography (SPECT) were enrolled from 2010 to 2012. A total of 111 patients were enrolled, 33 from Indonesia, 21 from Malaysia, and 57 from Philippines. Patients underwent nine cycles of ESMT over 9 weeks. Patients were followed up for 3-6 months after ESMT treatment. During follow-up, patients were subjected to clinical evaluation, the Seattle Angina Questionnaire, assessment of nitrate intake, the 6-min walk test, echocardiography, and SPECT.

    RESULTS: The mean age of the population was 62.9±10.9 years. The summed difference score on pharmacologically induced stress SPECT improved from 9.53±17.87 at baseline to 7.77±11.83 at follow-up (P=0.0086). Improvement in the total Seattle Angina Questionnaire score was seen in 83% of patients (P<0.0001). Sublingual nitroglycerin use significantly decreased (1.14±1.01 tablets per week at baseline to 0.52±0.68 tablets per week at follow-up; P=0.0215). There were no changes in left ventricular function on echocardiography (0.33±9.97, P=0.93). The Canadian Cardiovascular Society score improved in 74.1% of patients.

    CONCLUSION: This multicenter prospective trial demonstrated that ESMT is both a safe and an efficacious means of managing medically refractory angina.

  12. Chan CM, Wan Ahmad WA, Yusof MM, Ho GF, Krupat E
    Psychooncology, 2015 Jun;24(6):718-25.
    PMID: 25345781 DOI: 10.1002/pon.3714
    Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In this study, we examined the prevalence of psychiatric morbidity and its association with cancer survival over time.
  13. Ng SH, Mohd Zain MS, Zakaria F, Wan Ishak WR, Wan Ahmad WA
    Biomed Res Int, 2015;2015:214918.
    PMID: 26682215 DOI: 10.1155/2015/214918
    Pleurotus sajor-caju (PSC) is an edible oyster mushroom featuring high nutritional values and pharmacological properties. Objective. To investigate the hypoglycemic and antidiabetic effects of single and repeated oral administration of PSC aqueous extract in normal and diabetic rats.
  14. Wan Ahmad WN, Sakri F, Mokhsin A, Rahman T, Mohd Nasir N, Abdul-Razak S, et al.
    PLoS One, 2015;10(1):e0116867.
    PMID: 25614985 DOI: 10.1371/journal.pone.0116867
    BACKGROUND: Inflammation, endothelial activation and oxidative stress have been established as key events in the initiation and progression of atherosclerosis. High-density lipoprotein cholesterol (HDL-c) is protective against atherosclerosis and coronary heart disease, but its association with inflammation, endothelial activation and oxidative stress is not well established.

    OBJECTIVES: (1) To compare the concentrations of biomarkers of inflammation, endothelial activation and oxidative stress in subjects with low HDL-c compared to normal HDL-c; (2) To examine the association and correlation between HDL-c and these biomarkers and (3) To determine whether HDL-c is an independent predictor of these biomarkers.

    METHODS: 422 subjects (mean age±SD = 43.2±11.9 years) of whom 207 had low HDL-c concentrations (HDL-c <1.0 mmol/L and <1.3 mmol/L for males and females respectively) and 215 normal controls (HDL-c ≥1.0 and ≥1.3 mmol/L for males and females respectively) were recruited in this study. The groups were matched for age, gender, ethnicity, smoking status, diabetes mellitus and hypertension. Fasting blood samples were collected for analysis of biomarkers of inflammation [high-sensitivity C-reactive protein (hsCRP) and Interleukin-6 (IL-6)], endothelial activation [soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1), soluble Intercellular Adhesion Molecule-1 (sICAM-1) and E-selectin)] and oxidative stress [F2-Isoprostanes, oxidized Low Density Lipoprotein (ox-LDL) and Malondialdehyde (MDA)].

    RESULTS: Subjects with low HDL-c had greater concentrations of inflammation, endothelial activation and oxidative stress biomarkers compared to controls. There were negative correlations between HDL-c concentration and biomarkers of inflammation (IL-6, p = 0.02), endothelial activation (sVCAM-1 and E-selectin, p = 0.029 and 0.002, respectively), and oxidative stress (MDA and F2-isoprostane, p = 0.036 and <0.0001, respectively). Multiple linear regression analysis showed HDL-c as an independent predictor of IL-6 (p = 0.02) and sVCAM-1 (p<0.03) after correcting for various confounding factors.

    CONCLUSION: Low serum HDL-c concentration is strongly correlated with enhanced status of inflammation, endothelial activation and oxidative stress. It is also an independent predictor for enhanced inflammation and endothelial activation, which are pivotal in the pathogenesis of atherosclerosis and atherosclerosis-related complications.

  15. Chan CM, Wan Ahmad WA, Yusof MM, Ho GF, Krupat E
    Asian Pac J Cancer Prev, 2015;16(16):6895-8.
    PMID: 26514463
    BACKGROUND: We aimed to explore whether levels of patient-centredness, job satisfaction and psychological distress varied between oncology nurses and doctors.

    MATERIALS AND METHODS: In a cross-sectional study using self-administered questionnaires, a total of 24 nurses and 43 doctors were assessed for patient-centredness, psychological distress, and job satisfaction using the Patient-Practitioner Orientation Scale, Hospital Anxiety and Depression Scale, and Job Satisfaction Scale. Data were analysed using descriptive statistics, independent samples t-test and MANCOVA, with p<0.05 considered significant.

    RESULTS: Overall response rate was 95.6% (43/45) for physicians and 85.7% (24/28) for nurses. Even after adjusting for known covariates, our principal finding was that doctors reported greater psychological distress compared to nurses (p=0.009). Doctors also reported lower job satisfaction compared to nurses (p = 0.017), despite higher levels of patient-centredness found in nurses (p=0.001). Findings may be explained in part by differences in job characteristics and demands.

    CONCLUSIONS: Mental health is an important concern not just in cancer patients but among healthcare professionals in oncology.

  16. Wan Ahmad WS, Zaki WM, Ahmad Fauzi MF
    Biomed Eng Online, 2015;14:20.
    PMID: 25889188 DOI: 10.1186/s12938-015-0014-8
    Unsupervised lung segmentation method is one of the mandatory processes in order to develop a Content Based Medical Image Retrieval System (CBMIRS) of CXR. The purpose of the study is to present a robust solution for lung segmentation of standard and mobile chest radiographs using fully automated unsupervised method.
  17. Lye JL, Soon LK, Wan Ahmad WA, Tan SC
    Malays J Med Sci, 2015 Jul-Aug;22(4):23-31.
    PMID: 26715905 MyJurnal
    Stem cell research has been extensively explored worldwide to enhance human health in medical setting. Nevertheless, there is currently no full understanding of the stem cell knowledge and attitude levels among student nurses in Malaysia. This study aimed to assess the level of stem cell knowledge, attitude toward stem cell application in medicine, and its association with years of education, among Universiti Sains Malaysia (USM) undergraduate nursing students.
  18. Leschke M, Waliszewski M, Pons M, Champin S, Nait Saidi L, Mok Heang T, et al.
    Catheter Cardiovasc Interv, 2016 Sep;88(3):358-66.
    PMID: 26650913 DOI: 10.1002/ccd.26261
    OBJECTIVES: This observational study assessed the 9-month clinical outcomes in an « all comers » population with a focus on patients with atrial fibrillation (AF) after thin strut bare metal stenting.

    BACKGROUND: Drug eluting stent (DES) implantation is the treatment of choice for coronary artery disease (CAD) leaving only marginal indications for the use of bare metal stents (BMS). However, selected treatment populations with DES contraindications such as patients who cannot sustain 6-12 months of dual antiplatelet therapy (DAPT) remain candidates for BMS implantations.

    METHODS: Thin strut bare metal stenting in a priori defined subgroups were investigated in a non-randomized, international, multicenter «all comers» observational study. Primary endpoint was the 9-month TLR rate whereas secondary endpoints included the 9-month MACE and procedural success rates.

    RESULTS: A total of 783 patients of whom 98 patients had AF underwent BMS implantation. Patient age was 70.4 ± 12.8 years. Cardiovascular risk factors in the overall population were male gender (78.2%, 612/783), diabetes (25.2%, 197/783), hypertension (64.1%, 502/783), cardiogenic shock (4.9%, 38/783) and end stage renal disease (4.9%, 38/783). In-hospital MACE was 4.1% (30/783) in the overall population. The 9-month TLR rate was 4.5% (29/645) in the non-AF group and 3.3% (3/90) in the AF group (P = 0.613). At 9 months, the MACE rate in the AF-group and non-AF group was not significantly different either (10.7%, 69/645 vs. 6.7%, 6/90; P = 0.237). Accumulated stroke rates were 0.3% (2/645) in the non-AF subgroup at baseline and 1.1% (1/90) in the AF subgroup (P = 0.264).

    CONCLUSION: Bare metal stenting in AF patients delivered acceptably low TLR and MACE rates while having the benefit of a significantly shorter DAPT duration in a DES dominated clinical practice. © 2015 Wiley Periodicals, Inc.

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