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Fulltext Effective Dose Estimation of Patients Administered with 18F-FDG and Ga-68 DOTATATE in PET/CT Examination Associated with Gender and Weight

Kamal, I., Said, M. A., Bathumalai, J., Abdul Razak, H. R., Abdul Karim, M. K.

Physics and Technology in Medicine, 2020;1(1):15-21.
MyJurnal

The whole-body fluorodeoxyglucose F18 (18F-FDG) and gallium-68 (Ga-68 DOTATATE) are the most common radiopharmaceutical use in PET/CT imaging for cancer staging. Although radiopharmaceutical for PET/CT examination has been acknowledged for its safety and efficacy, the internal dosimetry and effective dose (ED) from the examinations are rarely discussed. Hence, this study aimed to evaluate radiation ED for whole-body radiopharmaceuticals PET/CT concerning patients’ gender and their weight. A total of 82 oncology patients (44 males and 38 females) were collected retrospectively from Institut Kanser Negara, Putrajaya. Data, such as 18F-FDG and Ga-68 DOTATATE activity and patient demography (weight, height, age), were recorded and analyzed. Effective doses from both internal and external exposure were calculated using the coefficient
provided by the International Commission on Radiological Protection (ICRP) report. The total ED of 18F-FDG for male patients was 20.2 ± 8.6 mSv and for female patients were 19.0 ± 8.2 mSv while total whole-body ED for Ga-68 DOTATATE for male patients was 18.5 ± 7.0 mSv and 17.0 ± 5.6 mSv for female patients. The ratio for ED between male and female were 1:1 for both examinations ranged from 12.0 – 23 mSv. From this study, it indicated that the ED of Ga-68 DOTATATE was far lower when compared to the ED of 18F-FDG by a factor of 0.7. Therefore, it is crucial to optimize the PET/CT protocol dose in order to uphold the dose as low as reasonably achievable (ALARA).
Fulltext Utilization of Palm Oil Clinker as Cement Replacement Material

Kanadasan J, Abdul Razak H

Materials (Basel), 2015 Dec 16;8(12):8817-8838.
PMID: 28793748 DOI: 10.3390/ma8125494

The utilization of waste materials from the palm oil industry provides immense benefit to various sectors of the construction industry. Palm oil clinker is a by-product from the processing stages of palm oil goods. Channelling this waste material into the building industry helps to promote sustainability besides overcoming waste disposal problems. Environmental pollution due to inappropriate waste management system can also be drastically reduced. In this study, cement was substituted with palm oil clinker powder as a binder material in self-compacting mortar. The fresh, hardened and microstructure properties were evaluated throughout this study. In addition, sustainability component analysis was also carried out to assess the environmental impact of introducing palm oil clinker powder as a replacement material for cement. It can be inferred that approximately 3.3% of cement production can be saved by substituting palm oil clinker powder with cement. Reducing the utilization of cement through a high substitution level of this waste material will also help to reduce carbon emissions by 52%. A cleaner environment free from pollutants can be created to ensure healthier living. Certain industries may benefit through the inclusion of this waste material as the cost and energy consumption of the product can be minimized.
Fulltext Metastatic nasal chondrosarcoma

Sathappan S, Razak HA, Loo CP

Med J Malaysia, 2007 Oct;62(4):347-8.
PMID: 18551946 MyJurnal

Chondrosarcomas are uncommon tumors which originates in the head and neck and accounts for approximately 10 to 15% of all cases. Most chondrosarcomas exhibit an indolent growth pattern. Nasoseptal tumors may mimic common sinonasal conditions, making early diagnosis difficult. We report a case of nasoseptal metastatic chondrosarcoma which was atypical, characterized by an aggressive growth pattern and widely disseminated.
Fulltext Haemangiopericytoma of the oropharynx

Balakrishnan R, Abdul-Razak HA, Jaspal S, Subramanian S, Shaharyar AM

Med J Malaysia, 2008 Dec;63(5):413-4.
PMID: 19803304 MyJurnal

Haemangiopericytoma (HPC) is a rare vascular tumor arising from the pericytes of Zimmermann and is characterized by its unpredictable and variable biological behavior. These tumors are common in the trunk and the extremities and less than 16% of the cases occur in the head & neck region. Its occurrence in the oral cavity and pharynx is uncommon. We report an extremely rare case of haemangiopericytoma of the oropharynx arising from the tonsillo-lingual sulcus as a pedunculated mass, which was successfully excised perorally after a preliminary tracheostomy. No recurrence has been noted on a follow-up of more than six years.
Ten-year trend in prevalence and outcome of Down syndrome with congenital heart disease in a middle-income country

Zahari N, Mat Bah MN, A Razak H, Thong MK

Eur J Pediatr, 2019 Aug;178(8):1267-1274.
PMID: 31222391 DOI: 10.1007/s00431-019-03403-x

Limited data are available on the survival of patients with Down syndrome and congenital heart disease (CHD) from middle-income countries. This retrospective cohort study was performed to determine the trends in the prevalence and survival of such patients born from January 2006 to December 2015 in Malaysia. Among 754 patients with Down syndrome, 414 (55%) had CHD, and no significant trend was observed during the 10 years. Of these 414 patients, 30% had lesions that closed spontaneously, 35% underwent surgery/intervention, 9% died before surgery/intervention, and 10% were treated with comfort care. The overall mortality rate was 23%, the median age at death was 7.6 months, and no significant changes occurred over time. The early and late post-surgery/intervention mortality rates were 0.7% and 9.0%, respectively. Most deaths were of non-cardiac causes. The overall 1-, 5-, and 10-year survival rates were 85.5%, 74.6%, and 72.9%, respectively. Patients with severe lesions, persistent pulmonary hypertension of the newborn, atrioventricular septal defect, and pulmonary hypertension had low survival at 1 year of age.Conclusion: The prevalence of CHD in patients with Down syndrome is similar between Malaysia and high-income countries. The lower survival rate is attributed to limited expertise and resources which limit timely surgery. What is Known: • The survival of patients with Down syndrome with congenital heart disease (CHD) has improved in high-income countries. However, little is known about the survival of patients with Down syndrome with CHD from middle-income countries. • In the Caucasian population, atrioventricular septal defect is the most common type of CHD associated with Down syndrome. What is New: • In middle-income countries, the prevalence of CHD is the same as in high-income countries, but with a lower survival rate. • In the Asian population, ventricular septal defect is the most common type of CHD in patients with Down syndrome.
Fulltext Sustainability, Eco-Point and Engineering Performance of Different Workability OPC Fly-Ash Mortar Mixes

Razi PZ, Abdul Razak H, Khalid NHA

Materials (Basel), 2016 May 06;9(5).
PMID: 28773465 DOI: 10.3390/ma9050341

This study investigates the engineering performance and CO₂ footprint of mortar mixers by replacing Portland cement with 10%, 20%, 40% and 60% fly ash, a common industrial waste material. Samples of self-compacting mortar (SCM) were prepared with four different water/binder ratios and varying dosages of superplasticizer to give three ranges of workability, i.e., normal, high and self-compacting mortar mix. The engineering performance was assessed in term of compressive strength after designated curing periods for all mixes. CO₂ footprint was the environmental impact indicator of each production stage. The optimum mix obtained was at 10% replacement rate for all mixes. Total production emission reduced by 56% when the fly ash replacement rate increased from 0% to 60% (maximum). This is translated to a reduction of 80% in eco-points (assuming that the energy consumption rate of production with 0% fly ash is at 100%). Such re-utilization is encouraged since it is able to reduce possible soil toxicity due to sulfur leaching by 5% to 27% and landfill area by 15% to 91% on average.
Fulltext Combined Effects of Eurycoma longifolia and Testosterone on Androgen-Deficient Osteoporosis in a Male Rat Model

Saadiah Abdul Razak H, Shuid AN, Naina Mohamed I

Evid Based Complement Alternat Med, 2012;2012:872406.
PMID: 22924057 DOI: 10.1155/2012/872406

Androgen-deficient osteoporosis in men is treated with testosterone therapy, which is associated with side effects. Eurycoma longifolia (EL) is known to possess androgenic properties and has been reported to protect bone from androgen-deficient osteoporosis in experimental animal models. The present study aimed to determine the effectiveness of combination therapy of EL and testosterone (T) in treating androgen-deficient osteoporosis. Forty male Sprague-Dawley rats were divided into: sham-operated (SHAM), orchidectomized-control (ORX), orchidectomized with testosterone (ORX + T), orchidectomized with EL (ORX + EL), and orchidectomized with combined T and EL therapy (ORX + T + EL). EL was administered via oral gavages daily at the dose of 15 mg/kg. T was injected intramuscularly at 8 mg/kg and 4 mg/kg for the ORX + T and ORX + T + EL groups, respectively. Following 6 weeks of treatment, the osteocalcin levels of ORX + T and ORX + T + EL groups were significantly lower than the SHAM group (P < 0.05). The posttreatment CTX levels of ORX + T and ORX + T + EL groups were significantly lower than their pretreatment levels (P < 0.05). Biomechanically, the strain parameter of the ORX + T + EL group was significantly higher than the ORX group (P < 0.05). Thus, the combination therapy of EL and low-dose T has potential for treatment of androgen-deficient osteoporosis. The lower T dose is beneficial in reducing the sideeffects of testosterone therapy.
Fulltext The diagnostic performance of a single GeneXpert MTB/RIF assay in an intensified tuberculosis case finding survey among HIV-infected prisoners in Malaysia

Al-Darraji HA, Abd Razak H, Ng KP, Altice FL, Kamarulzaman A

PLoS One, 2013;8(9):e73717.
PMID: 24040038 DOI: 10.1371/journal.pone.0073717

Delays in tuberculosis (TB) diagnosis, particularly in prisons, is associated with detrimental outcomes. The new GeneXpert MTB/RIF assay (Xpert) offers accurate and rapid diagnosis of active TB, but its performance in improving case detection in high-transmission congregate settings has yet to be evaluated. We assessed the diagnostic accuracy of a single Xpert assay in an intensified case finding survey among HIV-infected prisoners in Malaysia.
Periprosthetic Fractures after Total Knee Arthroplasty: the Influence of Pre-Operative Mechanical Factors versus Intraoperative Factors

Zainul-Abidin S, Lim B, Bin-Abd-Razak HR, Gatot C, Allen JC, Koh J, et al.

Malays Orthop J, 2019 Jul;13(2):28-34.
PMID: 31467648 DOI: 10.5704/MOJ.1907.005

Introduction: Periprosthetic fractures are a devastating complication following total knee arthroplasty. Little is known about the effect of mechanical factors on the incidence of periprosthetic fractures. The aim of this study was to examine the correlation between pre-operative mechanical factors, like side of surgery, coronal alignment and pre-operative range of motion and intra-operative factors, and the incidence of a periprosthetic fracture, following primary total knee arthroplasty (TKA). Materials and Methods: Forty-two patients with periprosthetic fractures (PPF) after primary TKA were identified from our hospital arthroplasty registry. These patients were matched two-to-one for gender and age at primary knee arthroplasty to 84 patients without PPF. The incidence of periprosthetic fracture with regards to laterality, coronal alignment and pre-operative range of motion was analysed. Intra-operative factors like implant type, patellar resurfacing and notching were also analysed using logistic regression. Results: Coronal alignment, pre-operative range of motion and patella resurfacing were not significant predictors of periprosthetic fractures. Anterior femoral notching was found to be significantly higher in the fracture group with an odds ratio of 17. Left sided surgery was also significantly higher in the periprosthetic fracture group. Conclusion: Periprosthetic fractures are 17 times more likely to occur in a knee with anterior femoral notching. Preoperative factors like coronal alignment and poor preoperative range of motion do not seem to increase the risk of periprosthetic fractures after TKA.
Correction to: Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country

Mat Bah MN, Alias EY, Razak H, Sapian MH, Foo FH, Abdullah N

Eur J Pediatr, 2021 Aug;180(8):2607.
PMID: 34160651 DOI: 10.1007/s00431-021-04160-6
Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country

Mat Bah MN, Alias EY, Razak H, Sapian MH, Foo FH, Abdullah N

Eur J Pediatr, 2021 Aug;180(8):2599-2606.
PMID: 34086103 DOI: 10.1007/s00431-021-04135-7

Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms. What is Known: • Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population. • Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms. What is New: • In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities. • Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.
Fulltext Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia

Mat Bah MN, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY

J Perinatol, 2021 04;41(4):786-793.
PMID: 33589728 DOI: 10.1038/s41372-021-00962-6

OBJECTIVE: This study aims to determine the immediate outcome of persistent pulmonary hypertension of the newborn (PPHN) and risk factors for mortality in the era of inhaled nitric oxide (iNO).
STUDY DESIGN: This observational cross-sectional study includes 195 confirmed PPHN with a gestational age of ≥34 weeks without congenital heart disease. Multivariable logistic regression was used to identify risk factors for mortality.
RESULTS: The mortality rate was 16.4%, with the highest mortality with pulmonary hypoplasia. Of 195, 65% received iNO; 18% were iNO non-responders with the majority having pulmonary hypoplasia. Independent risk factors for mortality were the presence of reversal of flow at the descending aorta, pulmonary hypoplasia, APGAR scores ≤ 5 at 5 min, and idiopathic PPHN with an adjusted odds ratio of 15.9, 7.5, 6.7, and 6.4, respectively.
CONCLUSIONS: Despite the usage of iNO, mortality due to PPHN remains high and is related to etiology and cardiac function.
The cytotoxicity effect of bismuth oxide particles synthesized hydrothermally using different reaction temperatures in vitro

Md Saad WM, Mohd Noor NA, Mohamad Salin NS, Mohd Z, Eshak Z, Abdul Razak HR

Med J Malaysia, 2024 Mar;79(Suppl 1):8-13.
PMID: 38555879

INTRODUCTION: Bismuth oxide (Bi2O3) particles gained attention in preclinical research especially in medical imaging. Bismuth oxide with its long circulation time is an alternative to the current iodine contrast media which directly possesses high X-ray attenuation coefficient. Exploration of bismuth compound is hampered owing to challenges in synthesizing control for in vivo stability.
MATERIALS AND METHODS: This study aimed are to characterize Bi2O3 particles synthesized at 60, 90 and 120 °C via hydrothermal method and investigated cytotoxicity of cell viability assay, cell morphology analysis, intracellular reactive oxygen species (ROS) assay and expression of ER stress genes by real-time PCR.
RESULTS: Results indicated that the size of rod-shaped Bi2O3 particles increased with rising synthesizing temperatures. The cytotoxicity of Bi2O3 particles in Chang liver cells was size-dependent. Bigger-sized Bi2O3 particles resulted in lesser toxicity effects. mRNA expressions of GRP78 and C/EBP homologous protein (CHOP) were down-regulated in all treated Chang liver cells due to the increasing size of Bi2O3 particles. Bi2O3 particles synthesized at 120 °C was found to be less toxic than iodine.
CONCLUSION: Data suggested that the response of Chang liver cells to Bi2O3 particle cytotoxicity has a significant relationship with its reaction temperatures. This outcome is important in hazard assessment of Bi2O3 particles as a new contrast media and provides better understanding in synthesizing control to enhance its biocompatibility.
Fulltext The prevalence of psychological distress and its association with coping strategies among medical interns in Malaysia: A national-level cross-sectional study

Ismail M, Lee KY, Sutrisno Tanjung A, Ahmad Jelani IA, Abdul Latiff R, Abdul Razak H, et al.

Asia Pac Psychiatry, 2020 Aug 26;13(2):e12417.
PMID: 32964660 DOI: 10.1111/appy.12417

INTRODUCTION: The prevalence of psychological distress is increasing worldwide. Stressful working environments and high expectations in medical practice put doctors at high risk of depression, anxiety, and stress, especially among medical interns. Effective coping strategies may reduce psychological distress in the clinical setting. This study aimed to determine the prevalence of psychological distress and its association with coping strategies among medical interns in Malaysia.
METHOD: A total of 431 medical interns at 26 Malaysian Ministry of Health hospitals participated in this cross-sectional study in 2017. Self-administered questionnaires consisting of sociodemographic characteristics, items from DASS and BRIEF COPE were used. Descriptive analysis was done followed by further analysis with chi-square and Spearman correlation tests.
RESULTS: The prevalence of stress, anxiety, and depression was 29.7%, 39.9%, and 26.2%, with a significantly higher prevalence among female and younger interns. Three-quarters of them (73.1%) applied problem-focused strategies as the main coping mechanism. Emotion-focused coping strategies showed a significant but weak correlation with anxiety and stress whereas avoidance-based coping strategies were significantly correlated with depression, anxiety, and stress.
DISCUSSION: Medical internship is a highly grueling period. Besides emphasizing clinical competency, internship training should also impart the practice of healthy coping mechanisms. The vulnerable groups of females and younger interns should be taught positive coping skills so that they are empowered to handle any stressors on their personal and professional lives. Optimum psychological wellbeing of the medical interns can improve the overall work performance and quality of care for patients.

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