Kamarul Imran | Universiti Sains Malaysia (original) (raw)

Papers by Kamarul Imran

Introduction: Tuberculosis (TB) affects onethird of the world's population. Anti-TB drugs with is... more Introduction: Tuberculosis (TB) affects onethird of the world's population. Anti-TB drugs with isoniazid, rifampicin and pyrazinamide are very effective but they can cause hepatotoxicity. Many risk factors have been recognised. Data on prevalence of anti-TB drug-induced hepatitis as well as the contributing risk factors are scarce in Malaysia. This observational case control study was designed to look at the prevalence and the risk factors of drug-induced hepatitis in our population.

Diabetes Research and Clinical Practice, 2011

To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult M... more To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria.A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations.Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malaysians (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridaemia (47.4%).Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country's healthcare costs and services.

Asian Journal of Surgery, 2007

To determine whether or not multimodality monitoring technique would result in a better outcome s... more To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients.This was a prospective randomized study that included all adults with traumatic severe head injury who had a Glasgow Coma Score < 9 and computed tomography scan features that did not reveal significant infratentorial pathology. Subjects were randomized into a multimodality group where they received multiple cerebral monitoring or into a standard single modality group where they received only intracranial pressure monitoring. The outcome was analysed 6 months post treatment using the Barthel Index.The outcome at 6 months post treatment between the two groups was not statistically significant (p < 0.48). However, the percentage of subjects who were independent at 6 months was higher in the multimodality group (21.2%) compared with the single modality group (17.3%).Multimodality monitoring for severely head-injured patients has no effect on outcome. However, study with a larger sample size and improvement in groups comparison are required to ascertain the above findings.

Aims Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known ab... more Aims Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population-based study to examine these.

Asian Journal of Andrology, 2010

This study investigated the effect of treatment with the proprietary standardized, water-soluble ... more This study investigated the effect of treatment with the proprietary standardized, water-soluble extract of the root of the Malaysian plant, Eurycoma longifolia Jack, which is thought to enhance male fertility with regard to higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in male partners of sub-fertile couples with idiopathic infertility. A total of 350 patients were given 200 mg of the extract daily and follow-up semen analyses were performed every 3 months for 9 months. Of these 350 patients, 75 patients completed one full cycle of 3 months. Follow-up semen analyses in these patients showed significant improvement in all semen parameters. The proprietary extract of Eurycoma longifolia Jack significantly improved the sperm quality in these patients, allowing for 11 (14.7%) spontaneous pregnancies.

Standardized water soluble extract of the root of Eurycoma longifolia jack, a common Malaysian fo... more Standardized water soluble extract of the root of Eurycoma longifolia jack, a common Malaysian folklore medicine known to have testosterone enhancing effect, including anti stress, anti aging effect with normalizing growth hormone besides SOD activity is given to the male clients with idiopathic male infertility to evaluate its efficacy. Each client were given a dose of 200mg daily of the Extract and follow up semen analysis were done every three monthly cycle for three cycles. 75 men at least completed one full cycle. There were improvements in the follow up sperm concentration, percent motility and percent morphology. There were 11(15%) spontaneous pregnancies. The remaining opted for ART procedures, 60% were able to do IUI and the rest IVF (20%)/ICSI (5%).

A cross-sectional comparative study was conducted to determine the nutritional status among physi... more A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ≥30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ≥140 and/or DBP ≥90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of "high risk" individuals (TC ≥6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.

International Journal of Infectious Diseases, 2008

Asian Journal of Surgery, 2010

To determine the 5-year survival rate and prognostic factors for survival in patients with colore... more To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival.We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95–7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37–9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92–15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26–11.21).Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.

Journal of Cancer Research and Clinical Oncology, 2011

Purpose The purpose of this study was to evaluate the role of HPV and p53 polymorphisms in oral s... more Purpose The purpose of this study was to evaluate the role of HPV and p53 polymorphisms in oral squamous cell carcinomas (OSCC) affecting Malaysian population. Methods We analysed frozen samples from 105 OSCC as well as 105 oral specimens derived from healthy individuals. PCR assays targeting two regions of the virus were used. PCR amplification for the analysis of p53 codon 72 arginine/proline alleles was carried out in a separate reaction. Results HPV DNA was detected in 51.4% OSCC samples, while 24.8% controls were found to be HPV positive. HPV was found to be significantly associated with OSCC (P < 0.001, OR = 4.3 after adjustment for habits) when compared to controls. High-risk HPV was found to be significantly associated with OSCC cases (P < 0.05). Demographic profiles of age, gender, race and habits were not associated with HPV presence in cases and controls. However, significantly less HPV positivity was seen in poorly differentiated compared to well-differentiated OSCCs. No significant association was found between HPV positivity and p53 polymorphisms in cases and control groups. Additionally, we found no association of codon 72 polymorphism with oral cancer. Conclusions This study indicates that high-risk HPV infection is one of the contributing factors for OSCCs. HPV 16 was the predominant type found in Malaysian patients with OSCC. Further, we did not find any association between p53 codon 72 polymorphism and HPV infection or between the p53 polymorphism and the risk of oral cancer.

The Journal of Infection in Developing Countries, 2009

Background: The outcome indicator of nosocomial infection (NI) in the intensive care unit (ICU) i... more Background: The outcome indicator of nosocomial infection (NI) in the intensive care unit (ICU) is used to benchmark the quality of patient care in Malaysia. We conducted a three-year prospective study on the incidences of ventilator-associated pneumonia (VAP), risk factors, and patterns of the microorganisms isolated in three ICUs. Methodology: A follow-up in prospective cohort surveillance was conducted on patients admitted to an adult medical-surgical ICU of a university hospital and two governmental hospitals in Malaysia from October 2003 to December 2006. VAP was detected using CDC criteria which included clinical manifestation and confirmed endotracheal secretion culture results. Results: In total, 215 patients (2,306 patient-days) were enrolled into the study. The incidence of ICU-acquired device-related NI was 29.3 % (n = 63). The device-related VAP infection rate was 27.0 % (n = 58), with a mechanical ventilator utilization rate of 88.7%. The death rate due to all ICU-acquired NI including sepsis was 6.5%. The most common causative pathogen was Klebsiella pneumoniae (n = 27). Multivariate analysis using Cox regression showed that the risk factors identified were aspiration pneumonia (HR = 4.09; 95% CI = 1.24, 13.51; P = 0.021), cancer (HR = 2.51; 95% CI = 1.27, 4.97; P = 0.008), leucocytosis (HR=3.43; 95% CI= 1.60, 7.37; P=0.002) and duration of mechanical ventilation (HR=1.04; 95% CI = 1.00, 1.08; P = 0.030). Age, gender and race were not identified as risk factors in the multivariable analysis performed. Conclusion: The incidence of VAP was comparable to that found in the National Nosocomial Infection Surveillance (NNIS) System report of June 1998. The incidence of VAP was considered high for the three hospitals studied.

Introduction: Tuberculosis (TB) affects onethird of the world's population. Anti-TB drugs with is... more Introduction: Tuberculosis (TB) affects onethird of the world's population. Anti-TB drugs with isoniazid, rifampicin and pyrazinamide are very effective but they can cause hepatotoxicity. Many risk factors have been recognised. Data on prevalence of anti-TB drug-induced hepatitis as well as the contributing risk factors are scarce in Malaysia. This observational case control study was designed to look at the prevalence and the risk factors of drug-induced hepatitis in our population.

Diabetes Research and Clinical Practice, 2011

To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult M... more To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria.A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations.Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malaysians (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridaemia (47.4%).Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country's healthcare costs and services.

Asian Journal of Surgery, 2007

To determine whether or not multimodality monitoring technique would result in a better outcome s... more To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients.This was a prospective randomized study that included all adults with traumatic severe head injury who had a Glasgow Coma Score < 9 and computed tomography scan features that did not reveal significant infratentorial pathology. Subjects were randomized into a multimodality group where they received multiple cerebral monitoring or into a standard single modality group where they received only intracranial pressure monitoring. The outcome was analysed 6 months post treatment using the Barthel Index.The outcome at 6 months post treatment between the two groups was not statistically significant (p < 0.48). However, the percentage of subjects who were independent at 6 months was higher in the multimodality group (21.2%) compared with the single modality group (17.3%).Multimodality monitoring for severely head-injured patients has no effect on outcome. However, study with a larger sample size and improvement in groups comparison are required to ascertain the above findings.

Aims Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known ab... more Aims Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population-based study to examine these.

Asian Journal of Andrology, 2010

This study investigated the effect of treatment with the proprietary standardized, water-soluble ... more This study investigated the effect of treatment with the proprietary standardized, water-soluble extract of the root of the Malaysian plant, Eurycoma longifolia Jack, which is thought to enhance male fertility with regard to higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in male partners of sub-fertile couples with idiopathic infertility. A total of 350 patients were given 200 mg of the extract daily and follow-up semen analyses were performed every 3 months for 9 months. Of these 350 patients, 75 patients completed one full cycle of 3 months. Follow-up semen analyses in these patients showed significant improvement in all semen parameters. The proprietary extract of Eurycoma longifolia Jack significantly improved the sperm quality in these patients, allowing for 11 (14.7%) spontaneous pregnancies.

Standardized water soluble extract of the root of Eurycoma longifolia jack, a common Malaysian fo... more Standardized water soluble extract of the root of Eurycoma longifolia jack, a common Malaysian folklore medicine known to have testosterone enhancing effect, including anti stress, anti aging effect with normalizing growth hormone besides SOD activity is given to the male clients with idiopathic male infertility to evaluate its efficacy. Each client were given a dose of 200mg daily of the Extract and follow up semen analysis were done every three monthly cycle for three cycles. 75 men at least completed one full cycle. There were improvements in the follow up sperm concentration, percent motility and percent morphology. There were 11(15%) spontaneous pregnancies. The remaining opted for ART procedures, 60% were able to do IUI and the rest IVF (20%)/ICSI (5%).

A cross-sectional comparative study was conducted to determine the nutritional status among physi... more A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ≥30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ≥140 and/or DBP ≥90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of "high risk" individuals (TC ≥6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.

International Journal of Infectious Diseases, 2008

Asian Journal of Surgery, 2010

To determine the 5-year survival rate and prognostic factors for survival in patients with colore... more To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival.We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95–7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37–9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92–15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26–11.21).Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.

Journal of Cancer Research and Clinical Oncology, 2011

Purpose The purpose of this study was to evaluate the role of HPV and p53 polymorphisms in oral s... more Purpose The purpose of this study was to evaluate the role of HPV and p53 polymorphisms in oral squamous cell carcinomas (OSCC) affecting Malaysian population. Methods We analysed frozen samples from 105 OSCC as well as 105 oral specimens derived from healthy individuals. PCR assays targeting two regions of the virus were used. PCR amplification for the analysis of p53 codon 72 arginine/proline alleles was carried out in a separate reaction. Results HPV DNA was detected in 51.4% OSCC samples, while 24.8% controls were found to be HPV positive. HPV was found to be significantly associated with OSCC (P < 0.001, OR = 4.3 after adjustment for habits) when compared to controls. High-risk HPV was found to be significantly associated with OSCC cases (P < 0.05). Demographic profiles of age, gender, race and habits were not associated with HPV presence in cases and controls. However, significantly less HPV positivity was seen in poorly differentiated compared to well-differentiated OSCCs. No significant association was found between HPV positivity and p53 polymorphisms in cases and control groups. Additionally, we found no association of codon 72 polymorphism with oral cancer. Conclusions This study indicates that high-risk HPV infection is one of the contributing factors for OSCCs. HPV 16 was the predominant type found in Malaysian patients with OSCC. Further, we did not find any association between p53 codon 72 polymorphism and HPV infection or between the p53 polymorphism and the risk of oral cancer.

The Journal of Infection in Developing Countries, 2009

Background: The outcome indicator of nosocomial infection (NI) in the intensive care unit (ICU) i... more Background: The outcome indicator of nosocomial infection (NI) in the intensive care unit (ICU) is used to benchmark the quality of patient care in Malaysia. We conducted a three-year prospective study on the incidences of ventilator-associated pneumonia (VAP), risk factors, and patterns of the microorganisms isolated in three ICUs. Methodology: A follow-up in prospective cohort surveillance was conducted on patients admitted to an adult medical-surgical ICU of a university hospital and two governmental hospitals in Malaysia from October 2003 to December 2006. VAP was detected using CDC criteria which included clinical manifestation and confirmed endotracheal secretion culture results. Results: In total, 215 patients (2,306 patient-days) were enrolled into the study. The incidence of ICU-acquired device-related NI was 29.3 % (n = 63). The device-related VAP infection rate was 27.0 % (n = 58), with a mechanical ventilator utilization rate of 88.7%. The death rate due to all ICU-acquired NI including sepsis was 6.5%. The most common causative pathogen was Klebsiella pneumoniae (n = 27). Multivariate analysis using Cox regression showed that the risk factors identified were aspiration pneumonia (HR = 4.09; 95% CI = 1.24, 13.51; P = 0.021), cancer (HR = 2.51; 95% CI = 1.27, 4.97; P = 0.008), leucocytosis (HR=3.43; 95% CI= 1.60, 7.37; P=0.002) and duration of mechanical ventilation (HR=1.04; 95% CI = 1.00, 1.08; P = 0.030). Age, gender and race were not identified as risk factors in the multivariable analysis performed. Conclusion: The incidence of VAP was comparable to that found in the National Nosocomial Infection Surveillance (NNIS) System report of June 1998. The incidence of VAP was considered high for the three hospitals studied.