Displaying publications 1 - 20 of 33 in total

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  1. Sakthiswary R, Raymond AA
    Neural Regen Res, 2012 Aug 15;7(23):1822-31.
    PMID: 25624807 DOI: 10.3969/j.issn.1673-5374.2012.23.009
    The lack of curative therapies for neurodegenerative diseases has high economic impact and places huge burden on the society. The contribution of stem cells to cure neurodegenerative diseases has been unraveled and explored extensively over the past few years. Beyond substitution of the lost neurons, stem cells act as immunomodulators and neuroprotectors. A large number of preclinical and a small number of clinical studies have shown beneficial outcomes in this context. In this review, we have summarized the current concepts of stem cell therapy in neurodegenerative diseases and the recent advances in this field, particularly between 2010 and 2012. Further studies should be encouraged to resolve the clinical issues and vague translational findings for maximum optimization of the efficacy of stem cell therapy in neurodegenerative diseases.
  2. Sakthiswary R, Raymond AA
    PLoS One, 2013;8(1):e55275.
    PMID: 23383135 DOI: 10.1371/journal.pone.0055275
    BACKGROUND: Vitamin D deficiency is more prevalent among SLE patients than the general population. Over the past decade, many studies across the globe have been carried out to investigate the role of vitamin D in SLE from various clinical angles. Therefore, the aim of this systematic review is to summarise and evaluate the evidence from the published literature; focusing on the clinical significance of vitamin D in SLE.

    METHODS: THE FOLLOWING DATABASES WERE SEARCHED: MEDLINE, Scopus, Web of Knowledge and CINAHL, using the terms "lupus", "systemic lupus erythematosus", "SLE and "vitamin D". We included only adult human studies published in the English language between 2000 and 2012.The reference lists of included studies were thoroughly reviewed in search for other relevant studies.

    RESULTS: A total of 22 studies met the selection criteria. The majority of the studies were observational (95.5%) and cross sectional (90.9%). Out of the 15 studies which looked into the association between vitamin D and SLE disease activity, 10 studies (including the 3 largest studies in this series) revealed a statistically significant inverse relationship. For disease damage, on the other hand, 5 out of 6 studies failed to demonstrate any association with vitamin D levels. Cardiovascular risk factors such as insulin resistance, hypertension and hypercholesterolaemia were related to vitamin D deficiency, according to 3 of the studies.

    CONCLUSION: There is convincing evidence to support the association between vitamin D levels and SLE disease activity. There is paucity of data in other clinical aspects to make firm conclusions.

  3. Zam Zureena Mohd Rani, Nor Azian Abdul Murad, Saberi Saimun, Sri Noraima Othman, Rahman Jamal, Sue-Mian Then, et al.
    Neurology Asia, 2018;23(2):137-144.
    MyJurnal
    Background: The HLA-B*15:02 polymorphism in epileptic patients is known to be associated with carbamazepine-induced Stevens-Johnson syndrome (SJS). The prevalence of HLA-B*15:02 polymorphism seemed to be ethnic-specific with a higher frequency of HLA-B*15:02 in Asian compared to the Europeans. This study was performed to determine the frequency of the HLA-B*15:02 polymorphism in epileptic patients at the Chancellor Tuanku Muhriz Hospital-UKM Medical Centre (HCTM-UKMMC) using high resolution melting-real time PCR (HRM-QPCR) method.
    Methods: We performed a fast and effective in-house high resolution melting-real time polymerase chain reaction method and compared it with the conventional multiplex-PCR method. The specificity and sensitivity of each test were also determined using DNA from saliva.
    Results: Using the conventional multiplexPCR approach for screening, 25 out of 64 (39.1%) epileptic patients were positive for HLA-B*15:02. However, using the HRM-QPCR technique, 24/64 (37.5%) of the patients were positive. The one patient who tested positive by the multiplex-PCR but negative using the HRM-QPCR turned out to be negative by DNA sequencing. The HRM-QPCR and DNA sequencing showed 100% sensitivity and specificity. The multiplex-PCR showed 100% sensitivity and 98.4% specificity compared to both HRM-QPCR and DNA sequencing. The HRM-QPCR is also more cost-effective (
  4. Tee TY, Khoo CS, Raymond AA, Syazarina SO
    Neurology, 2019 08 06;93(6):e626-e627.
    PMID: 31383811 DOI: 10.1212/WNL.0000000000007905
  5. Then SM, Mohd Rani ZZ, Raymond AA, Jamal R
    Neurology Asia, 2013;18(11):27-29.
    MyJurnal
    Previous studies have shown that carbamazepine-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients is associated with the HLA-B*1502 allele. Screening for HLA-B*1502 before using carbamazepine can prevent SJS/TEN particularly in populations with high frequency of the allele. The objective of this paper was to describe how the UKM Medical Centre, Malaysia was able to set up a cost effective screening of HLA-B*1502 for patients taking carbamazepine. The cost of in-house HLA-B⁄1502 screening was less than those commercially available, and was sensitive and specific.
  6. Nor Hashimah AMM, Kan SL, Raymond AA
    J R Coll Physicians Edinb, 2022 Jun;52(2):134-137.
    PMID: 36147003 DOI: 10.1177/14782715221104860
    Calcinosis universalis (CU) is characterised by diffuse deposition of insoluble calcium salt in the skin, subcutaneous tissue or organs. Calcium deposits in the breast may be associated with an increased risk for developing breast cancer. We present a case of a 65-year-old woman diagnosed with CU secondary to undifferentiated connective tissue disease. She developed progressive calcification of her skin, which did not improve with oral medications aimed at reducing the calcification. Investigations to look for possible causes of calcification were all unremarkable. During follow-up, calcification was also found in both her breasts. Initial mammography was reported as fibroadenoma. However, 3 years later, she returned with metastatic breast cancer which presented with a massive pleural effusion of the right lung. Calcinosis universalis should now be considered as a risk factor for breast cancer.
  7. Subramaniam SR, Khoo CS, Raymond AA, Che Din N, Syed Zakaria SZ, Tan HJ
    J Clin Neurosci, 2020 Mar;73:31-36.
    PMID: 32094071 DOI: 10.1016/j.jocn.2020.02.003
    The objective of this study is to determine prevalence and factors leading to verbal learning and memory dysfunction among patients with epilepsy. A total of 211 subjects were recruited. Their verbal memory was assessed by Rey's Auditory Verbal Learning Test (RAVLT). This test was further subdivided into four major spheres for analysis, namely the verbal learning, interference list, immediate memory and delayed memory. All data collected were analyzed using Statistical Package for Social Sciences. Among the 211 patients, 55% (n = 116) had focal seizures and the remaining 45% (n = 95) had generalized seizures. Prevalence of verbal learning and memory impairment was high at 39.97% overall, and found most commonly in patients with focal impaired awareness seizures. Verbal learning and immediate memory dysfunction were significantly lower in focal impaired awareness group compared to others. Age more than 50 years, exposure to three or more antiepileptic drugs and use of carbamazepine more than 1000 mg a day were the predictors in poor verbal memory outcome. No statistical difference was observed in the mean RAVLT scores among the gender and hand dominance groups. Between patients with and without electroencephalogram changes as well as brain magnetic resonance imaging changes, the mean RAVLT scores showed no statistically significant difference. Verbal learning and memory impairment is prevalent among the epilepsy patients. The consequences of the memory impairment can be as debilitating as the seizure control. RAVLT is a reliable and practical test in the clinical setting.
  8. Miyata-Nozaka Y, Tan HJ, Wong SW, Raymond AA, Omar H, Zain SM
    Int J Clin Pharmacol Ther, 2021 Jan;59(1):8-16.
    PMID: 33026315 DOI: 10.5414/CP203761
    OBJECTIVE: Epilepsy is a common chronic neurological condition characterized by recurrent seizures. Approximately 30 - 40% of epileptic patients do not respond to antiepileptic drugs. Previous studies suggest that CYP3A5 polymorphisms affect carbamazepine metabolism.

    MATERIALS AND METHODS: To examine this hypothesis, in the present study, the associations between CYP3A5 variants (rs776746 and rs1419745) and response to carbamazepine and valproic acid monotherapy in Malaysian epileptic patients were evaluated.

    RESULTS: A total of 288 Malaysian epileptic patients were recruited and further reviewed, of whom 63 patients were on carbamazepine monotherapy, and 85 patients were on valproic acid monotherapy. There was no patient with drug hypersensitivity syndrome within the population. Subjects were genotyped by using Sequenom MassARRAY platform. This study found a significant association of CYP3A5 rs776746 with the carbamazepine treatment response in total patients (p = 0.026) and Malay ethnic subgroup (p = 0.006). In addition, a marginal significant association of CYP3A5 rs1419745 with carbamazepine treatment response was reported in the Malays. Similarly, CYP3A5 rs776746 was associated with valproic acid response in total patients (p = 0.037) and Malays (marginal p = 0.05).

    CONCLUSION: Our findings suggest that CYP3A5 polymorphisms affect carbamazepine and valproic acid response in Malaysian epileptic patients.

  9. Payus AO, Leow Wen Hsiang J, Leong JQ, Ibrahim A, Raymond AA
    Am J Case Rep, 2021 Jan 20;22:e928419.
    PMID: 33468985 DOI: 10.12659/AJCR.928419
    BACKGROUND Myasthenic crisis is a condition characterized by the sudden onset of myasthenic weakness involving the respiratory muscles and requires ventilatory support to prevent death. This is a case report of respiratory failure in a 43-year-old man as the first presentation of myasthenia gravis. CASE REPORT A 43-year-old man with underlying hypertension and a lacunar stroke with good muscle-power recovery presented with severe community-acquired pneumonia, complicated with respiratory failure requiring invasive ventilatory support. He responded well to the intravenous antibiotic therapy and after 1 week of treatment, he was hemodynamically stable and his septic parameters improved. However, he persistently failed to maintain adequate spontaneous respiratory effort after the removal of the ventilatory support and had to be reintubated multiple times. There was no other identifiable cause for the worsening respiratory failure. He had no clinical features or muscle weakness suggestive of myasthenia gravis. However, his blood test was positive for serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation tests showed the characteristic decremental response of compound muscle action potential amplitude, in keeping with the diagnosis of myasthenia gravis. He responded well to intravenous immunoglobulin and was discharged with anticholinesterase inhibitors and long-term immunosuppression therapy. CONCLUSIONS This report demonstrates that when patients are admitted to the hospital with acute respiratory failure without any underlying pulmonary disease and with weakness of the respiratory muscles, the diagnosis of myasthenia gravis presenting with a myasthenic crisis should be considered.
  10. Payus AO, Jeffree MS, Ohn MH, Tan HJ, Ibrahim A, Chia YK, et al.
    Neurol Sci, 2021 Dec 01.
    PMID: 34853897 DOI: 10.1007/s10072-021-05785-z
    INTRODUCTION: The novel Coronavirus Disease 2019 (COVID-19) is an infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has been spreading rapidly amongst humans and causing a global pandemic. The notorious infection has shown to cause a wide spectrum of neurological syndrome, including autoimmune encephalitis.

    OBJECTIVE: Here, we systematically review the literature on autoimmune encephalitis that developed in the background of SARS-CoV-2 infections and also the possible pathophysiological mechanisms of auto-immune mediated damage to the nervous system.

    METHODOLOGY: An exhaustive search was made in Medline/PubMed, Embase, Scopus and other medical databases, and 28 relevant published articles were selected according to the strict inclusion criteria.

    RESULTS: Autoimmune encephalitis can occur via three possible proposed pathophysiological mechanism and can manifest during or after the acute infection period. It is more common in adult but can also occur in the paediatric patients. There were various spectra of autoantibody panels reported including antineuronal antibody, anti-gangliosides antibody and onconeural antibody. Majority of the patients responded well to the immunomodulating therapy and achieved good recovery.

    CONCLUSION: In conclusion, SARSCoV-2 infection can induce various spectrum of autoimmune encephalitis. It is a major concern since there is very limited long-term study on the topic. Hence, this review aims to elucidate on the potential long-term complication of SARS-CoV-2 infection and hopefully to improve the management and prognosis of COVID-19.

  11. Then SM, Rani ZZ, Raymond AA, Ratnaningrum S, Jamal R
    Asian Pac J Allergy Immunol, 2011 Sep;29(3):290-3.
    PMID: 22053601
    We describe the association of the HLA-B*1502 allele in 27 epilepsy patients (19 Malays, 8 Chinese) treated with carbamazepine (CBZ) at the UKM Medical Center (UKMMC), 6 with CBZ-Steven Johnson Syndrome (CBZ-SJS), 11 with CBZ-induced rash, 2 with suspected phenytoin-induced rash and 8 negative controls. Our study showed that 10 (6 Malay, 4 Chinese) patients were positive for HLA-B*1502. Out of the 10 patients, six were confirmed to have CBZ-SJS (p = 0.0006), while four patients developed a skin rash. However there were 6 Malay patients and 1 Chinese patient that developed a skin rash after CBZ administration who were not positive for the allele, indicating that there might be more that one allele associated with CBZ-induced hypersensitivity. Another 2 patients were suspected of having phenytoin-induced rash, instead of CBZ, and these patients did not have HLA-B*1502. In conclusion, this study confirmed the association of HLA-B*1502 with CBZ-SJS among Malaysian epilepsy patients, however there might be other genes that could be responsible for the CBZ-induced rash.
  12. Golpich M, Rahmani B, Mohamed Ibrahim N, Dargahi L, Mohamed Z, Raymond AA, et al.
    Mol Neurobiol, 2015 Feb;51(1):313-30.
    PMID: 24696268 DOI: 10.1007/s12035-014-8689-6
    Parkinson's disease (PD) is a chronic neurodegenerative movement disorder characterized by the progressive and massive loss of dopaminergic neurons by neuronal apoptosis in the substantia nigra pars compacta and depletion of dopamine in the striatum, which lead to pathological and clinical abnormalities. A numerous of cellular processes including oxidative stress, mitochondrial dysfunction, and accumulation of α-synuclein aggregates are considered to contribute to the pathogenesis of Parkinson's disease. A further understanding of the cellular and molecular mechanisms involved in the pathophysiology of PD is crucial for developing effective diagnostic, preventative, and therapeutic strategies to cure this devastating disorder. Preconditioning (PC) is assumed as a natural adaptive process whereby a subthreshold stimulus can promote protection against a subsequent lethal stimulus in the brain as well as in other tissues that affords robust brain tolerance facing neurodegenerative insults. Multiple lines of evidence have demonstrated that preconditioning as a possible neuroprotective technique may reduce the neural deficits associated with neurodegenerative diseases such as PD. Throughout the last few decades, a lot of efforts have been made to discover the molecular determinants involved in preconditioning-induced protective responses; although, the accurate mechanisms underlying this "tolerance" phenomenon are not fully understood in PD. In this review, we will summarize pathophysiology and current therapeutic approaches in PD and discuss about preconditioning in PD as a potential neuroprotective strategy. Also the role of gene reprogramming and mitochondrial biogenesis involved in the preconditioning-mediated neuroprotective events will be highlighted. Preconditioning may represent a promising therapeutic weapon to combat neurodegeneration.
  13. Haerian BS, Baum L, Tan HJ, Kwan P, Raymond AA, Saruwatari J, et al.
    Pharmacogenomics, 2012 Oct;13(13):1477-85.
    PMID: 23057548 DOI: 10.2217/pgs.12.127
    Approximately 30% of epilepsy patients do not response to antiepileptic drugs (AEDs). The functional SCN1A IVS5N+5 polymorphism may play a role in response to some AEDs. The purpose of this study was to examine this hypothesis in a cohort study of Malaysian and Hong Kong Chinese epilepsy patients on sodium valproate (VPA) monotherapy and in a meta-analysis.
  14. Haerian BS, Lim KS, Tan CT, Raymond AA, Mohamed Z
    Pharmacogenomics, 2011 May;12(5):713-25.
    PMID: 21391884 DOI: 10.2217/pgs.10.212
    Several studies demonstrated a link between ABCB1 gene variants and the response to treatment in epilepsy, but the results have been inconclusive. Here, we performed the first haplotype meta-analysis to examine the association of haplotypes of ABCB1 common variants with the response to treatment in epilepsy.
  15. Salam A, Hamzah JC, Chin TG, Siraj HH, Idrus R, Mohamad N, et al.
    Pak J Med Sci, 2015;31(3):499-503.
    PMID: 26150832 DOI: 10.12669/pjms.313.7389
    OBJECTIVE: Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication.
    METHODS: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1(st) seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed.
    RESULTS: Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals.
    CONCLUSION: Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education.
    KEYWORDS: Malaysia; Medical education; Publication; Research; Undergraduate
  16. Hemmati F, Ghasemi R, Mohamed Ibrahim N, Dargahi L, Mohamed Z, Raymond AA, et al.
    Mol Neurobiol, 2014 Dec;50(3):797-810.
    PMID: 24464263 DOI: 10.1007/s12035-013-8631-3
    Neuroinflammation is known as a key player in a variety of neurodegenerative and/or neurological diseases. Brain Toll-like receptors (TLRs) are leading elements in the initiation and progression of neuroinflammation and the development of different neuronal diseases. Furthermore, TLR activation is one of the most important elements in the induction of insulin resistance in different organs such as the central nervous system. Involvement of insulin signaling dysregulation and insulin resistance are also shown to contribute to the pathology of neurological diseases. Considering the important roles of TLRs in neuroinflammation and central insulin resistance and the effects of these processes in the initiation and progression of neurodegenerative and neurological diseases, here we are going to review current knowledge about the potential crosstalk between TLRs and insulin signaling pathways in neuroinflammatory disorders of the central nervous system.
  17. Haerian BS, Baum L, Kwan P, Tan HJ, Raymond AA, Mohamed Z
    Pharmacogenomics, 2013 Jul;14(10):1153-66.
    PMID: 23859570 DOI: 10.2217/pgs.13.104
    Aim: Approximately a third of newly diagnosed epilepsy patients do not respond to antiepileptic drugs (AEDs). Evidence suggests that low penetrance variants in the genes of drug targets such as voltage-gated sodium channels may be involved in drug responsiveness. To examine this hypothesis, we compared data from two epilepsy cohorts from Malaysia and Hong Kong, as well as a meta-analysis from published data.

    Materials & methods: Genotype analysis of 39 polymorphisms located in the SCN1A, SCN2A and SCN3A genes was performed on 1504 epilepsy patients from Malaysia and Hong Kong who were receiving AEDs. Meta-analysis was performed for pooled data of SCN1A rs3812718 and rs2298771, and SCN2A rs17183814 polymorphisms.

    Results: Our data from the Hong Kong and Malaysia cohorts showed no significant allele, genotype and haplotype association of polymorphisms in the SCN1A, SCN2A, and SCN3A genes with drug responsiveness in epilepsy. This finding was supported by a meta-analysis for SCN1A rs3812718 and rs2298771, and for SCN2A rs17183814 polymorphisms.

    Conclusion: Our comprehensive study suggests that common polymorphisms in SCN1A, SCN2A and SCN3A do not play major roles in influencing response to AEDs.
  18. Sayed SZ, Abdul Wahat NH, Raymond AA, Hussein N, Omar M
    J Int Adv Otol, 2023 Jan;19(1):33-40.
    PMID: 36718034 DOI: 10.5152/iao.2023.21387
    BACKGROUND: This study investigates the test-retest reliability, aging effects, and differences in horizontal semicircular canals gain values between the head impulse paradigm and suppression head impulse paradigm.

    METHODS: Sixty healthy adult subjects aged 22-76-year-old (mean ± standard deviation=47.27 ± 18.29) participated in the head impulse paradigm and suppression head impulse paradigm using the video head impulse test. The Head impulse paradigm was used to assess all 6 semicircular canals, while suppression head impulse paradigm measured only the horizontal canals. Twenty subjects aged 22-40-year-old (25.25 ± 4.9) underwent a second session for the test-retest reliability.

    RESULTS: There were good test-retest reliability for both measures (right horizontal head impulse paradigm, intraclass correlation coefficient=0.80; left horizontal head impulse paradigm, intraclass correlation coefficient=0.77; right anterior head impulse paradigm, intraclass correlation coefficient=0.86; left anterior head impulse paradigm, intraclass correlation coefficient=0.78; right posterior head impulse paradigm, intraclass correlation coefficient=0.78; left posterior head impulse paradigm, intraclass correlation coefficient=0.75; right horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.76; left horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.79). The test-retest reliability for suppression head impulse paradigmanti-compensatory saccade latency and amplitude were moderate (right latency, intraclass correlation coefficient=0.61; left latency, intraclass correlation coefficient=0.69; right amplitude, intraclass correlation coefficient=0.69; left amplitude, intraclass correlation coefficient=0.58). There were no significant effects of age on head impulse paradigm and suppression head impulse paradigm vestibulo-ocular reflex gain values and suppression head impulse paradigmsaccade latency. However, the saccade amplitude became smaller with increasing age, P < .001. The horizontal suppression head impulse paradigm vestibuloocular reflex gain values were significantly lower than the head impulse paradigm for both sides (right, P = .004; left, P = .004).

    CONCLUSION: There was good test-retest reliability for both measures, and the gain values stabilized with age. However, suppression head impulse paradigm anti-compensatory saccade latency and amplitude had lower test-retest reliability than the gain. The suppression head impulse paradigm vestibulo-ocular reflex gain was lower than the head impulse paradigm and its anti-compensatory saccade amplitude reduced with increasing age.

  19. Azmin S, Khairul Anuar AM, Tan HJ, Nafisah WY, Raymond AA, Hanita O, et al.
    Parkinsons Dis, 2014;2014:472157.
    PMID: 24800102 DOI: 10.1155/2014/472157
    Background. The nonmotor symptoms are important determinants of health and quality of life in Parkinson's disease but are not well recognized and addressed in clinical practice. This study was conducted to determine the prevalence of nonmotor symptoms and their impact on quality of life in patients with Parkinson's disease. Methods. This was a cross-sectional study among patients with idiopathic Parkinson's disease. Exclusion criteria were a Mini Mental State Examination score of <21/30. Prevalence of nonmotor symptoms was determined using the NMSQuest. The severity of nonmotor symptoms and the quality of life were assessed using validated disease-specific questionnaires (PDQ-39 and NMSS). Results. A total of 113 patients consisting of 60 males and 53 females were recruited. The median duration of illness was 5.0 (2.0-8.0) years. The prevalence rate of nonmotor symptoms in our cohort was 97.3%. The most common reported nonmotor symptom in our cohort was gastrointestinal (76.1%). We found that the severity of the nonmotor symptoms was associated with poorer quality of life scores (r s : 0.727, P < 0.001). Conclusions. Nonmotor symptoms were highly prevalent in our patients with Parkinson's disease and adversely affected the quality of life of our patients. In contrast to western studies, the most common nonmotor symptom is gastrointestinal. The possibility of an Asian diet playing a role in this observation requires further study.
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