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Fulltext Clinical and endoscopic features of peptic ulcer bleeding in Malaysia

Kandasami P, Harjit K, Hanafiah H

Med J Malaysia, 2004 Dec;59(5):617-22.
PMID: 15889564 MyJurnal

The characteristics of patients and the endoscopic features of 196 patients with bleeding peptic ulcer in a multi-ethnic population were investigated. There was a male preponderance (M: F= 6.3: 1) and their mean age was 63.5 years. The prevalence of peptic ulcer bleeding in the Malays and Indians was similar to the ethnic distribution of population. However, the Chinese were over represented. Nearly 40% of patients studied had at least one co-existing medical illness. Hypertension and ischaemic heart disease were the most common diseases. History of non-steroidal anti-inflammatory drug usage was identified in 48% of the patients and it was the commonest risk factor associated with bleeding ulcers. More than 80% of bleeding ulcers were located in the duodenum and the pylorus. Endoscopic features of active bleeding or recent bleed were identified in more than 60% of the patients. The study notes that bleeding peptic ulcer is a serious and a potentially life threatening condition. It is a disease of the elderly and, with the steadily increasing elderly population in the country, the admissions rates of peptic ulcer bleeding is expected to rise. There is a need to plan for appropriate technical support, critical care facilities and expertise to avoid unacceptable outcomes.
Fulltext Bleeding peptic ulcer: experience with endoscopic therapy

Harjit K, Kandasami P, Hanafiah H

Med J Malaysia, 2002 Jun;57(2):154-60.
PMID: 24326645

Bleeding is a serious complication of peptic ulcer and mortality rate has remained at approximately 10% or more. Traditionally surgeons selected patients who were at significant risk of continued or re-bleeding and advocated early surgery. However, patients with bleeding peptic ulcers are generally elderly with coexisting medical illness and surgery results in significant morbidity and mortality. In the last decade, endoscopic haemostatic therapy has been effective in arresting the bleeding with surgical option considered only after endoscopic treatment has failed. We report the outcome of 196 patients who were endoscopically diagnosed to have bleeding from peptic ulcers. One hundred and thirty patients were to have active bleeding or recent bleed from the ulcer. Endoscopic adrenaline injection therapy was used in 53 patients who had active bleeding ulcers and another 77 patients with endoscopic evidence of recent bleed. The injection therapy was successfully in 127 (97.7%) patients. The treatment failed in three patients and they underwent urgent surgery. Re-bleeding occurred in 26 (20.5%) patients and endoscopic adrenaline therapy was repeated in these cases. Haemostatic was achieved in 19 patients, however 7 patients continued to bleed and required surgery. There were 3 deaths, principally from advanced age and coexisting medical illness. Endoscopic therapy for bleeding peptic ulcers is simply to apply, safe and effective. In cases of re-bleeding after initial endoscopic hemostasis, re-treatment is a preferable alternative to surgery. The role of surgery is limited to bleeding that is refractory or inaccessible to endoscopic control.
Misdiagnosed infected aneurysm presenting as pyrexia of unknown origin (PUO)

Abdikarim M, Shahari S, Idris MA, Hanafiah H, Kosai NR, Das S

Clin Ter, 2014;165(4):199-201.
PMID: 25203333 DOI: 10.7417/CT.2014.1733

Infected aneurysm is a life threatening clinical condition that is associated with significant morbidity and mortality. Early detection is essential for a rapid and efficacious initial treatment for better prognosis. Since the introduction of antibiotic therapy and concomitant decline of endocarditis, true mycotic aneurysms are rarely seen. The usual treatment consists of antibiotics along with aggressive surgical debridement of the infected tissue and vascular reconstruction, if needed. We here describe an infected aneurysm presenting as pyrexia of unknown origin and discuss the clinical features and challenges encountered in the treatment.
MMP-9: biomarker for abdominal aneurysm

Affirul CA, Azim IM, Hanafiah H, Nor Azmi K, Rozman Z

Clin Ter, 2013;164(6):e479-83.
PMID: 24424226 DOI: 10.7417/CT.2013.1640

INTRODUCTION: Matrix Metalloproteinase 9 (MMP-9) has been shown to express significantly on organ tissue culture in Abdominal Aortic Aneurysm (AAA) patients. Prior studies have shown the correlation between MMP-9 concentration levels with AAA raising the probability of its usage as a biomarker in AAA disease. However, results of previous studies have been conflicting. The purpose of this study is to identify the correlation between MMP-9 concentration levels with AAA disease and further define the utility as a biomarker for our center population.
MATERIALS AND METHODS: This is prospective controlled trial. Peripheral venous blood sample is obtained from 20 patients with AAA and 36 normal control subjects. MMP-9 concentration levels were determined by an enzyme-linked immunosorbent assay and compared with subjects abdominal ultrasonography or computed tomography of abdomen.
RESULTS: Mean (± SE) MMP-9 was 23.94 ± 0.60 ng/mL in normal control subjects and 21.39 ± 1.03 ng/mL in patients with AAAs (p ← 0.05 versus normal control subjects). MMP-9 correlate significantly with AAA (p=0.004). There was no correlation of MMP-9 levels with age, gender, or other risk factors. The cutoff point is 12.54 for aorta size <3.0 cm. The sensitivity and specificity of MMP-9 were 60% and 64% respectively.
CONCLUSIONS: MMP-9 levels correlate significantly with AAA with a cutoff point of 12.54. However, the utility of MMP-9 as a diagnostic test is limited due to low sensitivity and specificity. An elevated MMP-9 has limited use to predict the presence of AAA (positive predictive value: 60%) and a normal MMP-9 level was insufficient to determine the absence of AAA (negative predictive value: 36.1%).
MRI findings suggestive of Alzheimer's disease in patients with primary open angle glaucoma - a single sequence analysis using rapid 3D T1 spoiled gradient echo

Hanafiah M, Johari B, Ab Mumin N, Musa AA, Hanafiah H

Br J Radiol, 2022 May 01;95(1133):20210857.
PMID: 35007174 DOI: 10.1259/bjr.20210857

OBJECTIVE: Primary open-angle glaucoma (POAG) is a degenerative optic neuropathy disease which has somewhat similar pathophysiology to Alzheimer's disease (AD). This study aims to determine the presence of medial temporal atrophy and parietal lobe atrophy in patients with POAG compared to normal controls using medial temporal atrophy (MTA) scoring and posterior cortical atrophy (PCA) scoring system on T1 magnetization-prepared rapid gradient-echo.
METHODS: 50 POAG patients and 50 normal subjects were recruited and an MRI brain with T1-magnetization-prepared rapid gradient-echo was performed. Medial temporal lobe and parietal lobe atrophy were by MTA and PCA/Koedam scoring. The score of the PCA and MTA were compared between the POAG group and the controls.
RESULTS: There was a significant statistical difference between PCA score in POAG and the healthy control group (p-value = 0.026). There is no statistical difference between MTA score in POAG compared to the healthy control group (p-value = 0.58).
CONCLUSION: This study suggests a correlation between POAG and PCA score. Potential application of this scoring method in clinical diagnosis and monitoring of POAG patients.
ADVANCES IN KNOWLEDGE: The scoring method used in AD may also be applied in the diagnosis and monitoring of POAGMRI brain, specifically rapid volumetric T1 spoiled gradient echo sequence, may be applied in POAG assessment.
Iatrogenic inguinal chyle fistula: a rare case report

Zubaidah NH, Jasmi AY, Hanafiah H, Shaker AH, Asri CM, Emad AR, et al.

Rom J Morphol Embryol, 2012;53(2):431-2.
PMID: 22732820

Chyle fistula may be common in the neck and thorax region but it is a rare entity in the inguinal region. The rarity of the incidence of chyle fistula and the tremendous response to conservative management are the important aspects to be remembered. We hereby report a case of iatrogenic inguinal chyle fistula complicating a femoral vein cannulation.
Fulltext Relationship between Physical Activity and Cardiovascular Risk Factors: A Cross-Sectional Study among Low-Income Housewives in Kuala Lumpur

Mohd Saat NZ, Hanawi SA, M F Farah N, Mohd Amin H, Hanafiah H, Shamsulkamar NS

Int J Environ Res Public Health, 2021 06 04;18(11).
PMID: 34200066 DOI: 10.3390/ijerph18116090

Cardiovascular disease is a significant public health concern worldwide, including in Malaysia. Various attempts have been made to resolve this issue. One of the most important methods of controlling cardiovascular risk factors is physical exercise. However, today's women, especially housewives, are often identified by a lack of physical activity. This is alarming to society, as cardiovascular disease can affect the quality of their life. The aim of this study is to determine the relationship between physical activity and cardiovascular risk factors among low-income housewives in Kuala Lumpur. A total of 63 housewives participated in this cross-sectional study. All participating housewives were asked to fill out a sociodemographic questionnaire and the short version of the International Physical Activity Questionnaire (IPAQ). To evaluate cardiovascular risk factors, anthropometric measurements and blood samples were taken. Findings showed that an average of 70.5 ± 232.4 min/week was spent on moderate-to-vigorous physical activity (MVPA), which indicated a low level of physical activity. Data showed that 90.5% of the subjects had low physical activity, 6.3% were moderate, and 3.2% were considered as having a high level of physical activity. For body mass index (BMI), 58.7% of the respondents were obese, 28.6% were overweight (29.10 ± 5.67 kg m-2), and 81.0% of subjects had a waist circumference (WC) value above the normal range (92.74 ± 16.40 cm). A two-way ANOVA test revealed significant mean differences between systolic blood pressure (mm/Hg) and age groups (p > 0.05). Nevertheless, there was a significant association between MVPA and cardiovascular risk factors using negative binomial regression (p < 0.01). The findings of this study highlight the need for health promotional programs to raise awareness, educate, and engage low-income housewives in lifestyle-enhancing behaviors.
Clinical efficacy and safety of a new 1000-mg suspension versus twice-daily 500-mg tablets of MPFF in patients with symptomatic chronic venous disorders: a randomized controlled trial

Carpentier P, van Bellen B, Karetova D, Hanafiah H, Enriquez-Vega E, Kirienko A, et al.

Int Angiol, 2017 Oct;36(5):402-409.
PMID: 28206732 DOI: 10.23736/S0392-9590.17.03801-9

BACKGROUND: Chronic venous disorders (CVD) is estimated to affect 30% to 50% of women and 10% to 30% of men. The most widely prescribed treatment for CVD worldwide is micronized purified flavonoid fraction 500 mg (MPFF). The aim of this clinical trial was to develop a new once daily 1000-mg oral suspension of MPFF.
METHODS: In an international, randomized, double-blind, parallel-group study, symptomatic individuals classified CEAP C0s to C4s were randomized in either treatment arm and treated for 8 weeks. Lower limb symptoms (discomfort, pain and heaviness) were assessed using Visual Analog Scales (VAS), and quality of life (QoL) was measured with the CIVIQ-20 Questionnaire.
RESULTS: A total of 1139 patients were included in the study. Both MPFF treatment regimens were well tolerated and associated with a significant reduction in lower limb symptoms. A non-inferiority of MPFF 1000-mg oral suspension once daily compared to MPFF 500-mg tablet twice daily (P<0.0001) was found for lower limb discomfort (-3.33 cm for MPFF 1000 mg and -3.37 cm for MPFF 500 mg), leg pain (-3.27 cm for MPFF 1000 mg and -3.31 cm for MPFF 500 mg) and leg heaviness (-3.41 cm for MPFF 1000 mg and -3.46 cm for MPFF 500 mg). The patients' QoL was improved by about 20 points on the CIVIQ scale in both groups (19.33 points for MPFF 1000 mg and 20.28 points for MPFF 500 mg).
CONCLUSIONS: MPFF 1000-mg oral suspension and MPFF 500-mg tablets treatments were associated with similar reductions in lower limb symptoms and QoL improvement. The new once daily MPFF1000-mg oral suspension has a similar safety profile to two tablets of MPFF 500 mg, with the advantage of one daily intake, potentially associated with improved patient adherence and easier CVD management.