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Fulltext Chest x-ray as an essential part of routine medical examination: is it necessary?

Izamin I, Rizal AM

Med J Malaysia, 2012 Dec;67(6):606-9.
PMID: 23770954 MyJurnal

INTRODUCTION: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination.
PURPOSE: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination.
METHODOLOGY: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider.
FINDINGS: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34.
DISCUSSION: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.
Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre

Kanaheswari Y, Mohd Rizal AM

J Paediatr Child Health, 2015 Dec;51(12):1175-81.
PMID: 26041512 DOI: 10.1111/jpc.12938

The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes.
Fulltext The risk and associated factors of female sexual dysfunction (FSD) in women with psoriasis

Adawiyah J, Moonyza AAK, Mohd Rizal AM, Hatta S, Nik Ruzyanei NJ, Marhani M, et al.

International Medical Journal Malaysia, 2017;16(1):107-114.
MyJurnal

Introduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis.
Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI).
Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis.
Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress.
Keywords: Psoriasis, female, sexual dysfunction, prevalence, risk factor, Malaysia
Study site: Dermatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Comparing extracorporeal shock wave lithotripsy and ureteroscopy for treatment of proximal ureteric calculi: a cost-effectiveness study

Izamin I, Aniza I, Rizal AM, Aljunid SM

Med J Malaysia, 2009 Mar;64(1):12-21.
PMID: 19852314

Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.
Fulltext Piperacillin-tazobactam plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients

Hamidah A, Rizal AM, Nordiah AJ, Jamal R

Singapore Med J, 2008 Jan;49(1):26-30.
PMID: 18204765

We evaluated piperacillin-tazobactam in association with amikacin in the initial empirical therapy of febrile neutropenic children.
Fulltext Evaluation of psychometric properties of the malay version perceived stress scale in two occupational settings in malaysia

Al-Dubai S, Ganasegeran K, Barua A, Rizal A, Rampal K

Ann Med Health Sci Res, 2014 Jul;4(Suppl 2):S104-7.
PMID: 25184074 DOI: 10.4103/2141-9248.138023

BACKGROUND: The 10-item version of Perceived Stress Scale (PSS-10) is a widely used tool to measure stress. The Malay version of the PSS-10 has been validated among Malaysian Medical Students. However, studies have not been conducted to assess its validity in occupational settings.
AIM: The aim of this study is to assess the psychometric properties of the Malay version of the PSS-10 in two occupational setting in Malaysia.
SUBJECTS AND METHODS: This study was conducted among 191 medical residents and 513 railway workers. An exploratory factor analysis was performed using the principal component method with varimax rotation. Correlation analyses, Kaiser-Meyer-Olkin, Bartlett's test of Sphericity and Cronbach's alpha were obtained. Statistical analysis was carried out using statistical package for the social sciences version 16 (SPSS, Chicago, IL, USA) software.
RESULTS: Analysis yielded two factor structure of the Malay version of PSS-10 in both occupational groups. The two factors accounted for 59.2% and 64.8% of the variance in the medical residents and the railway workers respectively. Factor loadings were greater than 0.59 in both occupational groups. Cronbach's alpha co-efficient was 0.70 for medical residents and 0.71 for railway workers.
CONCLUSION: The Malay version of PSS-10 had adequate psychometric properties and can be used to measure stress among occupational settings in Malaysia.
KEYWORDS: Factor structure; Malaysia; Occupational; Perceived stress scale; Psychometric properties; Validity
Fulltext The electroencephalogram changes in migraineurs

Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA

Med J Malaysia, 2007 Mar;62(1):56-8.
PMID: 17682573 MyJurnal

Migraine is associated with a variety of electroencephalographic (EEG) changes. Previous studies using analogue EEG and old diagnostic criteria may under or over report the prevalence of EEG changes in migraine. The objective of this study was to reevaluate the EEG changes in migraine patients diagnosed by applying the new International Classification of Headache Disorder -2 criteria. This was a case control study involving 70 migraine patients and 70 age and gender matched control who were subjected to scalp EEG. The EEG changes during hyperventilation (HV), which were significantly more common in the migraine group were theta activity (34 vs 22, p = 0.038) and frontal intermittent rhythmic delta activity (FIRDA) (10 vs 3, p = 0.042). Applying the new ICHD -2 diagnostic criteria and digital EEG, this study yielded previously unrecognized features including FIRDA during HV on EEG.
Role of Helicobacter pylori virulence factor and genotypes in non-ulcer dyspepsia

Tan HJ, Rizal AM, Rosmadi MY, Goh KL

J Gastroenterol Hepatol, 2006 Jan;21(1 Pt 1):110-5.
PMID: 16706821

The role of Helicobacter pylori (HP) in non-ulcer dyspepsia is debatable. Eradicating HP will help a small group of non-ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non-ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not.
Distribution of Helicobacter pylori cagA, cagE and vacA in different ethnic groups in Kuala Lumpur, Malaysia

Tan HJ, Rizal AM, Rosmadi MY, Goh KL

J Gastroenterol Hepatol, 2005 Apr;20(4):589-94.
PMID: 15836708

There is a geographic variation in Helicobacter pylori (HP) genotypes and virulence factors. Cytotoxin associated genes A (cagA) and E (cagE), and certain vacuolating cytotoxin (vacA) genotypes are associated with peptic ulcer disease (PUD). There is also a different prevalence of PUD among different ethnic groups in Malaysia. The present study compared the distribution of vacA alleles and cagA and cagE status in three ethnic groups residing in Kuala Lumpur, Malaysia, and their association with clinical outcome.
Fulltext The coexistence of anxiety and depressive personality traits in migraine

Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA

Singapore Med J, 2007 Apr;48(4):307-10.
PMID: 17384877

Migraine is associated with a variety of personality traits. The objective of this study was to reevaluate the personality traits using Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in migraine patients diagnosed by applying the new International Classification of Headache Disorders-2 criteria.
Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia

Ho CC, Ngoo KS, Hamzaini AH, Rizal AM, Zulkifli MZ

Clin Ter, 2014;165(2):75-81.
PMID: 24770808 DOI: 10.7471/CT.2014.1680

OBJECTIVE: To determine the clinical utility of urinary bladder and prostate characteristics measured by ultrasound scan in predicting acute urinary retention (AUR) for men with bladder outlet obstruction with an underlying benign prostate hyperplasia (BPH).
MATERIALS AND METHODS: Consecutive men aged ≥50 years presenting with lower urinary tract symptoms (LUTS) or AUR were prospectively recruited in this cross-sectional study. International prostatic symptom score (IPSS) and serum prostate-specific antigen (PSA) were recorded. High-resolution ultrasound was used to measure bladder detrusor thickness (DT, mm), prostatic volume (PV, cm3), intravesical prostatic protrusion (IPP, mm), bladder wall thickness (BWT,mm), intravesical volume and bladder radius. The latter two parameters were used to estimate bladder weight (UEBW, g), assuming a spherical bladder.
RESULTS: Among selected patients, thirty had AUR while 32 men presented with LUTS only. There were significant differences between those with and without AUR in their age (70.5 vs 66.0, p=0.017), IPSS (24.0 vs 18.5, p=0.009), serum PSA (6.18 vs 1.77, p=0.002), PV (56.7 vs 32.4, p=0.006), BWT (5.0 vs 4.4, p=0.034) and UEBW (39.1 vs 25.0, p=0.0003). Multivariate analysis revealed high IPSS and UEBW to be predictors for AUR. UEBW was the strongest predictor of AUR: area under ROC curve was 0.767, with sensitivity and specificity of 63.3% and 87.5%, respectively, at cut-off point of 35 g. The likelihood ratio for AUR was also best with UEBW≥35 g.
CONCLUSIONS: Combined with IPSS, ultrasound determined bladder characteristic, particularly UEBW, is a useful tool in predicting AUR in men with BPH.
Quality of life in Malaysian colorectal cancer patients: a preliminary result

Natrah MS, Ezat S, Syed MA, Rizal AM, Saperi S

Asian Pac J Cancer Prev, 2012;13(3):957-62.
PMID: 22631679

OBJECTIVE: Rapidly increasing colorectal cancer (CRC) incidence in Malaysia and the introduction of cutting edge new treatments, which prolong survival, mean that treatment outcome measures meed to be evaluated, including consideration of patient's quality of life (QoL) assessment. There are limited data on QoL in CRC patients, especially in Malaysia. Therefore, this study was performed focusing on cancer stages and age groups.
METHODS: The cross sectional study was conducted from June to September 2011 at three public tertiary hospitals with the EORTC QLQ C-30 questionnaire in addition to face to face interview and review of medical records of 100 respondents.
RESULTS: The mean age was 57.3 (SD 11.9) years with 56.0% are males and 44.0% females, 62% of Malay ethnicity, 30% Chinese, 7% Indian and 1% Sikh. Majority were educated up to secondary level (42%) and 90% respondents had CRC stages III and IV. Mean global health status (GHS) score was 79.1 (SD 21.4). Mean scores for functional status (physical, emotional, role, cognitive, social) rangeds between 79.5 (SD 26.6) to 92.2 (SD 13.7). Mean symptom scores (fatigue, pain, nausea/vomiting, constipation, diarrhea, insomnia, dyspnoea, loss of appetite) ranged between 4.00 (SD 8.58) to 20.7 (SD 30.6). Respondents role function significantly deteriorates with increasing stage of the disease (p=0.044). Females had worse symptoms of pain (p=0.022), fatigue (p=0.031) and dyspnoea (p=0.031). Mean insomnia (p=0.006) and diarrhea (p=0.024) demonstrated significant differences between age groups.
CONCLUSION: QOL in CRC patients in this study was comparable to that in other studies done in developed countries. Pain, fatigue and dyspnoea are worse among female CRC patients. Given that functions deteriorates with advanced stage of the disease at diagnosis, a systematic screening programme to detect cases as early as possible is essential nationwide.
Association of Malaysian Helicobacter pylori virulence polymorphisms with severity of gastritis and patients' ethnicity

Alfizah H, Ramelah M, Rizal AM, Anwar AS, Isa MR

Helicobacter, 2012 Oct;17(5):340-9.
PMID: 22967117 DOI: 10.1111/j.1523-5378.2012.00956.x

Polymorphisms of Helicobacter pylori cagA and vacA genes do exist and may contribute to differences in H. pylori infection and gastroduodenal diseases among races in the Malaysian population. This study was conducted to characterize the polymorphisms in H. pylori cagA and vacA in Malaysian population.
Fulltext Caregivers' satisfaction of healthcare delivery at paediatric clinics of Universiti Kebangsaan Malaysia Medical Centre in 2009

Aniza I, Rizal AM, Ng YS, Mardhiyyah M, Helmi I, Syamimi BK, et al.

Med J Malaysia, 2011 Jun;66(2):84-8.
PMID: 22106682

Patient's satisfaction has become increasingly important as patients evaluate healthcare services for both medical cost and quality. The purpose of this study was to measure the prevalence and the factors influencing caregivers' satisfaction. A cross sectional study of 262 respondents using universal sampling method was conducted at the paediatric clinics of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Overall, 90.5% were satisfied with the services provided. Satisfaction rates based on various healthcare delivery domains were: 95.0% for communication skills, 88.5% for interpersonal aspect, 83.6% for technical quality, 82.1% for financial aspect, 72.9% for time spent with doctors and 64.9% for ease of contact. This study shows that the caregivers (an unpaid person who helps a person cope with disease) were highly satisfied with the communicational aspect delivered by the clinic. However, there is still room for improvement on ease of contact domain and waiting time in order to produce high quality service.

Study site: Paediatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Fulltext Most prevalent unmet supportive care needs and quality of life of breast cancer patients in a tertiary hospital in Malaysia

Edib Z, Kumarasamy V, Binti Abdullah N, Rizal AM, Al-Dubai SA

Health Qual Life Outcomes, 2016;14:26.
PMID: 26898558 DOI: 10.1186/s12955-016-0428-4

Addressing breast cancer patients' unmet supportive care needs in the early stage of their survivorship have become a prime concern because of its significant association with poor quality of life (QOL), which in turn increases healthcare utilization and costs. There is no study about unmet supportive care needs of breast cancer patients in Malaysia. This study aims to assess the most prevalent unmet supportive care needs of Malaysian breast cancer patients and the association between QOL and patients' characteristics, and their unmet supportive care needs.
Fulltext Cost analysis of cataract surgery with intraocular lens implantation: a single blind randomised clinical trial comparing extracapsular cataract extraction and phacoemulsification

Rizal AM, Aljunid SM, Normalina M, Hanom AF, Chuah KL, Suzainah Y, et al.

Med J Malaysia, 2003 Aug;58(3):380-6.
PMID: 14750378

A randomised single blinded clinical trial to compare the cost of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) between March and December 2000. A total of 60 patients were included in this study. The cost of a cataract surgery incurred by hospital, patients and households up to two months after discharge were included. The costs of training, loss of patients' income after discharge and intangible costs were excluded. Results showed that the average cost for one ECCE operation is RM1,664.46 (RM1,233.04-RM2,377.64) and for PEA is RM1,978.00 (RM1,557.87-RM3,334.50). During this short period of follow up, it can be concluded that ECCE is significantly cheaper than PEA by an average difference of RM 313.54 per patient (p < 0.001). Cost of equipment and low frequency of PEA technique done in HUKM were the two main reasons for the high unit cost of PEA as compared to ECCE.
Factors associated with control of type I diabetes in Malaysian adolescents and young adults

Tan SM, Shafiee Z, Wu LL, Rizal AM, Rey JM

Int J Psychiatry Med, 2005;35(2):123-36.
PMID: 16240970 DOI: 10.2190/EQ71-RMWV-6CEJ-1DGM

Objectives: To examine the association between ethnicity, depression, quality of life, and diabetic control in Malaysian adolescents and young adults with type I diabetes mellitus.

Methods: Fifty-two outpatients with type I diabetes (mean age 15.5 years) who attended a Diabetes Clinic were included. The level of HbA1c was the measure of diabetes control used (better control defined as HbA1c < 10%). Other variables were measured through questionnaires (e.g., depressive symptoms, quality of life), computerized diagnostic interviews (major depression), and medical records (e.g., demographic, family circumstances, compliance with treatment).

Results: Ethnic Chinese youth showed better diabetic control than Malays and Indians (mean HbA1c 9.1%, 10.3%, and 11.0% respectively). Young people with better diabetic control (HbA1c < 10%) were more likely to have better quality of life and less likely to live in problematic families. When the cut-off for diabetic control was stricter (HbA1c < or = 8%), the young person's compliance was the main predictor of poor control. Family problems were also associated with poor control but to a lesser extent. The initial association between poorer diabetes control and depression became non-significant when quality of life was taken into account.

Conclusions: There are ethnic differences in juvenile diabetic control in this Malaysian sample which need to be understood further. Previous findings of an association between quality of life and glycemic control were verified but different definitions of good control showed different associations with individual and environmental variables. Clinicians' awareness and early intervention for psychosocial problems (for example, inadequate family support) could improve diabetes control.
Fulltext What are the direct medical costs of managing type 2 diabetes mellitus in Malaysia?

Feisul IM, Azmi S, Mohd Rizal AM, Zanariah H, Nik Mahir NJ, Fatanah I, et al.

Med J Malaysia, 2017 10;72(5):271-277.
PMID: 29197881 MyJurnal

INTRODUCTION: An economic analysis was performed to estimate the annual cost of diabetes mellitus to Malaysia.

METHODS: We combined published data and clinical pathways to estimate cost of follow-up and complications, then calculated the overall national cost. Costs consisted of diabetes follow-up and complications costs.

RESULTS: Patient follow-up was estimated at RM459 per year. Complications cost were RM42,362 per patient per year for nephropathy, RM4,817 for myocardial infarction, RM5,345 for stroke, RM3,880 for heart failure, RM5,519 for foot amputation, RM479 for retinopathy and RM4,812 for cataract extraction.

CONCLUSION: Overall, we estimated the total cost of diabetes as RM2.04 billion per year for year 2011 (both public and private sector). Of this, RM1.40 billion per year was incurred by the government. Despite some limitations, we believe our study provides insight to the actual cost of diabetes to the country. The high cost to the nation highlights the importance of primary and secondary prevention.
Fulltext The Effects of Fixed Combination of Bimatoprost-Timolol and Travoprost-Timolol on Intraocular Pressure in Patients With Primary Open-Angle Glaucoma or Ocular Hypertension, Previously on Nonfixed Combination of Latanoprost and Timolol

Lee MY, Teh NC, Nur Zulekha M, Thayanithi S, Jelinar MN, Rizal AM, et al.

Asia Pac J Ophthalmol (Phila), 2012;1(4):208-12.
PMID: 26107474 DOI: 10.1097/APO.0b013e31825c5b1b

PURPOSE: To compare the effects of fixed combination of bimatoprost-timolol and travoprost-timolol on intraocular pressure (IOP) in patients with primary open-angle glaucoma or ocular hypertension.
DESIGN: This was a prospective, randomized, observer-masked, crossover parallel comparison trial.
METHODS: Forty-one patients with primary open-angle glaucoma or ocular hypertension on nonfixed combination of latanoprost and timolol with IOP of 21 mm Hg or less were randomized to either bimatoprost-timolol or travoprost-timolol fixed combinations for 8-week treatment period. Intraocular pressure was measured at 8 AM, 12 PM, 4 PM, and 8 PM at the baseline and at the end point. Conjunctiva hyperemia and superficial punctate keratopathy after treatment with each fixed combination therapy were assessed and compared with the baseline. Patients were then switched to the opposite drug without a medication-free period for another 8-week, and diurnal IOP measurement was repeated.
RESULTS: Bimatoprost-timolol fixed combination reduced the baseline mean diurnal IOP statistically significantly from 17.3 mm Hg [95% confidence interval (CI), 16.8-17.7 mm Hg] to 16.4 mm Hg (95% CI, 15.9-17.0 mm Hg) (P = 0.036). Travoprost-timolol fixed combination lowered the mean diurnal IOP to 17.1 mm Hg (95% CI, 16.5-17.7 mm Hg), but it was not significant. Direct comparison between the 2 fixed combinations showed no significant difference. Both fixed combinations had no significant effect on conjunctiva hyperemia. Interestingly, patients on travoprost-timolol fixed combination had significantly less superficial punctuate keratopathy (P = 0.012).
CONCLUSIONS: Both fixed combination of bimatoprost-timolol and travoprost-timolol had no significantly different ocular hypotensive effect. However, bimatoprost-timolol fixed combination produced additional IOP lowering in patients previously treated with nonfixed combination of latanoprost and timolol.
cagA gene variants in Malaysian Helicobacter pylori strains isolated from patients of different ethnic groups

Ramelah M, Aminuddin A, Alfizah H, Isa MR, Jasmi AY, Tan HJ, et al.

FEMS Immunol. Med. Microbiol., 2005 May 1;44(2):239-42.
PMID: 15866222

Helicobacter pylori infection of a distinct subtype of cagA may lead to different pathological manifestation. The aim of this study is to determine the presence of cagA gene and its variants in H. pylori infection among different ethnic groups and its effect on gastroduodenal diseases. Overall detection of cagA among the 205 clinical isolates of H. pylori was 94%. Variations in size of the 3' region of cagA gene were examined among 192 Malaysian H. pylori cagA-positive strains. Results showed that three cagA variants differing in fragment length of PCR products were detected and designated as type A (621-651bp), type B (732-735bp) and type C (525 bp). Although there was no association between any of the cagA subtypes with peptic ulcer disease (p>0.05), an association between cagA subtypes with a specific ethnic group was observed. Specific-cagA subtype A strains were predominantly isolated from Chinese compared to Malays and Indians (p<0.0005), and cagA subtype B strains were predominantly isolated from Malays and Indians compared to Chinese (p<0.05). The cagA type A strains of H. pylori is commonly found in the Chinese patients who have a higher risk of peptic ulcer disease, thus indicating that it could be used as an important clinical biomarker for a more severe infection.

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