mafauzy mohamed - Academia.edu (original) (raw)

Papers by mafauzy mohamed

Research paper thumbnail of Translation and cross-cultural adaptation of the Malay version of the painDETECT Questionnaire

Neurology Asia

Background: The painDETECT questionnaire (PDQ) is a useful tool for screening of patients with ne... more Background: The painDETECT questionnaire (PDQ) is a useful tool for screening of patients with neuropathic pain. This study aimed to translate the PDQ into the Malay language (PDQ-M) and to achieve cross-cultural adaptation of the questionnaire for use in Malaysia. Methods: The translation and cultural adaptation process of the English version of PDQ was performed based on international guidelines. Subsequently, 97 patients with neuropathic and nociceptive pain based on clinician’s diagnoses were recruited to complete three-type numeric rating scale (NRS) of pain followed by PDQ-M. Results: On the basis of cognitive debriefing, several changes of the translated PDQ-M were made. A total of 53 patients with neuropathic pain and 44 with nociceptive pain (54.6% females, 45.4% males, mean age 52.4 years ± 14.2) were recruited into this study. The most common class of analgesia prescribed for patients with neuropathic pain was anti-convulsant, whereas co-analgesic therapy, which includes ...

Research paper thumbnail of Correction: ARISE—a prospective, non-interventional, single-arm study assessing clinical parameters associated with the use of insulin degludec/insulin aspart in patients with type 2 diabetes in realworld settings: rationale and design

Research paper thumbnail of Open label clinical trial to study adverse effects and tolerance to dry powder of the aerial part of andrographis paniculata in patients type 2 with diabetes mellitus

PubMed, 2005

Adverse effects and tolerance to dry powder of aerial part of Andrographis paniculata (Burm.f.) N... more Adverse effects and tolerance to dry powder of aerial part of Andrographis paniculata (Burm.f.) Nees were studied in 20 patients with type 2 diabetes mellitus for a period of 12 weeks. Patients were given powdered A. paniculata starting with 600 mg daily, gradually increasing to a maximum of 1.8 gm daily. Parameters monitored included body weight, blood pressure, liver function tests, renal function tests, cardiac enzymes, haemogram, serum electrolytes, fasting blood glucose, HbA1c, blood cholesterol, serum triglycerides and blood hormone levels (triiodotyronine, thyroxine, thyrotropin, insulin, fasting cortisol). None of the above mentioned parameters showed significant change during the study period except for a fall in HbA1c by 5.46% (p<0.01) and fasting S. insulin by 20.93% (p<0.003). In conclusion, A. paniculata powder did not induced significant adverse events based on parameters observed in our study but significantly lowered HbA1c and fasting serum insulin in patients with type 2 diabetes.

Research paper thumbnail of MJMS and the challenges of a research university

Research paper thumbnail of Cardiomyopathy in pregnancy: 2 case reports

PubMed, Apr 1, 1989

Cardiomyopathy developed in the peripartum period in two healthy primigravida at 41 and 42 weeks ... more Cardiomyopathy developed in the peripartum period in two healthy primigravida at 41 and 42 weeks of gestation are presented. In the first case, the patient presented with pulmonary oedema and had cardiac arrest immediately after admission. After resuscitation, a live baby was delivered by Caesarean section. Second cardiac arrest occurred after 12 hours of operation and the patient was resuscitated again. On the 8th post operative day, patient died of D.I.V.C. and renal failure. The second case was a twin pregnancy associated with pregnancy induced hypertension. Caesarean section was performed for foetal distress. She developed pulmonary oedema with left ventricular failure on the second post operative day, was resuscitated and discharged on the 15th day. These are the first two cases to be reported from Hospital University Sains Malaysia. Reference is made to three other cases in which a similar pathological process might have occurred.

Research paper thumbnail of Ensuring the standard of medical graduates in Malaysia

Research paper thumbnail of Comparison of Vitamin D Levels, Bone Metabolic Marker Levels, and Bone Mineral Density among Patients with Thyroid Disease: A Cross-Sectional Study

Diagnostics, Dec 11, 2020

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate... more Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm 2). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.

Research paper thumbnail of A Randomized, Double-Blind, Placebo-Controlled, Multi-Center, Cross-Over Study of Rosuvastatin in Children and Adolescents (Aged 6 to <18 Years) with Homozygous Familial Hypercholesterolemia (Hofh)

Journal of the American College of Cardiology, Apr 1, 2016

ABSTRACT

Research paper thumbnail of Safety and effectiveness of insulin detemir in type 2 diabetes: Results from the ASEAN cohort of the A1chieve study

Diabetes Research and Clinical Practice, Apr 1, 2013

To determine the safety and effectiveness of insulin detemir (IDet) in type 2 diabetes patients f... more To determine the safety and effectiveness of insulin detemir (IDet) in type 2 diabetes patients from the ASEAN cohort of the A1chieve study. Patients from Indonesia, Malaysia, Philippines and Singapore prescribed IDet at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions including major hypoglycaemia over 24 weeks. Secondary endpoints included changes in the frequency of hypoglycaemia, serious adverse events and effectiveness assessments. This sub-analysis included 1540 patients (insulin-naive, 1239; insulin-experienced, 301) with mean age ± SD 56.4 ± 10.9 years, BMI 25.4 ± 4.6 kg/m(2) and diabetes duration 6.9 ± 5.3 years. Insulin-naive patients received a baseline IDet dose of 0.24 ± 0.11 U/kg titrated up to 0.37 ± 0.21 U/kg by Week 24. The pre-study insulin dose in insulin-experienced patients was 0.41 ± 0.25 U/kg and baseline IDet dose was 0.31 ± 0.24 U/kg titrated up to 0.40 ± 0.20 U/kg by Week 24. Overall hypoglycaemia decreased from 1.73 to 0.46 events/patient-year from baseline to Week 24 (change in proportion of patients affected, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At Week 24, 1 major hypoglycaemic event was reported in 1 insulin-experienced patient. IDet significantly improved glucose control (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) at Week 24. The lipid profile and systolic blood pressure improved (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body weight did not change significantly. Quality of life was positively impacted (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). IDet was well-tolerated and improved glycaemic control without increasing the risk of hypoglycaemia or weight gain.

Research paper thumbnail of Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia

Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia, May 4, 2023

Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaem... more Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naïve or insulin-naïve patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal-bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%-50% and taken during sahur, while the pre-Ramadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp.

Research paper thumbnail of Current Insights on Dyslipidaemia Management for Prevention of Atherosclerotic Cardiovascular Disease: A Malaysian Perspective

The Malaysian Journal of Medical Science, Feb 28, 2023

Dyslipidaemia is highly prevalent in the Malaysian population and is one of the main risk factors... more Dyslipidaemia is highly prevalent in the Malaysian population and is one of the main risk factors for atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein cholesterol (LDL-C) is recognised as the primary target of lipid-lowering therapy to reduce the disease burden of ASCVD. Framingham General CV Risk Score has been validated in the Malaysian population for CV risk assessment. The Clinical Practice Guidelines (CPG) on the management of dyslipidaemia were last updated in 2017. Since its publication, several newer randomised clinical trials have been conducted with their results published in research articles and compared in meta-analysis. This underscores a need to update the previous guidelines to ensure good quality care and treatment for the patients. This review summarises the benefits of achieving LDL-C levels lower than the currently recommended target of < 1.8mmol/L without any safety concerns.

Research paper thumbnail of Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region

Journal of diabetes science and technology, Jul 21, 2023

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick i... more Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection–related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.

Research paper thumbnail of An audit on diabetes management in Asian patients treated by specialists: the Diabcare-Asia 1998 and 2003 studies

Current Medical Research and Opinion, Jan 8, 2008

To collect information on diabetes management, including psychosocial aspects, in patients manage... more To collect information on diabetes management, including psychosocial aspects, in patients managed by specialists 5 years after they were first surveyed in 1998. Data on demography, diabetes status, management and complications were collected via medical records, interview and laboratory assessments. HbA(1c) was analysed by a central laboratory prospectively. Patient profile was similar in the 1998 (N = 21,838) and 2003 cohorts (N = 15,549): 95% were diagnosed as type 2 diabetes mellitus and were obese (BMI approximately 25 kg/m(2)). Glycaemic control was unsatisfactory in many patients (mean HbA(1c) approximately 8%; fasting glucose approximately 9 mmol/L). Lipids were well-controlled but hypertension was not. The incidence of neuropathy ( approximately 33%) and cataract ( approximately 27%) were high. The majority ( approximately 71%) of patients in both cohorts were treated with oral antidiabetic drug (OAD) monotherapy; approximately 24% were on insulin therapy. Approximately half of the 2003 cohort reported a healthy state of well-being. Quality of life did not appear to have suffered as a result of having diabetes. However, many patients were worried about hypoglycaemic risk (53.9%) or worsening of diabetes (45.8%) and insulin initiation (64.5%). Although both cohorts were separate cross-sectional studies of diabetes management status in Asia, the results showed that the demography profile, glycaemic control and cardiovascular risk factors were remarkably similar in both cohorts 5 years after the first survey. More concerted efforts are needed to increase diabetes awareness and education.

Research paper thumbnail of Retracted: Western pacific consensus proposals for management of prediabetes

International Journal of Clinical Practice, Mar 5, 2021

Prediabetes and diabetes burden become the strong challenge in the Western Pacific region. Predia... more Prediabetes and diabetes burden become the strong challenge in the Western Pacific region. Prediabetes with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and the mixed-status (IFG+IGT) are considered as risk factors for the development of diabetes. Effective early intervention for prediabetes can significantly delay the progression of the onset of diabetes, even if reverse blood glucose to normal. Increasing evidence shows that without targeted intervention, the progression from prediabetes to diabetes occurs more frequently in Asians compared to Caucasians. Consequently, it is essential to timely detect the populations at higher risk and effectively implement intervention and management to prevent diabetes. Significant evidence also supports the effectiveness of adjusting lifestyle in combination with medication to delay the onset of diabetes. A working group of Western Pacific expertise in diabetes conducted to develop evidence-based consensus recommendations to guide the management of patients with prediabetes. These consensual recommendations are intended to provide a clear and concise approach to the management of individuals with prediabetes.

Research paper thumbnail of 173-LB: Using a Diabetes Kidney Disease (DKD) Registry to Treat to Multiple Targets (TMT)—A JADE Technology-Based RCT

Diabetes, Jun 1, 2019

DKD causes co-morbidities made preventable by attaining multiple targets. Patient empowerment, re... more DKD causes co-morbidities made preventable by attaining multiple targets. Patient empowerment, regular feedback and team-based care assisted by JADE Technology with risk stratification and decision support may improve targets attainment and clinical outcomes. In 2014-2018, 2435 patients1 with DKD2 (age:67.6±9.9 years, DM duration:16.5±9.7 years; BMI:26.9±4.7 kg/m2; A1c:7.9±1.6%; SBP:139±18 mmHg; LDL-C:2.35±1.05 mmol/L; TG:1.92±1.29 mmol/L; RASi:70.0%; statin:74.8%; CVD:32.0%, cancer:5.0%, heart failure:3.9%, ≥3 targets3:33.6%), were randomized to usual care (UC=809), empowered care (EC=819) and team-based empowered care (TEC=807) for 1 year with endpoints defined at year 1 and when study ends. After structured assessment, EC and TEC received JADE report, with EC receiving 3-monthly phone calls by nurses and TEC, additional 3-monthly review by a doctor-nurse team with JADE follow-up reports. Amongst 1837 returnees at 1 year, TEC had the lowest HbA1c and LDL-C and highest proportion with ≥3 targets (TMT)4. Non-returnees had worse risk profiles and were less likely to have familial DM and received prior DM education. At study end (2019)5, TMT group (27/408) had fewer CV-renal-cancer endpoints than non-TMT group (66/676) with RR of 0.678 (95% CI: 0.668-0.687). Empowerment, information support and continuing team-based care improve risk factor control and clinical outcomes in DKD. Disclosure J.C.N. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp &amp;amp; Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare. K.T. Nguyen: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novo Nordisk A/S, Sanofi-Aventis. A. Tan: None. Y.C. Chia: None. C. Hwu: None. E. Hong: None. Y. Thewjitcharoen: None. J. Du: None. S. Yoo: None. R.C. Mirasol: None. E.S. Lau: None. V. Lau: None. A.W.C. Fu: None. M. Mohamed: None. K. Yoon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp;amp; Dohme Corp., Novo Nordisk Inc. Speaker’s Bureau; Self; Takeda Pharmaceutical Company Limited. C. Tsang: None. A. Luk: None. Funding Asia Diabetes Foundation

Research paper thumbnail of Medical schools : the supply and availability of qualified human resources - challenges and opportunities

Research paper thumbnail of Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes: A Real-World, Prospective, Non-interventional Study Across Six Countries

Advances in Therapy, Jun 25, 2022

Introduction: Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insuli... more Introduction: Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (a basal insulin) and insulin aspart (a prandial insulin). The aim of this study was to investigate clinical outcomes in people with type 2 diabetes (T2D) after initiating IDe-gAsp treatment in a real-world setting. Methods: This 26-week, open-label, non-interventional study was conducted in Australia, India, Malaysia, Philippines, Saudi Arabia, and South Africa. Data were obtained from 1102 adults with T2D initiating or switching to IDe-gAsp from antidiabetic treatments (including oral antidiabetic drugs, basal insulin, basal-bolus insulin, premix insulin, and glucagon-like peptide 1 receptor agonist) per local clinical practice. Results: Compared with baseline, there was

Research paper thumbnail of DNA Methylation: An Epigenetic Insight into Type 2 Diabetes Mellitus

Current Pharmaceutical Design, Sep 1, 2016

DNA methylation, a major regulator of epigenetic modifications has been shown to alter the expres... more DNA methylation, a major regulator of epigenetic modifications has been shown to alter the expression of genes that are involved in aspects of glucose metabolism such as glucose intolerance, insulin resistance, β-cell dysfunction and other conditions, and it ultimately leads to the pathogenesis of type 2 diabetes mellitus (T2DM). Current evidence indicates an association of DNA methylation with T2DM. This review provides an overview of how various factors play crucial roles in T2DM pathogenesis and how DNA methylation interacts with these factors. In addition, an update on current approaches and their pros and cons is provided as a basis for the adoption of suitable techniques in future DNA methylation research towards better management of T2DM. To elucidate the mechanistic relationship between vital environmental factors and the development of T2DM, a better understanding of the changes in gene expression associated with DNA methylation at the molecular level is still needed.

Research paper thumbnail of Dyslipidaemic patter of patients with type 2 diabetes mellitus

The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using Ame... more The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using American Diabetes Association guidelines for the classification of lipoprotein concentrations into CVD risk categories. The total number screened was 211 type 2 diabetic patients who were on treatment between 2001-2002 for diabetes at the Outpatient Diabetes Clinic in HUSM Kubang Kerian. Fasting venous blood samples were analysed for plasma glucose, glycated hemoglobin and serum lipids. Type 2 diabetic patients with high, borderline, and low risk LDL cholesterol level were 62 %, 25 %, and 10 %, respectively. There were 26 % patients in the high risk HDL cholesterol group, 31 % were in the borderline risk group, and 43 % were in the low risk group. Only 3 % and 25 % of patients had triglycerides concentration in the high and borderline risk categories, respectively, but 72 % had low risk triglycerides levels. More female and younger subjects than men and older subjects had HDL cholesterol in high and borderline risk categories. The percentages of patients with triglycerides values at high and borderline high risk category were higher in poor and acceptable glycaemic control groups than good glycaemic control group. The most prevalent dyslipidaemia pattern was an isolated LDL cholesterol increase, which was observed in 35 % of the patients. The second most common pattern of dyslipidaemia was a combination of LDL cholesterol above goal with HDL cholesterol below target, which was observed in 30 % patients. Patients with established dyslipidaemia will require advice regarding diet, exercise and improvement in glycaemic control. An active strategy of early detection and drug treatment for dyslipidaemia is needed for type 2 diabetic patients.

Research paper thumbnail of A Randomized, Placebo-Controlled Crossover Study to Evaluate Postprandial Glucometabolic Effects of Mulberry Leaf Extract, Vitamin D, Chromium, and Fiber in People with Type 2 Diabetes

Diabetes Therapy, Mar 1, 2023

Introduction: Reducing postprandial (PP) hyperglycemia and PP glucose excursions is important for... more Introduction: Reducing postprandial (PP) hyperglycemia and PP glucose excursions is important for overall glycemic management. Although most therapeutic lifestyle interventions that reduce caloric intake would affect this, there is no particular nutritional intervention favored. Methods: We evaluated the effects of a novel natural food adjuvant combining mulberry leaf extract (MLE) with other bioactive ingredients, in people with type 2 diabetes (T2D) originating from Asia, on improving PP glucometabolic response in a randomized controlled exploratory crossover, two-center study (USA, Singapore). A 2-g blend of 250 mg MLE [containing 12.5 mg of 1-deoxynojirimycin (DNJ)], fiber (1.75 g), vitamin D 3 (0.75 lg), and chromium (75 lg), compared with a similar blend without the MLE, was sprinkled over a 350-kcal breakfast meal (55.4 g carbs) and PP blood glucose (primary exploratory endpoint), insulin, and incretin hormones (GLP-1, GIP) were evaluated in blood samples over 3 h. Changes in incremental areas under the concentration curve (iAUC) and maximum concentrations (C max) were compared. Results: Thirty individuals (12 women, mean age 59 years, HbA1c 7.1%, BMI 26.5 kg/m 2) were enrolled and the MLE-based blend relative to the blend without MLE significantly reduced glucose iAUC at 1 h (-20%, p \ 0.0001), 2 h (-17%,

Research paper thumbnail of Translation and cross-cultural adaptation of the Malay version of the painDETECT Questionnaire

Neurology Asia

Background: The painDETECT questionnaire (PDQ) is a useful tool for screening of patients with ne... more Background: The painDETECT questionnaire (PDQ) is a useful tool for screening of patients with neuropathic pain. This study aimed to translate the PDQ into the Malay language (PDQ-M) and to achieve cross-cultural adaptation of the questionnaire for use in Malaysia. Methods: The translation and cultural adaptation process of the English version of PDQ was performed based on international guidelines. Subsequently, 97 patients with neuropathic and nociceptive pain based on clinician’s diagnoses were recruited to complete three-type numeric rating scale (NRS) of pain followed by PDQ-M. Results: On the basis of cognitive debriefing, several changes of the translated PDQ-M were made. A total of 53 patients with neuropathic pain and 44 with nociceptive pain (54.6% females, 45.4% males, mean age 52.4 years ± 14.2) were recruited into this study. The most common class of analgesia prescribed for patients with neuropathic pain was anti-convulsant, whereas co-analgesic therapy, which includes ...

Research paper thumbnail of Correction: ARISE—a prospective, non-interventional, single-arm study assessing clinical parameters associated with the use of insulin degludec/insulin aspart in patients with type 2 diabetes in realworld settings: rationale and design

Research paper thumbnail of Open label clinical trial to study adverse effects and tolerance to dry powder of the aerial part of andrographis paniculata in patients type 2 with diabetes mellitus

PubMed, 2005

Adverse effects and tolerance to dry powder of aerial part of Andrographis paniculata (Burm.f.) N... more Adverse effects and tolerance to dry powder of aerial part of Andrographis paniculata (Burm.f.) Nees were studied in 20 patients with type 2 diabetes mellitus for a period of 12 weeks. Patients were given powdered A. paniculata starting with 600 mg daily, gradually increasing to a maximum of 1.8 gm daily. Parameters monitored included body weight, blood pressure, liver function tests, renal function tests, cardiac enzymes, haemogram, serum electrolytes, fasting blood glucose, HbA1c, blood cholesterol, serum triglycerides and blood hormone levels (triiodotyronine, thyroxine, thyrotropin, insulin, fasting cortisol). None of the above mentioned parameters showed significant change during the study period except for a fall in HbA1c by 5.46% (p<0.01) and fasting S. insulin by 20.93% (p<0.003). In conclusion, A. paniculata powder did not induced significant adverse events based on parameters observed in our study but significantly lowered HbA1c and fasting serum insulin in patients with type 2 diabetes.

Research paper thumbnail of MJMS and the challenges of a research university

Research paper thumbnail of Cardiomyopathy in pregnancy: 2 case reports

PubMed, Apr 1, 1989

Cardiomyopathy developed in the peripartum period in two healthy primigravida at 41 and 42 weeks ... more Cardiomyopathy developed in the peripartum period in two healthy primigravida at 41 and 42 weeks of gestation are presented. In the first case, the patient presented with pulmonary oedema and had cardiac arrest immediately after admission. After resuscitation, a live baby was delivered by Caesarean section. Second cardiac arrest occurred after 12 hours of operation and the patient was resuscitated again. On the 8th post operative day, patient died of D.I.V.C. and renal failure. The second case was a twin pregnancy associated with pregnancy induced hypertension. Caesarean section was performed for foetal distress. She developed pulmonary oedema with left ventricular failure on the second post operative day, was resuscitated and discharged on the 15th day. These are the first two cases to be reported from Hospital University Sains Malaysia. Reference is made to three other cases in which a similar pathological process might have occurred.

Research paper thumbnail of Ensuring the standard of medical graduates in Malaysia

Research paper thumbnail of Comparison of Vitamin D Levels, Bone Metabolic Marker Levels, and Bone Mineral Density among Patients with Thyroid Disease: A Cross-Sectional Study

Diagnostics, Dec 11, 2020

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate... more Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm 2). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.

Research paper thumbnail of A Randomized, Double-Blind, Placebo-Controlled, Multi-Center, Cross-Over Study of Rosuvastatin in Children and Adolescents (Aged 6 to <18 Years) with Homozygous Familial Hypercholesterolemia (Hofh)

Journal of the American College of Cardiology, Apr 1, 2016

ABSTRACT

Research paper thumbnail of Safety and effectiveness of insulin detemir in type 2 diabetes: Results from the ASEAN cohort of the A1chieve study

Diabetes Research and Clinical Practice, Apr 1, 2013

To determine the safety and effectiveness of insulin detemir (IDet) in type 2 diabetes patients f... more To determine the safety and effectiveness of insulin detemir (IDet) in type 2 diabetes patients from the ASEAN cohort of the A1chieve study. Patients from Indonesia, Malaysia, Philippines and Singapore prescribed IDet at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions including major hypoglycaemia over 24 weeks. Secondary endpoints included changes in the frequency of hypoglycaemia, serious adverse events and effectiveness assessments. This sub-analysis included 1540 patients (insulin-naive, 1239; insulin-experienced, 301) with mean age ± SD 56.4 ± 10.9 years, BMI 25.4 ± 4.6 kg/m(2) and diabetes duration 6.9 ± 5.3 years. Insulin-naive patients received a baseline IDet dose of 0.24 ± 0.11 U/kg titrated up to 0.37 ± 0.21 U/kg by Week 24. The pre-study insulin dose in insulin-experienced patients was 0.41 ± 0.25 U/kg and baseline IDet dose was 0.31 ± 0.24 U/kg titrated up to 0.40 ± 0.20 U/kg by Week 24. Overall hypoglycaemia decreased from 1.73 to 0.46 events/patient-year from baseline to Week 24 (change in proportion of patients affected, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At Week 24, 1 major hypoglycaemic event was reported in 1 insulin-experienced patient. IDet significantly improved glucose control (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) at Week 24. The lipid profile and systolic blood pressure improved (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body weight did not change significantly. Quality of life was positively impacted (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). IDet was well-tolerated and improved glycaemic control without increasing the risk of hypoglycaemia or weight gain.

Research paper thumbnail of Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia

Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia, May 4, 2023

Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaem... more Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naïve or insulin-naïve patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal-bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%-50% and taken during sahur, while the pre-Ramadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp.

Research paper thumbnail of Current Insights on Dyslipidaemia Management for Prevention of Atherosclerotic Cardiovascular Disease: A Malaysian Perspective

The Malaysian Journal of Medical Science, Feb 28, 2023

Dyslipidaemia is highly prevalent in the Malaysian population and is one of the main risk factors... more Dyslipidaemia is highly prevalent in the Malaysian population and is one of the main risk factors for atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein cholesterol (LDL-C) is recognised as the primary target of lipid-lowering therapy to reduce the disease burden of ASCVD. Framingham General CV Risk Score has been validated in the Malaysian population for CV risk assessment. The Clinical Practice Guidelines (CPG) on the management of dyslipidaemia were last updated in 2017. Since its publication, several newer randomised clinical trials have been conducted with their results published in research articles and compared in meta-analysis. This underscores a need to update the previous guidelines to ensure good quality care and treatment for the patients. This review summarises the benefits of achieving LDL-C levels lower than the currently recommended target of < 1.8mmol/L without any safety concerns.

Research paper thumbnail of Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region

Journal of diabetes science and technology, Jul 21, 2023

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick i... more Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection–related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.

Research paper thumbnail of An audit on diabetes management in Asian patients treated by specialists: the Diabcare-Asia 1998 and 2003 studies

Current Medical Research and Opinion, Jan 8, 2008

To collect information on diabetes management, including psychosocial aspects, in patients manage... more To collect information on diabetes management, including psychosocial aspects, in patients managed by specialists 5 years after they were first surveyed in 1998. Data on demography, diabetes status, management and complications were collected via medical records, interview and laboratory assessments. HbA(1c) was analysed by a central laboratory prospectively. Patient profile was similar in the 1998 (N = 21,838) and 2003 cohorts (N = 15,549): 95% were diagnosed as type 2 diabetes mellitus and were obese (BMI approximately 25 kg/m(2)). Glycaemic control was unsatisfactory in many patients (mean HbA(1c) approximately 8%; fasting glucose approximately 9 mmol/L). Lipids were well-controlled but hypertension was not. The incidence of neuropathy ( approximately 33%) and cataract ( approximately 27%) were high. The majority ( approximately 71%) of patients in both cohorts were treated with oral antidiabetic drug (OAD) monotherapy; approximately 24% were on insulin therapy. Approximately half of the 2003 cohort reported a healthy state of well-being. Quality of life did not appear to have suffered as a result of having diabetes. However, many patients were worried about hypoglycaemic risk (53.9%) or worsening of diabetes (45.8%) and insulin initiation (64.5%). Although both cohorts were separate cross-sectional studies of diabetes management status in Asia, the results showed that the demography profile, glycaemic control and cardiovascular risk factors were remarkably similar in both cohorts 5 years after the first survey. More concerted efforts are needed to increase diabetes awareness and education.

Research paper thumbnail of Retracted: Western pacific consensus proposals for management of prediabetes

International Journal of Clinical Practice, Mar 5, 2021

Prediabetes and diabetes burden become the strong challenge in the Western Pacific region. Predia... more Prediabetes and diabetes burden become the strong challenge in the Western Pacific region. Prediabetes with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and the mixed-status (IFG+IGT) are considered as risk factors for the development of diabetes. Effective early intervention for prediabetes can significantly delay the progression of the onset of diabetes, even if reverse blood glucose to normal. Increasing evidence shows that without targeted intervention, the progression from prediabetes to diabetes occurs more frequently in Asians compared to Caucasians. Consequently, it is essential to timely detect the populations at higher risk and effectively implement intervention and management to prevent diabetes. Significant evidence also supports the effectiveness of adjusting lifestyle in combination with medication to delay the onset of diabetes. A working group of Western Pacific expertise in diabetes conducted to develop evidence-based consensus recommendations to guide the management of patients with prediabetes. These consensual recommendations are intended to provide a clear and concise approach to the management of individuals with prediabetes.

Research paper thumbnail of 173-LB: Using a Diabetes Kidney Disease (DKD) Registry to Treat to Multiple Targets (TMT)—A JADE Technology-Based RCT

Diabetes, Jun 1, 2019

DKD causes co-morbidities made preventable by attaining multiple targets. Patient empowerment, re... more DKD causes co-morbidities made preventable by attaining multiple targets. Patient empowerment, regular feedback and team-based care assisted by JADE Technology with risk stratification and decision support may improve targets attainment and clinical outcomes. In 2014-2018, 2435 patients1 with DKD2 (age:67.6±9.9 years, DM duration:16.5±9.7 years; BMI:26.9±4.7 kg/m2; A1c:7.9±1.6%; SBP:139±18 mmHg; LDL-C:2.35±1.05 mmol/L; TG:1.92±1.29 mmol/L; RASi:70.0%; statin:74.8%; CVD:32.0%, cancer:5.0%, heart failure:3.9%, ≥3 targets3:33.6%), were randomized to usual care (UC=809), empowered care (EC=819) and team-based empowered care (TEC=807) for 1 year with endpoints defined at year 1 and when study ends. After structured assessment, EC and TEC received JADE report, with EC receiving 3-monthly phone calls by nurses and TEC, additional 3-monthly review by a doctor-nurse team with JADE follow-up reports. Amongst 1837 returnees at 1 year, TEC had the lowest HbA1c and LDL-C and highest proportion with ≥3 targets (TMT)4. Non-returnees had worse risk profiles and were less likely to have familial DM and received prior DM education. At study end (2019)5, TMT group (27/408) had fewer CV-renal-cancer endpoints than non-TMT group (66/676) with RR of 0.678 (95% CI: 0.668-0.687). Empowerment, information support and continuing team-based care improve risk factor control and clinical outcomes in DKD. Disclosure J.C.N. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp &amp;amp; Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare. K.T. Nguyen: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novo Nordisk A/S, Sanofi-Aventis. A. Tan: None. Y.C. Chia: None. C. Hwu: None. E. Hong: None. Y. Thewjitcharoen: None. J. Du: None. S. Yoo: None. R.C. Mirasol: None. E.S. Lau: None. V. Lau: None. A.W.C. Fu: None. M. Mohamed: None. K. Yoon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp;amp; Dohme Corp., Novo Nordisk Inc. Speaker’s Bureau; Self; Takeda Pharmaceutical Company Limited. C. Tsang: None. A. Luk: None. Funding Asia Diabetes Foundation

Research paper thumbnail of Medical schools : the supply and availability of qualified human resources - challenges and opportunities

Research paper thumbnail of Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes: A Real-World, Prospective, Non-interventional Study Across Six Countries

Advances in Therapy, Jun 25, 2022

Introduction: Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insuli... more Introduction: Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (a basal insulin) and insulin aspart (a prandial insulin). The aim of this study was to investigate clinical outcomes in people with type 2 diabetes (T2D) after initiating IDe-gAsp treatment in a real-world setting. Methods: This 26-week, open-label, non-interventional study was conducted in Australia, India, Malaysia, Philippines, Saudi Arabia, and South Africa. Data were obtained from 1102 adults with T2D initiating or switching to IDe-gAsp from antidiabetic treatments (including oral antidiabetic drugs, basal insulin, basal-bolus insulin, premix insulin, and glucagon-like peptide 1 receptor agonist) per local clinical practice. Results: Compared with baseline, there was

Research paper thumbnail of DNA Methylation: An Epigenetic Insight into Type 2 Diabetes Mellitus

Current Pharmaceutical Design, Sep 1, 2016

DNA methylation, a major regulator of epigenetic modifications has been shown to alter the expres... more DNA methylation, a major regulator of epigenetic modifications has been shown to alter the expression of genes that are involved in aspects of glucose metabolism such as glucose intolerance, insulin resistance, β-cell dysfunction and other conditions, and it ultimately leads to the pathogenesis of type 2 diabetes mellitus (T2DM). Current evidence indicates an association of DNA methylation with T2DM. This review provides an overview of how various factors play crucial roles in T2DM pathogenesis and how DNA methylation interacts with these factors. In addition, an update on current approaches and their pros and cons is provided as a basis for the adoption of suitable techniques in future DNA methylation research towards better management of T2DM. To elucidate the mechanistic relationship between vital environmental factors and the development of T2DM, a better understanding of the changes in gene expression associated with DNA methylation at the molecular level is still needed.

Research paper thumbnail of Dyslipidaemic patter of patients with type 2 diabetes mellitus

The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using Ame... more The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using American Diabetes Association guidelines for the classification of lipoprotein concentrations into CVD risk categories. The total number screened was 211 type 2 diabetic patients who were on treatment between 2001-2002 for diabetes at the Outpatient Diabetes Clinic in HUSM Kubang Kerian. Fasting venous blood samples were analysed for plasma glucose, glycated hemoglobin and serum lipids. Type 2 diabetic patients with high, borderline, and low risk LDL cholesterol level were 62 %, 25 %, and 10 %, respectively. There were 26 % patients in the high risk HDL cholesterol group, 31 % were in the borderline risk group, and 43 % were in the low risk group. Only 3 % and 25 % of patients had triglycerides concentration in the high and borderline risk categories, respectively, but 72 % had low risk triglycerides levels. More female and younger subjects than men and older subjects had HDL cholesterol in high and borderline risk categories. The percentages of patients with triglycerides values at high and borderline high risk category were higher in poor and acceptable glycaemic control groups than good glycaemic control group. The most prevalent dyslipidaemia pattern was an isolated LDL cholesterol increase, which was observed in 35 % of the patients. The second most common pattern of dyslipidaemia was a combination of LDL cholesterol above goal with HDL cholesterol below target, which was observed in 30 % patients. Patients with established dyslipidaemia will require advice regarding diet, exercise and improvement in glycaemic control. An active strategy of early detection and drug treatment for dyslipidaemia is needed for type 2 diabetic patients.

Research paper thumbnail of A Randomized, Placebo-Controlled Crossover Study to Evaluate Postprandial Glucometabolic Effects of Mulberry Leaf Extract, Vitamin D, Chromium, and Fiber in People with Type 2 Diabetes

Diabetes Therapy, Mar 1, 2023

Introduction: Reducing postprandial (PP) hyperglycemia and PP glucose excursions is important for... more Introduction: Reducing postprandial (PP) hyperglycemia and PP glucose excursions is important for overall glycemic management. Although most therapeutic lifestyle interventions that reduce caloric intake would affect this, there is no particular nutritional intervention favored. Methods: We evaluated the effects of a novel natural food adjuvant combining mulberry leaf extract (MLE) with other bioactive ingredients, in people with type 2 diabetes (T2D) originating from Asia, on improving PP glucometabolic response in a randomized controlled exploratory crossover, two-center study (USA, Singapore). A 2-g blend of 250 mg MLE [containing 12.5 mg of 1-deoxynojirimycin (DNJ)], fiber (1.75 g), vitamin D 3 (0.75 lg), and chromium (75 lg), compared with a similar blend without the MLE, was sprinkled over a 350-kcal breakfast meal (55.4 g carbs) and PP blood glucose (primary exploratory endpoint), insulin, and incretin hormones (GLP-1, GIP) were evaluated in blood samples over 3 h. Changes in incremental areas under the concentration curve (iAUC) and maximum concentrations (C max) were compared. Results: Thirty individuals (12 women, mean age 59 years, HbA1c 7.1%, BMI 26.5 kg/m 2) were enrolled and the MLE-based blend relative to the blend without MLE significantly reduced glucose iAUC at 1 h (-20%, p \ 0.0001), 2 h (-17%,