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Clinical and radiological profile of symptomatic knee osteoarthritis in Malaysia

Veerapen K, Asokan RN, Rathakrishnan V

APLAR Journal of Rheumatology, 2004;7(2):97-107.
DOI: 10.1111/j.1479-8077.2004.00069.x

Aims: To create a clinical and radiological profile of patients with symptomatic osteoarthritis of the knee in Malaysia.
Methods: One hundred consecutive patients presenting with symptomatic knee osteoarthritis at a private rheumatology clinic were profiled for demographic and clinical features. Anteroposterior weight-bearing, skyline and lateral knee X-rays were taken. Statistical Package for Social Sciences was used for data analysis.
Results: Women predominated (93%). Fifty-eight percent of the patients reported bilateral knee pain. Difficulty in walking, climbing and squatting was high (85%, 97% and 93% respectively). Patients with knee pain had a higher BMI than controls. Radiological abnormality, related to osteoarthritis was present in 97%. Osteophytes were generally tricompartmental while joint space narrowing was less evident in the lateral tibiofemoral joint than in the medial tibiofemoral joint and the patellofemoral joint. Almost half (49%) the patients manifested radiological varus deformity The severity of radiological abnormality increased with age. Although patients with unilateral pain had milder radiological abnormality, it tended to be bilateral. Clinically detectable hip abnormality and nodal osteoarthritis were uncommon, as was radiological chondrocalcinosis.
Conclusions: Patients presenting with symptomatic knee osteoarthritis to a rheumatology service had a high degree of disability, radiological abnormality and varus deformity. Radiological abnormalities were essentially bilateral and tricompartmental. © Asia Pacific League of Associations for Rheumatology.
Fulltext A community child and adolescent guidance clinic in Malaysia

Krahl W, Quek SL, Raman N

Med J Malaysia, 1981 Sep;36(3):171-3.
PMID: 7329374

Study site: Child and Adolescent Guidance Clinic, Hospital Bahagia, Perak, Malaysia
Determination of naltrexone dosage for narcotic agonist blockade in detoxified Asian addicts

Navaratnam V, Jamaludin A, Raman N, Mohamed M, Mansor SM

Drug Alcohol Depend, 1994 Feb;34(3):231-6.
PMID: 8033761

Thirty-eight, adult, male, detoxified, Malaysian opiate addicts participated in this double-blind clinical evaluation of naltrexone. Addicts from three ethnic groups: Chinese, Malays, and Indians received a weekly regimen of naltrexone (100 mg on Days 1 and 3, and 150 mg on Day 5). Subjects were randomly assigned to receive intravenous challenge with either 25 mg heroin or placebo 12, 24, 48, and 72 h after the third naltrexone dose. Physiological and subjective parameters were measured at each challenge interval. Results indicated that naltrexone was effective in blocking the physiological and psychological effects of heroin for at least 48 and 72 h, respectively, in detoxified Malaysian opiate addicts. The efficacy of naltrexone did not differ among the three ethnic groups evaluated in this study.
High prevalence of thyroid function test abnormalities in chronic schizophrenia

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N

Aust N Z J Psychiatry, 1994 Dec;28(4):620-4.
PMID: 7794205

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n = 152, p = 0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n = 449, p = 0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT41 and FT31 were significantly lower in those with low or high TSH (p < 0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.
Mechanotransduction of mesenchymal stem cells (MSCs) during cardiomyocytes differentiation

Raman N, Imran SAM, Ahmad Amin Noordin KB, Wan Kamarul Zaman WS, Nordin F

Heliyon, 2022 Nov;8(11):e11624.
PMID: 36425431 DOI: 10.1016/j.heliyon.2022.e11624

Cardiac muscle cells have an innate capacity to perceive and react to mechanical strain via a mechanism known as mechanotransduction, whereby the cardiac muscle cells are intrinsically capable of sensing and responding to mechanical strain. This process occurs in the heart when mechanical inputs are converted to biochemical processes that result in myocardial structure and function changes. Mechanotransduction and its downstream effects work as compensatory mechanisms during early load adaptation. However, prolonged, and aberrant loading may cause maladaptive remodeling, resulting in altered physiological function, pathological cardiac hypertrophy, and heart failure. The rapid advancement of stem cell research has raised the hopes of both patients and clinicians. Mesenchymal progenitors have become one of the most intriguing possibilities for treating illnesses ranging from cartilage abnormalities to heart issues. Their immunomodulatory properties have also allowed for allogenic usage, besides expanding their potential for cardiomyocyte applications. In the present review, we highlighted mesenchymal stem cells (MSCs) in cardiovascular mechanotransduction, differentiation of cardiomyocytes and the use of MSCs in cardiovascular disease and tissue engineering.
Delayed HIV testing and treatment seeking, and associated support needs among people living with HIV in Malaysia: a qualitative study

Chong SCS, Kamarulzaman A, Azwa I, Ng RX, Chong ML, Raman N, et al.

Sex Health, 2021 05;18(2):147-155.
PMID: 33715762 DOI: 10.1071/SH20180

Background By the end of 2017, an estimated 83% of people living with HIV in Malaysia knew their serostatus. However, the Ministry of Health reported a high proportion of those newly diagnosed had low CD4 counts <200 cells/µL, indicating late presentation for testing may be pervasive.
METHODS: A qualitative study was conducted to explore the context and experiences of people at risk of HIV infection testing and seeking treatment later in the course of their infection. Participants recruited (n = 20) were HIV positive, aged >18 years who fit the description of late presentation (World Health Organization defined as CD4 cell count <350 cells/µL). Semi-structured interviews were conducted, and a framework approach was used to interrogate the data.
RESULTS: Many participants perceived themselves at low risk of HIV infection and did not undergo routine voluntary testing; rather, they were diagnosed when seeking treatment for serious illness or as part of mandatory employment-related testing. Perceived lack of confidentiality and potential discriminatory behaviour at public health facilities were significant deterrents to testing. Participants were satisfied with HIV treatment, but rarely sought psychosocial support in order to 'protect' their privacy.
CONCLUSION: Unless drivers of HIV infection are effectively addressed, including stigmatising and discriminatory practices, and low health literacy, the occurrence of late presentation will persist. Their collective impact will not only jeopardise efforts to improve the treatment cascade, but may also impact engagement with other biomedical prevention and care technologies.
Health-related quality of life among Malaysian pediatric survivors of central nervous system tumor

Rajagopal R, Raman N, Ong LC, Foo JC, Fong CY

Pediatr Hematol Oncol, 2023 Feb;40(1):26-39.
PMID: 35608384 DOI: 10.1080/08880018.2022.2069895

Pediatric central nervous system tumor survivors (CNSTS) experience late effects that may affect their health-related quality of life (HRQOL). The study aims: i) compare HRQOL among Malaysian CNSTS with acute lymphoblastic leukemia survivors (ALLS) and healthy children, and ii) explore factors associated with low HRQOL. We performed a comparative cross-sectional HRQOL study of 46 CNSTS aged 5-18 years and 90 ALLS (age and gender-matched) who completed treatment for >1 year, and a published cohort of healthy children. Pediatric Quality of Life Inventory (PedsQL) was used for all groups and PedsQL Cancer Module for CNSTS and ALLS. Multiple regression analysis was used to determine factors associated with low HRQOL. Mean PedsQL total scale score, physical health score and psychosocial health score of CNSTS were 69.0 (SD 20.3), 68.7 (SD 27.9) and 69.2 (SD 19.2) respectively. These scores were significantly lower in all domains particularly in teenagers compared with healthy children and ALLS. The median PedsQL Cancer Module score of CNSTS was significantly lower than ALLS in total scale, cognitive problems and communication. Physical impairment was associated with lower PedsQL scores in all 3 domains; special education placement was associated with lower PedsQL total scale and physical health scores and clinically significant internalizing behavioral difficulties score was associated with lower PedsQL psychosocial health scores. CNSTS reported lower PedsQL scores in all domains than ALLS and healthy children. Clinicians need to be vigilant of HRQOL needs among CNSTS, especially those with risk factors of special education needs, physical impairment, and internalizing behavioral difficulties.
Fulltext Performance of a Novel Low-Cost, Instrument-Free Plasma Separation Device for HIV Viral Load Quantification and Determination of Treatment Failure in People Living with HIV in Malaysia: a Diagnostic Accuracy Study

Pham MD, Haile BA, Azwa I, Kamarulzaman A, Raman N, Saeidi A, et al.

J Clin Microbiol, 2019 04;57(4).
PMID: 30700508 DOI: 10.1128/JCM.01683-18

HIV viral load (VL) testing is the recommended method for monitoring the response of people living with HIV and receiving antiretroviral therapy (ART). The availability of standard plasma VL testing in low- and middle-income countries (LMICs), and access to this testing, are limited by the need to use fresh plasma. Good specimen collection methods for HIV VL testing that are applicable to resource-constrained settings are needed. We assessed the diagnostic performance of the filtered dried plasma spot (FDPS), created using the newly developed, instrument-free VLPlasma device, in identifying treatment failure at a VL threshold of 1,000 copies/ml in fresh plasma. Performance was compared with that of the conventional dried blood spot (DBS). Venous blood samples from 201 people living with HIV and attending an infectious disease clinic in Malaysia were collected, and HIV VL was quantified using fresh plasma (the reference standard), FDPS, and DBS specimens. VL testing was done using the Roche Cobas AmpliPrep/Cobas TaqMan v2.0 assay. At a threshold of 1,000 copies/ml, the diagnostic performance of the FDPS was superior (sensitivity, 100% [95% confidence interval {CI}, 89.1 to 100%]; specificity, 100% [95% CI, 97.8 to 100%]) to that of the DBS (sensitivity, 100% [95% CI, 89.4 to 100%]; specificity, 36.8% [95% CI, 29.4 to 44.7%]) (P