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  1. Fulltext Improving health care delivery through islamization of medical practice.
    Mohammad Yousuf Rathor, Azarisman SM Shah
    IIUM Medical Journal Malaysia, 2018;17(102):267-271.
    MyJurnal
    Advances in modern science and technology have not only reduced mortality from communicable diseases but increased physical comfort, life expectancy and quality of life. However its advances have generated changes in the moral values and basic philosophies of mankind, a bi-product being loss of faith in religion as a partner in healing. This has resulted in changes in lifestyle, moral degradation, laxity in sexual behaviours, and disrupting social values. New diseases caused by negative lifestyles such as sexual promiscuity, alcoholism, illicit drug use and smoking, take the greatest toll in terms of deaths and disability among young people. As a consequence, relevant international organizations have supported more novel approaches to health promotion.Good health is the basic requirement of every human being and one of the greatest blessings of ALLAH (SWT)on mankind. The Islamic way of life is a system of divine principles sent by Allah swt through revelation on Prophet Muhammad (saw) which covers physical, intellectual and spiritual needs of human life. It has many constructive ideas to offer in the field of health care and medical practice. It contains many teachings that urge nurturing of one’s health and rejecting any behaviour, which are contradictory to health. Therefore by adopting an “Islamic way of life” we can promote behavioural change. Since Islam encourages adoption of modern technology and science in support of a greater good, we must understand it and adopt all that is good in it and propagate it in the spirit of Tawhid (Unity of God), for the benefit of all humanity. This paper seeks to analyse how medical professionals can promote healthy behaviour to specific target groups and public in general through teachings of Islam.
  2. Fulltext Renal cell carcinoma in a von Hippel-Lindau syndrome: when should phaeochromocytoma be anticipated?
    Azarisman SM, Nor Azmi K
    Singapore Med J, 2007 Aug;48(8):779-82.
    PMID: 17657389
    A 39-year-old man was diagnosed with von Hippel-Lindau syndrome, which was associated with retinal haemangioblastoma, cervical cord haemangioblastoma and bilateral renal cell carcinoma. He subsequently underwent an arterial embolisation and cervical laminectomy, following a spinal angiogram of the cervical lesion. He also had a right radical nephrectomy, with no perioperative complications. However, on admission for the left radical nephrectomy, he was noted to have preoperative hypertension. Further investigation revealed an enlarged left adrenal gland on abdominal computed tomography scan and raised urinary catecholamines. We discuss the risk of renal cell carcinoma and phaeochromocytoma arising concomitantly in von Hippel-Lindau syndrome, and how best to investigate and manage them.
  3. Fulltext Prevalence and risk factors for menstrual disorders among systemic lupus erythematosus patients
    Fatnoon NN, Azarisman SM, Zainal D
    Singapore Med J, 2008 May;49(5):413-8.
    PMID: 18465054
    INTRODUCTION: This study aims to determine the prevalence and the types of menstrual disorders among patients with systemic lupus erythematosus (SLE) and to identify factors that influence their development.
    METHODS: 61 patients with SLE were enrolled into a cross-sectional, observational study at the medical outpatient clinic, Hospital Universiti Sains Malaysia. A total of 120 healthy women were selected randomly to act as the control group. A questionnaire was administered, vital signs were recorded, and blood was evaluated for routine investigations. A review of past medical records was also undertaken.
    RESULTS: The mean age and standard deviation for the study group was 33.23 +/- 10.96 years, the majority being ethnic Malays. 75 percent had a severe SLE disease activity index score on initial presentation, and 59 percent were on cyclophosphamide. 49 percent of the study population had menstrual irregularities, of which 60 percent had sustained amenorrhoea. Nine patients with sustained amenorrhoea had hormonal assays, which confirmed the diagnosis of premature menopause.
    CONCLUSION: This study showed that SLE patients had a higher risk of developing menstrual irregularities compared to the normal/healthy population. The risk was higher in the older age group (greater than 30 years old) and those on cyclophosphamide therapy, especially those with a cumulative dose of more than 10 g. Sustained amenorrhoea was the commonest irregularity and a majority of them had confirmed premature menopause.
    Study site: medical outpatient clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
  4. Fulltext Severe left anterior descending artery stenosis with proximal arteriovenous malformation presenting as acute myocardial infarction
    Oteh M, Azarisman SM, Hanim NM, Noorfaizan S
    Singapore Med J, 2009 Feb;50(2):e76-8.
    PMID: 19296018
    Congenital coronary artery anomalies are rare, with an incidence of about 0.06-1.3 percent of all patients undergoing cardiac catheterisation. They are commonly asymptomatic, but potentially serious lesions may lead to myocardial ischaemia, infarction and/or sudden cardiac death. The occurrence of a concomitant stenotic lesion is exceedingly rare. We report an 80-year-old man who presented with acute anterior myocardial infarction. Coronary angiography revealed severe proximal left anterior descending (LAD) and arteriovenous malformation (AVM) from the first septal branch of the LAD. The LAD stenosis and the AVM were successfully treated with two Jomed covered stents.
  5. Fulltext Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome
    Azarisman SM, Teo KS, Worthley MI, Worthley SG
    World J Cardiol, 2014 Jun 26;6(6):405-14.
    PMID: 24976912 DOI: 10.4330/wjc.v6.i6.405
    Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
  6. Recurrent in-stent restenosis with total occlusion remedied with drug-eluting balloon angioplasty
    Azarisman SM, Sabruddin MZ, Rosli MA
    Int Heart J, 2011;52(1):61-3.
    PMID: 21321471
    We report a 69 year old female who presented with chest pain to the Emergency Department of the National Heart Institute Malaysia. Her history revealed that she had had 2 separate episodes of chest pain beginning in 2002, resulting in total occlusion of her mid left anterior descending artery (LAD) requiring percutaneous coronary intervention and stenting on both occasions. Cine angiogram on her current admission revealed recurrent target lesion in-stent restenosis with total occlusion of the distal LAD. Intravascular ultrasound revealed multilayered suboptimally deployed stents in the LAD. Successive drug-eluting balloon deployments resulted in sustained patency of the LAD after 1 year.
  7. Fulltext Myocardial infarction induced by appetite suppressants in Malaysia
    Azarisman SM, Magdi YA, Noorfaizan S, Oteh M
    N Engl J Med, 2007 Nov 1;357(18):1873-4.
    PMID: 17978302 DOI: 10.1056/NEJMc070990
  8. Fulltext Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome
    Azarisman SM, Teo KS, Worthley MI, Worthley SG
    J Int Med Res, 2017 Dec;45(6):1680-1692.
    PMID: 29239257 DOI: 10.1177/0300060517698265
    Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with underlying ACS. The conventional methods of assessing ACS, which include electrocardiography and serological markers of infarct, can take time to manifest. Recent studies have investigated more sensitive and specific imaging modalities that can be used. Diastolic dysfunction occurs early following coronary artery occlusion and its detection is useful in confirming the diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic resonance provides a single imaging modality for comprehensive evaluation of chest pain in the acute setting. In particular, cardiac magnetic resonance has many imaging techniques that assess diastolic dysfunction post-coronary artery occlusion. Techniques such as measurement of left atrial size, mitral inflow, and mitral annular and pulmonary vein flow velocities with phase-contrast imaging enable general assessment of ventricular diastolic function. More novel imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and myocardial tagging, allow early determination of regional diastolic dysfunction and oedema. These findings may correspond to specific infarcted arteries that may be used to tailor eventual percutaneous coronary artery intervention.
  9. Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus
    Elnaem MH, Nik Mohamed MH, Zaman Huri H, Azarisman SM
    J Eval Clin Pract, 2018 06;24(3):521-527.
    PMID: 29508492 DOI: 10.1111/jep.12903
    RATIONALE: Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process.
    AIMS AND OBJECTIVES: This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge.
    METHODS: This was a cross-sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12-item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired-samples t-test.
    RESULTS: The response rate to both pre-and post-educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre-assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty-five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P 
  10. Fulltext Invasive rhinocerebral mucormycosis with orbital extension in poorly- controlled diabetes mellitus
    Hadzri MH, Azarisman SM, Fauzi AR, Kahairi A
    Singapore Med J, 2009 Mar;50(3):e107-9.
    PMID: 19352553
    Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.
  11. Characterisation of Myocardial Injury via T1 Mapping in Early Reperfused Myocardial Infarction and its Relationship with Global and Regional Diastolic Dysfunction
    Azarisman SM, Carbone A, Shirazi M, Bradley J, Teo KS, Worthley MI, et al.
    Heart Lung Circ, 2016 Nov;25(11):1094-1106.
    PMID: 27210302 DOI: 10.1016/j.hlc.2016.03.011
    BACKGROUND: Cardiovascular magnetic resonance (CMR) advances in imaging techniques, permits the ability to accurately characterise tissue injury post myocardial infarction. Pre-contrast T1 mapping enables this through measurement of pre-contrast T1 relaxation times. We investigate the relationship between T1 characterisation of myocardial injury with global and regional diastolic function.

    METHODS: Revascularised acute myocardial infarction patients with normal left ventricular (LV) systolic function on TTE were assessed by 1.5T CMR. Acute regional diastolic wall motion abnormalities, global diastolic function measurements, acute segmental damage fraction with LGE and mean segmental pre-contrast T1 values were assessed on matching short axis slices.

    RESULTS: Forty-four patients were analysed. Mean LVEF was 62.1±9.4%. No difference between NSTEMI (22/44) and STEMI in mean pre-contrast T1 values of infarcted (1025.0±109.2 vs 1011.0±81.6ms, p=0.70), adjacent (948.3±45.3 vs 941.1±46.6ms, p=0.70) and remote (888.8±52.8 vs 881.2±54.5ms, p=0.66) segments was detected. There was no correlation between pre-contrast T1 of infarcted segments with global diastolic dysfunction (E/A, r(2)=0.216, p=0.06; S/D, r(2)=0.243, p=0.053; E/E', r(2)=0.240, p=0.072), but there was significantly positive, moderate correlation with circumferential diastolic strain rate, (r(2)=0.579, p<0.01) with excellent agreement and reproducibility.

    CONCLUSION: Cardiac magnetic resonance evaluation of pre-contrast T1 values revealed no difference between NSTEMI and STEMI patients in terms of tissue characterisation post-myocardial infarction. However, pre-contrast T1 of infarcted tissue is significantly correlated with regional diastolic circumferential strain rate.

  12. Immediate postpartum cardiorespiratory collapse: a management quandary
    Azarisman SM, Liza RA, Radhiana H, Sujana SS, Maskon O, Rosli MA, et al.
    Blood Coagul Fibrinolysis, 2010 Sep;21(6):601-4.
    PMID: 20581659 DOI: 10.1097/MBC.0b013e32833c2b9f
    A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.
  13. Institutional hypertension control in Malaysia: a multicenter study focusing on gender and cardiovascular risk factor profile difference
    Oteh M, Azarisman SM, Azreen SA, Jamaluddin AR, Aszrin A, Ting CK, et al.
    Hypertens Res, 2011 Mar;34(3):319-24.
    PMID: 21150917 DOI: 10.1038/hr.2010.239
    The prevalence of hypertension in Malaysia is alarmingly high. The National Survey in 2006 showed 43% of people aged ≥30 had hypertension and among treated patients, only 26% reached the target blood pressure (BP) of <140/90 mmHg. We evaluated BP control in tertiary institutions in Malaysia and the difference in hypertension control between genders and within specific cardiovascular risk factor groups. This cross-sectional study aimed at determining BP control among hypertensive patients attending three specialist institutions in Malaysia, located in Kuala Lumpur, Kuantan and Kota Bharu. A total of 950 patients with known hypertension for at least 6 months were recruited between January 2007 and July 2008. There were more males (n=548, 57.7%) with a mean age of 60.3±10.5 (±s.d.) years. The mean systolic BP (SBP) and diastolic BP were 138.8±20.3 mmHg and 79.6±11.3 mmHg, respectively. In total, 48.5% of all the patients had good BP control (<140/90 mmHg). Males had better SBP control compared with female (SBP: 135.9±18.7 vs. 142.8±21.7 mmHg, P<0.001). Overall, 54.6% of the patients had ischemic heart disease (IHD), 24.2% had undergone coronary revascularization, 50.1% were diabetic, 68.6% hyperlipidemic, 17.3% smokers and 27.5% had renal impairment. Males and small numbers of antihypertensives used were independently associated with better treatment outcome. In summary, our data reveal a poorer BP control, secondary to higher SBP levels in women. Moreover, the gender difference is more pronounced in patients with concomitant diabetes mellitus, renal impairment and IHD.
  14. Fulltext Statin Therapy Prescribing for Patients with Type 2 Diabetes Mellitus: A Review of Current Evidence and Challenges
    Elnaem MH, Mohamed MHN, Huri HZ, Azarisman SM, Elkalmi RM
    J Pharm Bioallied Sci, 2017 Apr-Jun;9(2):80-87.
    PMID: 28717329 DOI: 10.4103/jpbs.JPBS_30_17
    Use of statin therapy in patients with type 2 diabetes mellitus (T2DM) has been recommended by most clinical guidelines. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among T2DM patients. It has been proved that statins are effective for primary or secondary CVD prophylaxis. Reports have highlighted the underutilization of statins in clinical practice and the suboptimal adherence to guideline recommendations. This review article points to summarize the current evidence confirming the role of statins in T2DM patients and to provide an overview of factors that may affect statins' prescribing patterns and compliance in clinical practice. Initiatives to enhance statin therapy prescribing should recognize the comprehensive nature of the prescribing process. Attempts to assure proper statin prescribing and utilization can help in achieving better clinical outcomes of statin therapy.
  15. Fulltext Compliance to national guidelines on the management of chronic obstructive pulmonary disease in Malaysia: a single centre experience
    Azarisman SM, Hadzri HM, Fauzi RA, Fauzi AM, Faizal MP, Roslina MA, et al.
    Singapore Med J, 2008 Nov;49(11):886-91; quiz 892-6.
    PMID: 19037555
    INTRODUCTION: Malaysia has a high rate of smoking prevalence and the figure is increasing. Although there has been many local and regional studies on the prevalence and symptomatology of chronic obstructive pulmonary disease patients, data is lacking on the degree of compliance to national management guidelines in the treatment of chronic obstructive pulmonary disease.
    METHODS: 86 patients who attended the respiratory outpatient clinic of the Hospital Universiti Kebangsaan Malaysia were enrolled into a prospective, observational study.
    RESULTS: 88 percent of the patients were male and the majority was ethnically Chinese (65 percent). The majority of patients were in the moderate to very severe categories, with a mean FEV1 of 0.97 +/- 0.56 L/sec and predicted mean FEV1 percentage of 43.1 +/- 21.3 percent. 58 percent of the patients were on long-acting beta-agonist, 65 percent were on inhaled steroids, and only 16 percent were on scheduled pulmonary rehabilitation.
    CONCLUSION: The low uptake rate for long-acting beta-agonist and pulmonary rehabilitation could be attributed to several factors. Financial cost, the need for strict compliance to a structured rehabilitation regime, lack of significant social support and clear up-to-date guidelines are possible reasons.
    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  16. Fulltext Blood pressure control among diabetic hypertensives under cardiology follow-up at a regional hospital in rural Malaysia
    Azarisman SM, Aszrin A, Marzuki AO, Fatnoon NN, Hilmi A, Hadzri MH, et al.
    Southeast Asian J Trop Med Public Health, 2010 Jul;41(4):973-81.
    PMID: 21073073
    Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.

    Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,
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