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Fulltext Update on the management of diabetes during Ramadan fast for healthcare practitioners

Rathor MY, Mohammad Fauzi AR, Omar AM

International Medical Journal Malaysia, 2014;13(2):67-72.
MyJurnal

Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinions.
Fulltext High prevalence of thyroid antibodies in urban population of peninsular Malaysia.

Shahar MA, Omar AM, AB Wahab N, Sukor N, Kamaruddin NA

IIUM Medical Journal Malaysia, 2020;19(2):3-12.
MyJurnal

Thyroid antibodies are closely related to autoimmune thyroid disorders. To date, there are no data on the prevalence of these antibodies among the Malaysian population. This study aimed to determine the prevalence of thyroid antibodies; and the factors associated with thyroid antibodies in the Malaysian adult population. MATERIALS AND METHODS: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. Fifteen mils of blood were withdrawn and analysed for thyroid function, anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies at a central laboratory. RESULTS: Among the total of 2190 respondents, the overall prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%, respectively; mainly found in urban and coastal areas. Only 7% to 9% of those with positive anti-TPO or anti-TG antibodies had either hypo-or hyperthyroidism. The predictors for positive anti-TPO antibody were female [adjusted OR 1.7 (95%CI: 1.2–2.4); p=0.001], Indian [adjusted OR 1.9 (95%CI: 1.1–3.1); p=0.020], and having a goitre [adjusted OR 1.8 (95%CI: 1.2–2.8), p=0.004]. The predictors of positive anti-TG antibody was female [adjusted OR 2.3 (95%CI: 1.6–3.3); p
Fulltext Living in rural areas of peninsular malaysia: risk factor for goitre.

Shahar MA, Omar AM, AB Wahab N, Sukor N, Kamaruddin NA

IIUM Medical Journal Malaysia, 2019;18(3):75-86.
MyJurnal

Thyroid disorders are among common medical conditions encountered in clinical practice. However, the disease burden among Malaysian population has not been established. This study was aimed to determine the prevalence of goitre and its associated factors among adult population in Peninsular Malaysia. Materials and Methods: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. The diagnosis of goitre was made by palpation and corroborated by the repeat examination by another investigator. The World Health Organization (WHO) goitre grading system was used. Fifteen millilitre of blood were withdrawn and analysed at a central laboratory. Results: Among 2190 respondents, the prevalence of goitre was 9.3%. Goitre was associated with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Females were at higher risk of goitre (adjusted OR = 2.4; 95% CI 1.6–3.5; p
Fulltext High proportion of adults with type 2 diabetes and poor glycated hemoglobin perceived that their diabetes control was excellent

Shahar MA, Omar AM, Loh HH

Can J Diabetes, 2019 Mar;43(2):98-104.e7.
PMID: 30145243 DOI: 10.1016/j.jcjd.2018.06.003

OBJECTIVES: As is true for other chronic illnesses, perception of disease control is pivotal to patient empowerment in diabetes care. This study aimed to describe the perception of diabetes control by patients with poor glycated hemoglobin (A1C) levels so as to explore the relationship between perception and various sociodemographic and disease characteristics and to measure the patients' knowledge, attitudes and practices in diabetes care.
METHODS: A cross-sectional study was made involving 276 patients with type 2 diabetes mellitus. After obtaining informed consent, their sociodemographics, medical histories and most recent available blood investigations were documented. Patients were asked about their perceptions of diabetes control-whether it was excellent, moderate or poor. A Malay-language knowledge, attitudes and practice questionnaire was administered to respondents. Analyses were descriptive and exploratory.
RESULTS: The median age of the subjects and the durations of diabetes were 56 (interquartile range, 48-62) years and 8 (interquartile range, 4-13) years, respectively. The median A1C level was 9.5% (interquartile range, 8.3%-11.4%). Despite having poor A1C levels, 28.4% of patients perceived that their diabetes control was excellent; 58.9% perceived it as moderate, and only 12.7% accurately perceived it as poor. A significant number of those with higher education had wrong perceptions, indicating that other factors, such as effective communication, need to be considered. The absence of an association between perception and duration of diabetes suggests that information given over the years did not contribute to patients' understanding of disease control. Younger patients had better knowledge scores. Those with higher education levels had higher quartiles of knowledge and attitude but not practice scores.
CONCLUSIONS: This study demonstrated discordance between perceived diabetes control and actual A1C levels, which may hinder effective diabetes care.
Study site: a tertiary referral center and a primary care centre in Kuantan, Pahang, Malaysia
Angiogenic and wound healing potency of fermented virgin coconut oil: in vitro and in vivo studies

Ibrahim AH, Li H, Al-Rawi SS, Majid ASA, Al-Habib OA, Xia X, et al.

Am J Transl Res, 2017;9(11):4936-4944.
PMID: 29218091

OBJECTIVE: The process of wound healing involves activation of keratinocytes, fibroblasts, endothelial cells, etc. Angiogenesis is crucial during the process of wound healing. Virgin coconut oil is widely utilized in South Asia for various purposes including food, medicinal and industrial applications. This study aimed to evaluate the potency of fermented virgin coconut oil (FVCO) in angiogenesis and wound healing via both in vitro and in vivo assays.
METHODS: Human umbilical vein endothelial (HUVEC), fibroblast (CCD-18) and retinal ganglion (RGC-5) cells were cultured in medium containing different concentrations of FVCO. The proliferation, migration and morphological changes of cells were determined. The angiogenic effect of FVCO was evaluated by rat aortic assay. The therapeutic effect of FVCO on wound healing was further assessed in a wound excision model in Sprague Dawley rats. The expression of phospho-VEGFR2 (vascular endothelial growth factor receptor 2) in HUVECs was detected by Western blot.
RESULTS: FVCO (6 and 12 µg/mL) significantly improved the proliferation of HUVEC, CCD-18 and RGC-5 cells (P < 0.05 or 0.01). FVCO (25 µg/mL) markedly increased the migration ability of CCD-18 and RGC-5 cells (P < 0.05). FVCO did not affect cell morphology as indicated by fluorescein diacetate (FDA), rhodamine 123 and Hoechst staining. FVCO (25, 50 and 100 µg/mL) significantly stimulated the ex vivo blood vessel formation as compared with negative control (P < 0.05). Rats in FVCO group had significantly smaller wound size, higher wound healing percentage, and shorter wound closure time when compared with control group since day 8 (P < 0.05), suggesting that oral FVCO administration notably promoted the wound healing process. FVCO treatment (6 and 12 µg/mL) significantly enhanced the phospho-VEGFR2 expression in HUVECs (P = 0.006 and 0.000, respectively).
CONCLUSION: Our study confirms a high angiogenic and wound healing potency of FVCO that might be mediated by the regulation of VEGF signing pathway.
Fulltext Estrogen Receptors in Nonfunctioning Pituitary Neuroendocrine Tumors: Review on Expression and Gonadotroph Functions

Haydar Ali Tajuddin A, Kamaruddin N, Sukor N, Azizan EA, Omar AM

J Endocr Soc, 2020 Dec 01;4(12):bvaa157.
PMID: 33241169 DOI: 10.1210/jendso/bvaa157

Estrogen (17β-estradiol or E2) is a crucial regulator of the synthesis and secretion of pituitary reproductive hormones luteinizing hormone, follicle-stimulating hormone, and prolactin. In this review, we summarize the role of estrogen receptors in nonfunctioning pituitary neuroendocrine tumors (NF-Pitnets), focusing on immunoexpression and gonadotroph cell proliferation and apoptosis. Gonadotroph tumors are the most common subtype of NF-Pitnets. Two major estrogen receptor (ER) isoforms expressed in the pituitary are estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ). Overall, estrogen actions are mostly exerted through the ERα isoform on the pituitary. The G protein-coupled estrogen receptor (GPER) located at the plasma membrane may contribute to nongenomic effects of estrogen. Nuclear immunoreactivity for ERα and ERβ was highest among gonadotroph and null cell tumors. Silent corticotroph tumors are the least immunoreactive for both receptors. A significantly elevated ERα expression was observed in macroadenomas compared with microadenomas. ERα and ERβ may act in opposite directions to regulate the Slug-E-cadherin pathway and to affect invasiveness of NF-Pitnets. In the cellular pathway, ERs regulate estrogen-induced proliferation and differentiation and impact several signaling pathways including the MAPK and PI3K/Akt pathway. Estrogen was the first-discovered inducer of pituitary tumor transforming gene 1 that was abundantly expressed in NF-Pitnets. ERα can be a potential biomarker for predicting tumor size and invasiveness as well as therapeutic target for NF-Pitnets. Selective estrogen receptor modulators or antiestrogen may represent as an alternative choice for the treatment of NF-Pitnets.
Fulltext Attitudes toward euthanasia and related issues among physicians and patients in a multi-cultural society of Malaysia

Rathor MY, Abdul Rani MF, Shahar MA, Jamalludin AR, Che Abdullah ST, Omar AM, et al.

J Family Med Prim Care, 2014 Jul;3(3):230-7.
PMID: 25374860 DOI: 10.4103/2249-4863.141616

INTRODUCTION: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia.
MATERIALS AND METHODS: Questionnaire based survey among consenting patients and physicians.
RESULTS: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status.
CONCLUSIONS: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.
KEYWORDS: Attitude; euthanasia; legalization; multi-cultural; physician-assisted suicide