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  1. Fulltext Profile of in-patient suicides in two hospitals in Malaysia
    Zain AM
    Med J Malaysia, 1991 Jun;46(2):171-6.
    PMID: 1839422
    A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.
  2. The effect of providing expressed breast milk on infection rates, mortality and breast feeding of preterm babies
    Ram, S.P., Zabidi Azhar M Hussin
    Malaysian Journal of Child Health, 1997;9(1):83-87.
    MyJurnal
    Two active interventions were carried out in order to encourage breast feeding of low birth weight (LBW) neonates who were admitted to the neonatal intensive care unit (NICU), Universiti Sains Malaysia. These were the establishment of (a) an effective transport system for conveying expressed breast milk (EBM) from the motherk home to the neonatal intensive care unit and (b) providing rooming-infacilities in the neonatal ward. The EBM was transported by a male health assistant, by the parents themselves or by the local bus company. A total of 473 babies were admitted from April 1994 to September 1995. Thirty-three babies weighed between 540-1000g and 440 were between 1001-2000g. A total of 226 (47.8%) babies were given mixed formula (less than 20% of daily needs) and EBM feeds (Group A) and 247 (52.2%) were given only formula feeds (Group B). A total of 79 babies died of which 5 were in Group A and 74 were in group B. (P value is 0.00). In Group A, 45 babies had clinical sepsis, 9 of whom were blood culture positive. Four of these babies died. In group B, out of 108 babies with clinical sepsis 36 were blood culture positive. 29 died because of the sepsis This study shows that by providing an effective transport system for breast milk expressed at home and the availability of roomingfacilities in the neonatal ward a significant number of LBW babies admitted to the NICU continue to receive their mothers' milk. The incidence of nosocomial sepsis and the over all mortality due to sepsis was significantly higher in those on full formulafeeding compared to those given mixed formula and expressed breast milk.
  3. Early clinical and radiographic analysis of the Fitmore cup
    Merican AM, Randle R
    J Arthroplasty, 2006 Sep;21(6):846-51.
    PMID: 16950037
    The Fitmore titanium mesh cementless acetabular component in 115 hip arthroplasties was reviewed at an average of 33 months of follow-up. None were revised nor had infection. One hip dislocated 4 years postoperatively. Two femoral components were revised. The average Harris Hip Score at the last follow-up was 90 points. In the 96 sets of radiographs available, there was no loosening or new radiolucency. One hip had nonprogressive osteolysis adjacent to a screw. This press-fit cup has its polar region flattened and is rim loading. Noncontact (gaps) at the acetabular floor is expected and is not critical for fixation. In all but 6 hips, these gaps filled. In 5 hips, a minimal gap (
  4. Fulltext Psychological stress and treatment--research issues
    Azhar MZ
    Med J Malaysia, 2004 Jun;59(2):143-5.
    PMID: 15559161
  5. Future needs and wants in medical education--the UPM experience
    Azhar MZ
    Med J Malaysia, 2005 Aug;60 Suppl D:24-7.
    PMID: 16315619
    Medical schools have existed in Malaysia for a very long time. The majority of practicing doctors has trained locally. From the early nineteen sixties when the first medical school was established to the current 7 public medical faculties, the standards of local trained doctors have always been exemplary. Now with more need for doctors to serve the country and the mushrooming of medical schools, the question of needs and wants of future medical schools and medical education need to be addressed. In this paper I will try to highlight what we in Universiti Putra Malaysia have been working on to improve the Medical and Health Sciences faculty to achieve greater heights to reach the future in the shortest possible time.
  6. The growing importance of mental health: are medical curricula responding?
    Azhar MZ
    Med J Malaysia, 2002 Dec;57 Suppl E:34-6.
    PMID: 12733191
    Mental health is becoming an important issue. Several local and international studies have proven that the incidence of mental illness is on the rise. Doctors have also been able to make more accurate diagnoses and treat mental disorders more reliably with the aid of recent research and newer drugs. As such it is necessary for the medical curricula to respond to this shift. Medical students must now be exposed to new psychiatric disorders and ways of managing them. The time spent in psychiatry and the mode of teaching must also be revised and modified to the current needs of patients.
  7. Fulltext Comparison of risperidone and other neuroleptics in the management of chronic schizophrenia using cognitive therapy
    Azhar MZ
    Med J Malaysia, 2000 Mar;55(1):7-13.
    PMID: 11072484
    A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.
  8. Fulltext Comparison of Fluvoxamine alone, Fluvoxamine and cognitive psychotherapy and psychotherapy alone in the treatment of panic disorder in Kelantan--implications for management by family doctors
    Azhar MZ
    Med J Malaysia, 2000 Dec;55(4):402-8.
    PMID: 11221150
    This paper reports the result of a brief therapy attempt at treating panic in a busy outpatient psychiatric clinic. The patients were cases of panic referred from the various outpatient clinics within the hospital complex. The patients were divided into three groups at random using one of three modalities of treatment, i.e. cognitive behaviour therapy (CBT), CBT and Fluvoxamine (FVX), and FVX alone. The therapy was aimed for a maximum of nine sessions after which the patients were to be discharged. There were 14 patients in each group. The results show that all the groups were similar in the severity and scores pre treatment but after the different types of treatment there was a significant difference among them. The FVX alone group, showed significant improvement from the pretreatment levels but did not show as much improvement as the other groups and the mean score was only 9.07 after nine sessions. The best group was the CBT in combination with FVX. This indicates that the best way to treat panic is to combine drug treatment and psychological treatment. It is also shown from the study that the combination group requires less FVX than the FVX alone group. This finding has implications for the treatment of panic at the family physician clinic.

    Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia
  9. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics
    Merican AM, Amis AA
    J Biomech, 2009 Jul 22;42(10):1539-1546.
    PMID: 19481211 DOI: 10.1016/j.jbiomech.2009.03.041
    The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175 N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100 degrees to 0 degrees flexion. This was repeated after the following ITB loads: 30, 60 and 90 N. There was no change with 30 N load for patellar translation. On average, at 60 and 90 N, the patella translated laterally by 0.8 and 1.4mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7 degrees, 1.2 degrees and 1.5 degrees for 30, 60 and 90 N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60 degrees and 75 degrees flexion. The increase was 5.2 degrees, 9.5 degrees and 13 degrees in this range for 30, 60 and 90 N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known.
  10. Fulltext Iliotibial band tension reduces patellar lateral stability
    Merican AM, Iranpour F, Amis AA
    J Orthop Res, 2009 Mar;27(3):335-9.
    PMID: 18925647 DOI: 10.1002/jor.20756
    This study investigated the effect of loading the iliotibial band (ITB) on the stability of the patellofemoral joint. We measured the restraining force required to displace the patella 10 mm medially and laterally (defined as medial and lateral stability, respectively) in 14 fresh-frozen knees from 0 to 90 degrees knee flexion. The testing rig allowed the patella to rotate and translate freely during this displacement. The quadriceps was separated into five components and loaded with 175 N total tension. Testing was performed at 0 to 90 N ITB tension. With no ITB tension, the lateral restraining force ranged from 82 to 101 N across 0 to 90 degrees flexion. Increasing ITB tension caused progressive reduction of the lateral restraining force. The maximum reduction was 25% at 60 degrees flexion and 90 N ITB tension. Medial restraining force increased progressively with increasing knee flexion and increasing ITB loads; it ranged from 74 N at 0 degrees knee flexion and 0 N ITB tension to 211 N at 90 degrees knee flexion and 90 N ITB tension. The maximum effect was an increase of medial restraining force of 50% at 90 degrees flexion and 90 N ITB tension.
  11. Textural and physical properties of retort processed rice noodles: Influence of chilling and partial substitution of rice flour with pregelatinized high-amylose maize starch
    Lubowa M, Yeoh SY, Easa AM
    Food Sci Technol Int, 2018 Sep;24(6):476-486.
    PMID: 29600879 DOI: 10.1177/1082013218766984
    This study investigated the influence of pregelatinized high-amylose maize starch and chilling treatment on the physical and textural properties of canned rice noodles thermally processed in a retort. Rice noodles were prepared from rice flour partially substituted with pregelatinized high-amylose maize starch (Hylon VII™) in the ratios 0, 5, 10, and 15% (wt/wt). High-amylose maize starch improved the texture and brightness of fresh (not retorted) noodles. Chilling treatment led to significant (P ≤ 0.05) improvement in the texture of fresh noodles at all levels of substitution with high-amylose starch. The highest hardness was recorded at 15% amylose level in chilled nonretorted noodles. Retort processing induced a major loss of quality through water absorption, retort cooking loss, decreased noodle hardness, and lightness. However, the results showed that amylose and chilling treatment positively reduced the impact of retorting. For each level of amylose substitution, a low retort cooking loss and increased noodle hardness were associated with a chilling treatment. For both chilled and nonchilled noodles, retort cooking loss and hardness increased with increasing levels of amylose substitution.
  12. Fulltext Anxiety disorders and quality of life among patients with hematological cancer in a Malaysian hospital
    Priscilla, D., Hamidin, A., Azhar, M. Z., Noorjan, K. O. N., Salmiah, M. S., Bahariah, K.
    Malaysian Journal of Medicine and Health Sciences, 2011;7(2):9-16.
    MyJurnal
    Objective: The purpose of this study is to access the prevalence of anxiety disorders and quality of life factors among hematological cancer patients in a Malaysian hospital. Methods: This study used a cross-sectional research design. It was conducted at the Ampang Hospital in Kuala Lumpur, a tertiary referral center for hematological cancer. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI); quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC30) questionnaire. Results: A total of 105 hematological cancer patients participated in the study, which constituted a response rate of 83.3%. The prevalence of anxiety disorders in our sample ranged from 1% to 24.8%. Overall, compared to patients without anxiety disorders, hematological cancer patients with anxiety disorders reported impaired quality of life in regards to emotional functioning, cognitive functioning, insomnia, dyspnoea, nausea and vomiting, appetite loss and constipation (p
  13. Fulltext Total phenolics, flavonoids and antioxidant activity of banana pulp and peel flours: influence of variety and stage of ripeness
    Fatemeh, S. R., Saifullah, R., Abbas, F. M. A., Azhar, M. E.
    International Food Research Journal, 2012;19(3):1041-1046.
    MyJurnal
    The influence of variety (Cavendish and Dream), stage of ripeness (green and ripe) and parts (pulp and peel) on antioxidative compounds and antioxidant activity of banana fruit was investigated. The TPC and TFC ranged widely from 75.01 to 685.57 mg GAE/100 g and 39.01 to 389.33 mg CEQ/100 g of dry matter respectively. Cavendish banana flour contained higher TPC and TFC compared to Dream variety. TPC and TFC values of banana peel were higher than those of banana pulp. Also, green banana showed higher TPC and TFC values than those of ripe fruit. Radical scavenging activities (inhibition of DPPH) of the extracts ranged from 26.55 to 52.66%. Although Dream banana peel extracts appeared to have low TPC and TFC, its antioxidant activities were ranked moderate to high. This implies that antioxidative compounds other than phenolics and flavonoids were probably responsible for inhibition of DPPH.
  14. Fulltext Physicochemical, pasting and gel textural properties of wheat-ripe Cavendish banana composite flours
    Ng, K. F., Abbas, F. M. A., Tan, T. C., Azhar, M. E.
    International Food Research Journal, 2014;21(2):655-662.
    MyJurnal
    Proximate composition, pH and amylose content of ripe Cavendish banana flour (RBF) prepared in this study were compared with all-purpose wheat flour (WF). RBF was found to be significantly (P < 0.05) higher in total carbohydrates and minerals content, while significantly (P < 0.05) lower in protein and fat contents compared with those of WF. Wheat-ripe banana composite flours (W-RBF) prepared by partial substitution of WF with RBF were assessed for swelling power, solubility, pasting properties and gel textural properties. Granular swelling of RBF occurred at a higher temperature compared to that of WF, suggesting that more energy and water were required to cook WF-RBF as the presence of soluble carbohydrates would compete for water and this would eventually delay starch hydration and granular expansion during cooking. Higher substitution with RBF led to higher soluble carbohydrates content, and increase in solubility index of WF-RBF. Partial substitution with RBF also resulted in significant (P < 0.05) decrease in pasting properties. A higher substitution of WF with RBF could reduce starch gelatinisation during cooking and retrogradation owing to the reduction of available starch in WF-RBF. All WF-RBF gels were significantly (P < 0.05) firmer and less sticky compared to WF gels.
  15. Fulltext A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004
    Lekhraj Rampal, G. R., Sanjay, R., Azhar, M. Z., Kamil, M. H.
    Malaysian Journal of Medicine and Health Sciences, 2006;2(2):61-69.
    MyJurnal
    Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live.
    Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence.
    Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire.
    Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%.
    Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19.1 years) was significantly lower compared to 29.8 years for the females (p<0.001). Key words: Smoking, prevalence, initiation age, duration, Terengganu state
  16. Fulltext Depression and quality of life among patients with hematological cancer in a Malaysian hospital
    Priscilla, D., Hamidin, A., Azhar, M. Z., Noorjan, K. O. N., Salmiah, M. S., Bahariah, K.
    Malaysian Journal of Medicine and Health Sciences, 2011;7(1):65-74.
    MyJurnal
    Objective: To determine the prevalence of major depressive disorder (MDD) in hematological cancer patients and to investigate MDD with quality of life. Methods: The research, which uses a cross sectional design, has been carried out at Ampang Hospital, Kuala Lumpur. The hospital is a tertiary referral center for cancer cases that include non-Hodgkin lymphoma, acute myelogenous leukemia, acute lymphoblastic leukemia, Hodgkin lymphoma and other hematological cancers. In total, 105 patients with hematological malignancies were included in the study. This study employed the MINI International Neuropsychiatric Interview for diagnosis of MDD, the Patient Health Questionnaire (PHQ-9) for symptom severity of depression and the European Organisation for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) to assess the quality of life of the respondents. Result: The response rate was 83.3%. The prevalence of MDD was 24.8% (n=26) with the majority of cases classified as moderately severe depression (38.5%). About 92.3% (n=24) of depressed hematological cancer patients were diagnosed with a current episode of MDD. The depressed patients also had significantly reduced quality of life in physical, role, emotional, cognitive and social domains (p
  17. Biomechanical analysis of knee laxity with isolated anteromedial or posterolateral bundle-deficient anterior cruciate ligament
    Kondo E, Merican AM, Yasuda K, Amis AA
    Arthroscopy, 2014 Mar;30(3):335-43.
    PMID: 24581258 DOI: 10.1016/j.arthro.2013.12.003
    The purpose of this study was to clarify the changes in the kinematics of the knee that result from isolated deficiency of the anteromedial (AM) or posterolateral (PL) bundle.
  18. Screening for depression with a brief questionnaire in a primary care setting: validation of the two questions with help question (Malay version)
    Mohd-Sidik S, Arroll B, Goodyear-Smith F, Zain AM
    Int J Psychiatry Med, 2011;41(2):143-54.
    PMID: 21675346 DOI: 10.2190/PM.41.2.d
    OBJECTIVE: To determine the diagnostic accuracy of the two questions with help question (TQWHQ) in the Malay language. The two questions are case-finding questions on depression, and a question on whether help is needed was added to increase the specificity of the two questions.
    METHOD: This cross sectional validation study was conducted in a government funded primary care clinic in Malaysia. The participants included 146 consecutive women patients receiving no psychotropic drugs and who were Malay speakers. The main outcome measures were sensitivity, specificity, and likelihood ratios of the two questions and help question.
    RESULTS: The two questions showed a sensitivity of 99% (95% confidence interval 88% to 99.9%) and a specificity of 70% (62% to 78%), respectively. The likelihood ratio for a positive test was 3.3 (2.5 to 4.5) and the likelihood ratio for a negative test was 0.01 (0.00 to 0.57). The addition of the help question to the two questions increased the specificity to 95% (89% to 98%).
    CONCLUSION: The two qeustions on depression detected most cases of depression in this study. The questions have the advantage of brevity. The addition of the help question increased the specificity of the two questions. Based on these findings, the TQWHQ can be strongly recommended for detection of depression in government primary care clnics in Malaysia. Translation did not apear to affect the validity of the TQWHQ.
  19. Fulltext The tale of two vessels, vascular complications following a breach of the pelvic inner table due to acetabular screws: a report of two cases
    Ayob KA, Merican AM, Sulaiman SH, Hariz Ramli AR
    Jt Dis Relat Surg, 2021;32(1):239-244.
    PMID: 33463444 DOI: 10.5606/ehc.2021.77862
    Injuries to the pelvic vasculature during total hip arthroplasties are rare but have serious consequence. They demand urgent and early identification so that appropriate treatment can be instituted. If the bleeding is severe, cardiovascular compromise occurs intraoperatively and this will alert the surgeon of this possibility during acetabular screw placement. Alternatively, a delay in diagnosis can occur because the bleeding and the injured vessel are in the pelvic cavity and not visualized during the surgery. In this article, we report two cases from our center occurring within a six-month interval that sustained a vascular injury during acetabular drilling for screw placement for cementless cup fixation. Each case had a different vessel injury and different lessons can be learned from these rare injuries. The first case had an injury of the inferior gluteal artery following a breach of the sciatic notch. The vessel was treated with percutaneous embolization. The second case demonstrated a venous injury, following a medial protrusio technique for congenital hip dysplasia and a short anterosuperior screw, transecting the external iliac vein. This was subsequently repaired using an endovascular technique. We conclude the reasons for these vessel injuries after analyzing advanced imaging, discuss measures to avoid vessel injury and detail the minimally invasive method for their treatment.
  20. Optimization of soy protein isolate, microbial transglutaminase and glucono-δ-lactone in gluten-free rice noodles
    Ojukwu M, Ofoedu C, Seow EK, Easa AM
    J Sci Food Agric, 2021 Jul;101(9):3732-3741.
    PMID: 33301191 DOI: 10.1002/jsfa.11004
    BACKGROUND: Rice flour does not contain gluten and lacks cohesion and extensibility, which is responsible for the poor texture of rice noodles. Different technologies have been used to mitigate this challenge, including hydrothermal treatments of rice flour, direct addition of protein in noodles, use of additives such as hydrocolloids and alginates, and microbial transglutaminase (MTG). Recently, the inclusion of soy protein isolate (SPI), MTG, and glucono-δ-lactone (GDL) in the rice noodles system yielded rice noodles with improved texture and more compact microstructure, hence the need to optimize the addition of SPI, MTG, and GDL to make quality rice noodles.

    RESULTS: Numerical optimization showed that rice noodles prepared with SPI, 68.32 (g kg-1 of rice flour), MTG, 5.06 (g kg-1 of rice flour) and GDL, 5.0 (g kg-1 of rice flour) gave the best response variables; hardness (53.19 N), springiness (0.76), chewiness (20.28 J), tensile strength (60.35 kPa), and cooking time (5.15 min). The pH, sensory, and microstructure results showed that the optimized rice noodles had a more compact microstructure with fewer hollows, optimum pH for MTG action, and overall sensory panelists also showed the highest preference for the optimized formulation, compared to other samples selected from the numerical optimization and desirability tests.

    CONCLUSION: Optimization of the levels of SPI, MTG, and GDL yielded quality noodles with improved textural, mechanical, sensory, and microstructural properties. This was partly due to the favourable pH value of the optimized noodles that provided the most suitable conditions for MTG crosslinking and balanced electrostatic interaction of proteins. © 2020 Society of Chemical Industry.

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