MyMedR

Fulltext Integrating an open-source course management system (Moodle) into the teaching of a first-year medical physiology course: a case study

Seluakumaran K, Jusof FF, Ismail R, Husain R

Adv Physiol Educ, 2011 Dec;35(4):369-77.

PMID: 22139773 DOI: 10.1152/advan.00008.2011

Educators in medical schools around the world are presently experimenting with innovative ways of using web-based learning to supplement the existing teaching and learning process. We have recently used a popular open-source course management system (CMS) called the modular object-oriented dynamic learning environment (Moodle) to construct an online site (DPhysiol) to facilitate our face-to-face teaching of physiology to a group of first-year students in the Bachelor of Medicine and Bachelor of Surgery program. The integration of the Moodle site into our teaching was assessed using online log activity, student examination marks, and feedback from students. The freely available Moodle platform was simple to use, helped to effectively deliver course materials, and has features that allowed cooperative learning. Students who used the CMS throughout their academic year and commented favorably regarding its use as a complement to the face-to-face classroom sessions. The group of students used the CMS obtained significantly higher scores in the final examination compared with the previous class that did not use the CMS. In addition, there was a significant correlation between student participation and performance in online quizzes and their final examination marks. However, students' overall online usage of the CMS did not correlate with their examination marks. We recommend Moodle as a useful tool for physiology educators who are interested in integrating web-based learning into their existing teaching curriculum.

Influence of DRD2 polymorphisms on the clinical outcomes of patients with schizophrenia

Zahari Z, Teh LK, Ismail R, Razali SM

Psychiatr Genet, 2011 Aug;21(4):183-9.

PMID: 21206399 DOI: 10.1097/YPG.0b013e3283437250

Variations in the gene for dopamine D2 receptor (DRD2) might have an influence on the outcome of antipsychotic treatment in schizophrenia. The objective of this study was to investigate the influence of DRD2 polymorphisms on treatment outcomes in patients with schizophrenia.

Fulltext Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Mohamad N, Bakar NH, Musa N, Talib N, Ismail R

Harm Reduct J, 2010;7:30.

PMID: 21167035 DOI: 10.1186/1477-7517-7-30

BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.

Mutational analysis of CYP2C8 in hypertensive patients using denaturing high performance liquid chromatography

Teh LK, Zahri MK, Zakaria ZA, Ismail R, Salleh MZ

J Clin Pharm Ther, 2010 Dec;35(6):723-8.

PMID: 21054465 DOI: 10.1111/j.1365-2710.2009.01146.x

CYP2C8 is involved in the cytochrome P450 (CYP) epoxygenase pathway. Arachidonic acid metabolites such as epoxyeicosatrienenoic acids and hydroxyeicosatetrenoic acids, produced may have a role in hypertension. We aimed to develop a medium through-put method for screening samples of known and new mutations of CYP2C8 using denaturing high performance liquid chromatography (DHPLC).

Antioxidative properties of Pandanus amaryllifolius leaf extracts in accelerated oxidation and deep frying studies

Nor FM, Mohamed S, Idris NA, Ismail R

Food Chem, 2008 Sep 15;110(2):319-27.

PMID: 26049222 DOI: 10.1016/j.foodchem.2008.02.004

The potential uses of Pandanus amaryllifolius leaf extract as a natural antioxidant were evaluated in refined, bleached and deodorized (RBD) palm olein, using accelerated oxidation and deep frying studies at 180°C from 0 to 40h. The extracts (optimum concentration 0.2%) significantly retarded oil oxidation and deterioration (P<0.05), comparably to 0.02% BHT in tests such as peroxide value, anisidine value, iodine value, free fatty acid, oxidative stability index (OSI), polar and polymer compound contents. In sensory evaluation studies, different batches of French fries were not significantly different (P<0.05) from one another for oiliness, crispiness, taste and overall acceptability when the same oil was used for up to the 40th hour of frying. P. amaryllifolius leaf extract, which had a polyphenol content of 102mg/g, exhibited an excellent heat-stable antioxidant property and may be a good natural alternative to existing synthetic antioxidants in the food industry.

Impact of CYP2D6 genetic polymorphism on tramadol pharmacokinetics and pharmacodynamics

Gan SH, Ismail R, Wan Adnan WA, Zulmi W

Mol Diagn Ther, 2007;11(3):171-81.

PMID: 17570739

Tramadol is metabolized by the highly polymorphic enzyme cytochrome P450 (CYP)2D6. Patients with different CYP2D6 genotypes may respond differently to tramadol in terms of pain relief and adverse events. In this study, we compare the pharmacokinetics and effects of tramadol in Malaysian patients with different genotypes to establish the pharmacokinetic-pharmacodynamic relationship of tramadol.

Single step PCR for detection of allelic variation of MDR1 gene (P-glycoprotein) among three ethnic groups in Malaysia

Teh LK, Lee WL, Amir J, Salleh MZ, Ismail R

J Clin Pharm Ther, 2007 Jun;32(3):313-9.

PMID: 17489883

P-glycoprotein (PgP) is the most extensively studied ATP-binding cassette (ABC) coded by MDR1 gene. To date, 29 single nucleotide polymorphisms (SNPs) have been identified; but only SNP C3435T has been correlated with intestinal PgP expression levels and shown to influence the absorption of orally taken drugs that are PgP substrates. Individuals homozygous for the T allele have more than fourfold lower PgP expression compared with C/C individuals. We developed a one step primer based allele specific PCR method to detect SNP at C3435T to investigate the distribution of this genotype in the local population.

Genetic polymorphism of CYP2D6 in patients with cardiovascular disease -- a cohort study

Teh LK, Zilfalil BA, Marina I, Rosemi BS, Ismail R

J Clin Pharm Ther, 2004 Dec;29(6):559-64.

PMID: 15584944 DOI: 10.1111/j.1365-2710.2004.00600.x

BACKGROUND: Cardiovascular diseases are complex diseases that are influenced by both environmental and genetic factors. CYP2D6 found in the brain and the heart is involved in the metabolism of many environmental and some endogenous substances and neurotransmitters responsible for maintaining homeostasis. This raises an interesting hypothesis that it may have a role in the development of or protection against cardiovascular diseases.
OBJECTIVE: To study the distribution of genotypes of CYP2D6 among patients with cardiovascular diseases in Malaysia.
METHOD:We obtained DNA from 128 patients who were followed up for cardiovascular diseases. Polymerase chain reaction-based methods were used to determine common CYP2D6 alleles.
RESULTS: One hundred and twenty-eight patients were enrolled. Most of the patients also had concurrent illnesses. Eleven genotypes were identified in the patients and 41% carried CYP2D6*1/*10. The second most common genotype was homozygous for the wild type gene, followed by homozygous CYP2D6*10/*10 at 14.48 %. A small percentage of the patients were heterozygous CYP2D6*1/*4. One patient was genotyped homozygous CYP2D6*4/*4 predicting a poor metabolizer prevalence of 0.78% (95% CI +/- 1.52%). Analysis using Hardy-Weinberg equilibrium showed that all of the gnotypes were consistent with equilibrium except for CYP2D6*1/*10 (chi(2); P < 0.05).
CONCLUSION: Our study suggests a possible involvement of CYP2D6 genotypes in cardiovascular system diseases, which need to be validated by further studies.

Population pharmacokinetic modelling of tramadol with application of the NPEM algorithms

Gan SH, Ismail R, Wan Adnan WA, Zulmi W, Jelliffe RW

J Clin Pharm Ther, 2004 Oct;29(5):455-63.

PMID: 15482390

Although the kinetic behaviour of tramadol has been described, the present study is the first to our knowledge, to report specifically on the population pharmacokinetic modelling of tramadol hydrochloride.

Intrapancreatic gastric duplication cyst-a rare cause of chronic abdominal pain in childhood

Lee CL, binti Che Daud CZ, binti Ismail R

J Clin Ultrasound, 2014 Jan;42(1):42-4.

PMID: 23303464 DOI: 10.1002/jcu.22029

We report a rare case of a gastric duplication cyst in the tail of the pancreas in a child presenting with chronic abdominal pain which was cured by excision of the cyst and adjacent pancreas. This case report highlights the role of sonography as an excellent imaging tool for depiction of the bowel wall and, hence, in aiding diagnosis even when clinical picture and findings of other modalities are nonspecific.

Genetic polymorphism of CYP2C8 in three Malaysian ethnics: CYP2C8*2 and CYP2C8*3 are found in Malaysian Indians

Muthiah YD, Lee WL, Teh LK, Ong CE, Ismail R

J Clin Pharm Ther, 2005 Oct;30(5):487-90.

PMID: 16164496

CYP2C8 is genetically polymorphic. Four variants, CYP2C8*2, CYP2C8*3, CYP2C8*4 and CYP2C8*5, which contain mutations in the coding regions have been reported to exhibit different enzyme activity as compared with CYP2C8*1.

Removal of iron and manganese by artificial destratification in a tropical climate (Upper Layang Reservoir, Malaysia)

Ismail R, Kassim MA, Inman M, Baharim NH, Azman S

Water Sci Technol, 2002;46(9):179-83.

PMID: 12448467

Environmental monitoring was carried out at Upper Layang Reservoir situated in Masai, Johor, Malaysia. The study shows that thermal stratification and natural mixing of the water column do exist in the reservoir and the level of stratification varies at different times of the year. Artificial destratification via diffused air aeration techniques was employed at the reservoir for two months. The results show that thermal stratification was eliminated after a week of continuous aeration. The concentrations of iron and to a lesser extent manganese in the water column was also reduced during the aeration period.

Ethnic differences in response to non-selective beta-blockade among racial groups in Malaysia

Rasool AH, Rahman AR, Ismail R, Hatim S, Abdullah AR, Singh R, et al.

Int J Clin Pharmacol Ther, 2000 May;38(5):260-9.

PMID: 10839470

OBJECTIVE: To determine whether racial differences in response to blockade of beta receptors occur among racial groups in Malaysia that are the Malays, Indians and Chinese. SUBJECTS, MATERIALS AND METHOD: 35 healthy male volunteers representing the 3 main racial groups in Malaysia (12 Malays, 12 Chinese and 11 Indians) were studied in a randomized, placebo-controlled, crossover and single-blind design. Propranolol 80 mg 12-hourly was given orally for 48 hours. Six hours after the last dose subjects attended an exercise session where resting and exercise heart rate, blood pressure, plasma potassium and glucose levels, resting FEV1 and plasma propranolol concentrations were recorded.

RESULTS: No significant difference in plasma propranolol (mean +/- SEM) levels was seen between races six hours after the last dose (Malays, 59.7 +/- 8.8 ng/ml, Indians, 67.6 +/- 19.3 ng/ml, Chinese, 58.4 +/- 7.9 ng/ml). Chinese were least sensitive to the bradycardic and hypotensive effects of propranolol at rest and exercise. Indians and Malays had significant reduction of supine systolic blood pressure with propranolol but not Chinese. Comparison of percentage reductions of systolic blood pressure at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.022). Similarly, comparison of percentage reductions of heart rate at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.040). Average change in potassium concentrations at peak exercise and recovery showed the Indians to have significantly higher increase in potassium levels with propranolol compared to the Malays (p = 0.038). However, no significant interethnic difference was seen in the reduction of glucose levels at rest, peak exercise or recovery. Also, no significant interethnic difference was seen in reduction of FEV1 values.

CONCLUSION: We, therefore, conclude that ethnic differences in response to blockade of beta-receptors exist among racial groups in Malaysia. These differences were seen at similar plasma drug levels between races suggesting ethnic differences in drug sensitivity, rather than differences in drug disposition.

Hypersensitivity reactions to high-dose co-trimoxazole in HIV-infected Malaysian and Scottish patients

Pakianathan MR, Kamarulzaman A, Ismail R, McMillan A, Scott GR

AIDS, 1999 Sep 10;13(13):1787-8.

PMID: 10509585

Heterogeneity of the CYP2D6 gene among Malays in Malaysia

Teh LK, Ismail R, Yusoff R, Hussein A, Isa MN, Rahman AR

J Clin Pharm Ther, 2001 Jun;26(3):205-11.

PMID: 11422605

Although Malays shared an origin with Chinese, their evolution saw substantial divergences. Phenotyping studies suggested that they differed in CYP2D6 polymorphism, with higher PM prevalence but lesser right-shift for debrisoquine MRs.

Genetic polymorphism of CYP2D6 in Chinese subjects in Malaysia

Ismail R, Teh LK, Amir J, Alwi Z, Lopez CG

J Clin Pharm Ther, 2003 Aug;28(4):279-84.

PMID: 12911679

Although Malaysian Chinese share an origin with the mainland Chinese, their evolution has been influenced by intermarriages. With a gene such as CYP2D6, which is highly polymorphic, it is expected that the Malaysian Chinese would exhibit a polymorphism profile different from those of the Chinese populations in other geographical locations.

Correlation of tramadol pharmacokinetics and CYP2D6*10 genotype in Malaysian subjects

Gan SH, Ismail R, Wan Adnan WA, Wan Z

J Pharm Biomed Anal, 2002 Sep 05;30(2):189-195.

PMID: 12191703

The aim of the present study is to investigate the influence of the CYP2D6*10 allele on the disposition of tramadol hydrochloride in Malaysian subjects. A single dose of 100 mg tramadol was given intravenously to 30 healthy orthopaedic patients undergoing various elective surgeries. After having obtained written informed consents, patients were genotyped for CYP2D6*10: the most common CYP2D6 allele among Asians by means of allele-specific polymerase chain reaction. The presence of other mutations (CYP2D6*1, *3, *4, *5, *9 and *17) was also investigated. Tramadol was extracted from 1 ml serum with an n-hexane: ethylacetate combination (4:1) after alkalinisation with ammonia (pH 10.6). Serum concentrations were measured by means of high-performance liquid chromatography. The pharmacokinetics of tramadol was studied during the 24 h after the dose. As among other Asians, the allele frequency for CYP2D6*10 among Malaysians was high (0.43). Subjects who were homozygous for CYP2D6*10 had significantly (P=0.046) longer mean serum half-life of tramadol than subjects of the normal or the heterozygous group (Kruskal-Wallis test). When patients were screened for the presence of other alleles, the pharmacokinetic parameter values were better explained. CYP2D6 activity may play a main role in determining tramadol pharmacokinetics. The CYP2D6*10 allele particularly was associated with higher serum levels of tramadol compared with the CYP2D6*1 allele. However, genotyping for CYP2D6*10 alone is not sufficient to explain tramadol disposition.

Pattern of skin diseases among patients attending an outpatient dermatology clinic in a tertiary hospital in urban Malaysia

Kwan Z, Wong SM, Robinson S, Tan LL, Ismail R

Australas J Dermatol, 2017 Nov;58(4):e267-e268.

PMID: 28660702 DOI: 10.1111/ajd.12541

An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country

Kwan SC, Ismail R, Ismail NH, Mohamed N

Soc Sci Med, 2021 05;276:113868.

PMID: 33799201 DOI: 10.1016/j.socscimed.2021.113868

This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.

The Malay Version of the Michigan Hand Outcomes Questionnaire: Cross-Cultural Adaptation, Validation and Reliability Testing

Lye JX, Kow RY, Ismail R, Khalid KA

J Hand Surg Asian Pac Vol, 2021 Jun;26(2):166-179.

PMID: 33928864 DOI: 10.1142/S2424835521500156

Background: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability and validity compared with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Malay-speaking population. Methods: The MHQ was cross-culturally adapted into a Malay version based on the guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ and DASH questionnaires. The MHQ was tested twice with an interval of two weeks in between. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method and Cronbach's alpha calculation, respectively. The association between MHQ and DASH questionnaire was assessed with Spearman's correlation calculation. Results: In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranging from 0.925 to 0.984. Cronbach's alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. Spearman's correlation factor of the MHQ in comparison with DASH showed a fair to moderately strong correlation with the values ranging from 0.513 to 0.757. Conclusions: The Malay version of MHQ was successfully translated and culturally-adapted with excellent reliability (reproducibility and internal consistency) and good construct validity.

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