POSTERS FOR HARM REDUCTION THEME

#96 COMPARISON BETWEEN WEEKLY VS DAILY DOSING L- IN
THYROXINE FOR THE TREATMENT OF HYPOTHYROIDISM

RAMADAN – A PILOT RANDOMIZED CONTROLLED TRIAL

Nurul Aulia Zakaria (Aulia Z)a , Mohammad Arif Shahar,(Shahar MA)b
a Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM)

b AVISENA Specialist Hospital

INTRODUCTION

• L-thyroxine should be taken daily on empty stomach for optimal absorption and sustained efficacy1
• During Ramadan patients found it difficult to take L-thyroxine on empty stomach during Sahur thus compliance is a

major issue and disease control will be compromised
• Aslam M et al found that more than 50% of patients have medication compliance issue during Ramadan2
• How do we improve L-thyroxine compliance during Ramadan? Weekly medication intake is more convenient compared

to daily intake but is it efficacious and safe as per daily intake?

METHODS • Once a week but seven times (7X) higher than usual daily dose of L-
thyroxine
WEEKLY (n:9)
• Taken at least 30 minutes pre- Sahur
DAILY (n:9) • Measure efficacy – thyroid hormone (TSH/T3/T4)- baseline & week 4
• Measure toxicity– cardiac parameters (holter,echo) baseline & week 2

(within 24hours high dose L-thyroxine ingestion)

• Daily usual dose of L-thyroxine
• Taken at least 2 hours after their last meal before bed
• Measure efficacy- thyroid hormones (TSH/T3/T4)-baseline & week 4
• Baseline cardiac parameters (holter,echo)

RESULTS & DISCUSSION SAFETY

EFFICACY

WEEKLY w0 w4 P value Thyroid Hormone within 24-hours of high dose L-Thyroxine
(Pre-Ramadan) (Ramadan week 4) 0.192
fT3 0.859 20
fT4 5.0(4.0,5.4) 4.5(3.65,5.25) 0.859
TSH 18 17.43
DAILY 13.21(8.19,14.63) 12.38(9.44,15.14) 0.293
fT3 0.953 fT3
fT4 2.63(1.0,7.36) 2.77(1.04,6.65) 0.011 p =0.65
TSH
16

14 13.21
12

10

5.0(4.0,5.4) 4.6(4.55,5.25) 8
14.48(1.58,16.14) 13.63(9.64,15.67)
3.65(0.45,16.10) fT4
1.8(0.23,5.57)
6 5 p =0.01 5.5

4
2.63

2 TSH 1.02
p =0.44

Ø No significant change of thyroid hormones in the weekly arm 0 week 2 (24hrs within high dosing)
(intervention arm) at the end of Ramadan – Weekly dosing is as week 0 (pre Ramadan)
efficaceous as daily dosing
fT4 fT3 TSH
Ø No hyper or hypothyroid symptoms were detected via
clinical scoring system assessment (billewicz,zulewski’s,wayne’s) WEEKLY ARM BASELINE WITHIN 24-HOURS P VALUE
0.3(0.2,0.4) DOSING 0.796
ECHO (systolic
time interval) 0.2(0.2,0.4)

Ø Despite significant increment of T4 after high dose ingestion HOLTER Normal Normal -

of L-thyroxine in weekly arm, there was no cardiac toxicity detected –
High dose weekly dosing of L-thyroxine is cardiac safe

CONCLUSION

Ø Weekly L-thyroxine dosing is biochemically and clinically as efficacious as daily dosing
Ø High dose exogenous L-thyroxine is cardiac safe

Ø Weekly dosing of L-thyroxine is convenient and can help improves medication compliance during Ramadan

References
1. Wenzel KW, Kirschsieper HE. Aspects of the absorption of oral L-thyroxine in normal man.Metabolism 1977 ; 26(1):1-8.
2. Aslam M, Healy MA.Compliance and drug therapy in fasting Moslem patients. J Clin Hosp Pharm 1986;11: 321-5

Acknowledgment www.postersession.com

IIUM Research Initiative Grant Scheme, Endocrinology unit HTAA, SASMEC

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#128

The Responsibility of Pharmacists in Providing Medication Safety at the Transition

of Care: The Development of a Study Protocol on Islamic Perception and Practice.

Mohamed Hassan Elnaema* Nor Ilyani Bt Mohamed Nazara

aQuality use of Medicines Research Group, Department of Pharmacy Practice, Kulliyyah of Pharmacy,

International Islamic University Malaysia

INTRODUCTION *Corresponding author: [email protected]

DISCUSSION AND CONCLUSIONS

 Patient safety is one of the most important components of
health care delivery at every level of care.

 It is well established that medication errors and adverse events
constitute a significant part of medication-related harm where a
majority is extracted from the transition of care.

 This study aims to assess the Islamic perception towards
practice of providing medication safety among pharmacists in
the tertiary hospital in Malaysia at the various transition of care
(hospital admission, within-hospital transfer and discharge).

 Also, it aims to provide basis for an Islamic framework in the
pharmacy practice of ensuring medication safety.

METHODS  This work would suggest that the critical role undertaken by
pharmacists to ensure medication safety could be imbued within
 A qualitative methodology is followed. an Islamic framework.

 A semi-structured interview guide is developed as the study  All the medication safety roles could be integrated with core
instrument. Islamic values.

 The instrument is developed and adapted from the WHO REFERENCES
established guideline, which includes five main domains:
1. World Health Organization. Medication safety in transitions
1. Appropriate prescribing and risk assessment, of care: technical report. World Health Organization; 2019.
2. Medication review,
3. Dispensing preparation and administration, 2. Davidson LA et al. Religion and conscientious objection: a
4. Communication and patient engagement, survey of pharmacists’ willingness to dispense medications.
5. Medication reconciliation at care transition. Social science & medicine. 2010 Jul 1;71(1):161-5.

 Integrated Islamic values to be constructed in the instrument: 3. Ogden J. Religious constraints on prescribing medication.
1. Accountability, Prescriber. 2016 Dec;27(12):47-51.
2. Responsibility,
3. Striving for the best, 4. Akanni SM. An exposition of Islamic medication in the light
4. Advice, of the Quran and Hadith. European Scientific Journal. 2013
5. Counselling. Jul 12;9(19).

 Inclusion criteria: Pharmacists whose practice in the direct
patient care in hospital and community settings.

 The study Investigator will conduct a series of recorded
interviews with eligible pharmacists till achieving the saturation
point.

 Thematic analysis of the interviews’ transcripts will be
performed accordingly.

RESULTS

 Findings are expected to give an overview of the Islamic
perspectives of pharmacy practitioners towards medication
safety.

 The findings to provide bases to conceptualize the Islamic values
that can be integrated with the role of pharmacists in ensuring
the safe use of medications.

RESEARCH POSTER PRESENTATION DESIGN © 2019

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#146

The efficacy and safety of second-generation antipsychotics used in
schizophrenia pharmacotherapy: A comparative review

Mohamed Hassan Elnaem

Quality Use of Medicines Research Group, Department of Pharmacy Practice, Kulliyyah of Pharmacy,

International Islamic University Malaysia

INTRODUCTION DISCUSSION AND CONCLUSIONS

 Antipsychotic medications are widely used to treat

schizophrenia because of their demonstrated clinical benefits.

 It is recommended that antipsychotic agents be tailored to the
patient's condition to maximise positive outcomes while
minimising adverse effects.

 This comparative review was conducted to highlight, summarise,
and provide updates on the differences in efficacy and safety in
the treatment of schizophrenia between various second-
generation antipsychotic drugs (SGAs).

METHODS

 A comparative review was conducted involving the published
literature between 2000 till January 2021.

 The search performed through three scientific databases:
Google Scholar, Science Direct, and PubMed.

 All English literature that reported comparison between
different SGAs in terms of efficacy and/or safety were included.

 We followed a systematic procedure to guide extracting,
charting, and synthesising the results.

RESULTS

Acute episodes

Efficacy Resistant cases

SGAs Maintenance
Metabolic side effects

Safety Cardiovascular side effects
Hyperprolactinemia
Neuroleptic malignant syndrome REFERENCES

1. Howes OD, Murray RM. Schizophrenia: An integrated
sociodevelopmental-cognitive model. Lancet. 2014;383(9929):1677-
1687.

2. Whiteford HA et al. Global burden of disease attributable to mental
and substance use disorders: Findings from the Global Burden of
Disease Study 2010. Lancet. 2013;382(9904):1575-1586.

3. Bruijnzeel D et al. Antipsychotic treatment of schizophrenia: An
update. Asian J Psychiatr. 2014;11:3-7.

4. Taylor JH et al. Time to Clinical Response in the Treatment of Early
Onset Schizophrenia Spectrum Disorders Study. J Child Adolesc
Psychopharmacol. 2021;31(1):46-52.

5. Yoshida K, Takeuchi H. Dose-dependent effects of antipsychotics on
efficacy and adverse effects in schizophrenia. Behav Brain Res.
2021;402:113098.

6. Meltzer HY et al. Lurasidone in the treatment of schizophrenia: A
randomised, double-blind, placebo- and olanzapine-controlled study.
Am J Psychiatry. 2011;168(9):957-967.

7. Stahl SM et al. Effectiveness of lurasidone for patients with
schizophrenia following 6 weeks of acute treatment with lurasidone,
olanzapine, or placebo: A 6-month, open-label, extension study. J Clin
Psychiatry. 2013;74(5):507-515.

RESEARCH POSTER PRESENTATION DESIGN © 2019

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#191

Polymerase chain reaction targeting lipopolysaccharide gene
for diagnosis of Burkholderia pseudomallei infection.

Engku Nuraishah Huda E. Zainudin1, How Soo Hin2, Mohammed Imad Al-Deen Mustafa
Mahmoud3, Quazi Manjurul Haque4

1Dept. of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia.

2 Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia,Kuantan, Pahang, Malaysia.

3 Department of Basic Medical Science, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.

4 Department of Medical Microbiology, College of Medicine, Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia
*Corresponding author: [email protected]

Abstract Results & Discussion

Introduction: Conflicting reports on the use of the polymerase chain LPS-PCR system performed directly on clinical specimens;
reaction (PCR) technique hampered its application as a diagnostic tool
for melioidosis. We explored the diagnostic potential of PCR by When performing PCR directly on clinical specimens, we were able to
targeting the lipopolysaccharide (LPS) gene of Burkholderia detect the LPS genes in 30 out of 31 direct clinical specimens. All positive
pseudomallei in clinical samples obtained from patients in the state of control strains tested positive for the LPS genes. 39 patients with negative
Pahang, Malaysia. Methods: Detection of B. pseudomallei was by culture blood culture were PCR negative. Four patients had positive PCR but
method and PCR, performed directly onto clinical specimens. Primers negative blood or other bodily fluid culture. This gives a sensitivity of
used in this PCR technique were derived from the LPS gene sequence of 96.8% and a specificity of 100%. Figure 2 showed ethidium bromide-
the bacteria as described by Wongratanacheewin et al. Results: When stained direct-from-specimen-LPS-PCR products on a 2% agarose gel.
PCR was performed to detect LPS genes of B. pseudomallei on culture
media, all 35 samples were tested positive. No false positive was noted Figure 1: Ethidium bromide-stained M 2 3 45 6M
when tested on 20 other organisms. When the same method was used on PCR products on a 2% agarose gel.
direct clinical samples, we were able to detect LPS genes in 30 out of 31 Lane M: DNA size markers. Lane 250bp 250bp
clinical isolates. This gives a sensitivity of 96.8% and specificity of 2,4,6: B. pseudomallei positive tested 200bp 178bp
100%. Conclusion: PCR targeting the LPS gene on blood or other bodily isolates. PCR products from clinical
fluids may be useful in the rapid diagnosis of melioidosis and should be isolates of B. pseudomallei were
carried out in hospitals with high incidences of melioidosis. identified at 178bp. No specific
amplifications were seen for S.
Key words: direct clinical sample, PCR, LPS genes, Burkholderia pneumoniae (3) and P. aeruginosa
pseudomallei (5).

Introduction & Objectives Melioidosis is associated with a very high mortality and most patients died
within 48 hours of admission 1-5. Usage of high dose ceftazidime or
Melioidosis is caused by the gram-negative bacillus, Burkholderia carbapenems had been associated with a better outcome in the management
pseudomallei, a common soil and fresh water saprophyte in tropical and of severe melioidosis 12-14 but these antibiotics are very costly and hence,
subtropical regions. It is endemic in tropical Australia1 and in Southeast cannot be given to all patients with suspected melioidosis. It is not
Asian countries, particularly Malaysia2-3, Thailand4 and Singapore5. The uncommon to encounter patients with melioidosis who deteriorate rapidly
overall mortality from this infection remains extremely high despite recent despite antibiotics. Furthermore, maintenance antimicrobial therapy is
advancement in its treatment. A study by Puthucheary et al 2 and in Pahang important to prevent relapses 15. Therefore, bacteriological diagnosis is
3 many years ago showed the mortality were 54-65% among patients with essential to guide clinicians in the early administration of the correct
bacteraemic melioidosis. In Singapore (1997 to 2001), the mortality was antibiotics and on the decision of maintenance antimicrobial therapy.
53% and was higher among those with pneumonia (73%) 6. Mortality in Serology may not be useful in endemic countries and has lower sensitivity
Australia 1 was reported lower; 37% with bacteraemic melioidosis. This and specificity compared to PCR.
was probably due to the wider use of ceftazidime or carbapenems and
better intensive care. Conclusions

A total of 35 patients were culture-confirmed melioidosis from September In conclusion, PCR targeting the LPS gene on clinical specimens of blood
2006 until December 2007. These patients comprised of 30 Malays, 3
Chinese, and 2 Indians. Isolates from various clinical samples were or other bodily fluid may be useful in the rapid diagnosis of melioidosis
collected from these 35 patients; 32 from blood, one from pus only, one
from broncho-alveolar lavage and blood, and another from urine and blood. and should be carried out in hospitals with high incidences of melioidosis.
LPS- PCR system for identification of organism isolated in culture.
Stringent clinical laboratory improvement amendment requirements must
In this test, detection of B. pseudomallei is accomplished by selective
amplification of the LPS virulence gene. We were able to detect the LPS be define the operational characteristics of the in-house PCR assay relative
genes in all 35 clinical isolates. All positive control strains tested positive
for the LPS genes. 20 organisms not isolated from our patients were PCR to current gold standards..
negative. This gives a sensitivity of 100% and a specificity of 100%.
Figure 1 showed ethidium bromide-stained PCR products on a 2% agarose Bibliography
gel.
1. Currie BJ, Fisher DA, Howard DM, et al. Endemic melioidosis in tropical Northern
Australia: a 10 year prospective study and review of the literature. Clin Infect Dis
2000; 31:981-86.

2. Puthucheary SD, Parasakthi N, Lee MK. Septicaenic melioidosis: a review of 50
cases from Malaysia. Trans R Soc Med Hyg 1992; 86:683-85.

3. How SH, Ng KH, Jamalludin AR, et al. Melioidosis in Pahang. Malaysia Med J
2005: 60: 606-13.

4. 4Heng BH, Goh KT, Yap EH, et al. Epidemiological surveillance of melioidosis in
Singapore. Ann Acad Med Singapore 1998; 27:478-84.

5. Mukhopadhyay A , Lee KH, Tambyah PA. Bacteraemic melioidosis pneumonia:
impact on outcome, clinical and radiological features. J Infect 2004; 48:334-8.

6. Chaowagul W, White NJ, Dance DAB, et al. Melioidosis: a major cause of
community-acquired septicemia in Northeastern Thailand. J Infect Dis 1989;
159:890-9.

7. Pitt, T. L., Aucken, H. & Dance, D. A. B.Homogeneity of lipopolysaccharide
antigens in Pseudomonas pseudomallei. J Infect 1992; 25: 139–146.

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#196

Viral infections: Brief review and

prevention from Islamic perspectives.

Engku Nuraishah Huda E. Zainudina, May Khin Soea, Amni Izzatib Nurul
Asyiqin Yusofa

aLecturer, Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, Jalan Sultan
Ahmad Shah, 25200 Kuantan, Pahang.
bStudent, Kulliyyah of Pharmacy, International Islamic University Malaysia, Jalan Sultan
Ahmad Shah, 25200 Kuantan, Pahang.
*Corresponding author: [email protected]

Abstract Discussion

Introduction: The magnitude of diseases caused by viral pathogens is In general, various transmission routes of virus infection have been
enormous. Some types of virus frequently leading to chronic infections discussed in this paper. These can be summarized as in Figure b. The virus
which cause significant medical and economic issues. Viral agents are can be transmitted either directly or indirectly, with or without the help from
constantly emerging or re-emerging with the recent Coronavirus a vector. Some viruses are transmissible just by direct contact (h) from an
outbreak causing panic to the people worldwide. Methodology: Relevant infected individual in which he or she obtained from fecal source (d), animal
literatures were reviewed based on a combination of one or more of the (e) or even facilitated with the presence of formite (j). In actuality, the
following keywords: infection, viral diseases, modes of transmission, possibilities for pathways taken by the virus to infect a healthy individual
prevention control. Islamic perspective related to the topic was extracted are endless. For instance, an infected individual who sneezes can transfer the
using the primary sources (related Qur’anic verses and Hadith) as well as virus to the next individual either by touching them (h) or touching a
secondary sources (fatwa; Islamic jurisprudence, made by Islamic doorknob (j) in which later touched by that healthy individual. This concept
scholars). Results: This review focuses on an intelligible framework that is also applied to the fecal-oral- route transmission whereby after an infected
highlights the differences between various modes of viral transmission individual defecates (d), the virus can be transmitted by shaking hands (h),
and prevention. Conclusion: Understanding viral modes of transmission sharing food (i) or touching surfaces (j) touched by the infected individual
and prevention methods may allow for improved surveillance and which later is ingested. In the vertical transmission, the transmission route
prevention measures. This review also demonstrates prevention methods that the virus takes is limited to the maternal-foetal route (g).
from Islamic beliefs in order to control future occurrence of disease
outbreaks. Another major outcome of this review would allow various However, the mother may
parties. i.e. students, university, the community, health scientists, medical acquire the infection from any
practitioners to be cognizant pertaining viral infection. other route but it is more likely
to occur through sexual
Key words: modes of transmission, preventive control, virus disease, intercourse (a). Virus infection
viral infection. that spreads through mosquito
bites (c) usually does not need
Introduction & Objectives additional intermediate. The
transmission simply passes off
Microbes comprise a practically endless, ever-expanding list of pathogens with the mosquito as the only
that have the potential to induce human disease of varying severity, with intermediate between a healthy
varying means of transmission to humans and of varying epidemiology. and an infected individual.
One of the simplest way to tackle the problem at hand is by addressing the This review paper also emphasized that the Holy Prophet (PBUH) was
source and the routes of disease transmission caused by virus so that so concerned about every aspect of human life including preventive of
prevention methods can be outlined afterwards. It would be of special disease including isolation/quarantive, good hygiene practice and healthy
interest to be able to characterize virus infections according to body lifestyle This was yielded from prophetic traditions that infused
systems, in contrast to the conventional existing categorization system. The preventive knowledge, which if humans could have made proper use
aim of this review is to develop an intelligible framework that highlights of it, they would be prevented from many illness and healed others.
the differences between various modes of disease transmission, prevention
with demonstrates prevention methods from Islamic beliefs in order to Conclusions
control future occurrence of disease outbreaks. Over the years, rising
number of infectious disease outbreaks have emerged across the world. This review gives a simplified picture of the general virus infection and
World Health Organization (WHO) ranked lower respiratory infections steps taken to manage the disease according to Islam. These prevention
(LRTI) as the fourth highest cause of deaths around the world as of 2016. steps help to avoid the beginning of a disease thus promotes healthy life.
Strategy of virus infection management can be focused on following
identification of its transmission routes. One should have an in- depth
knowledge about the way virus are transmitted so that proper interventions
can be applied accordingly. Therefore, this review provides an effortless
way of understanding virus transmission and prevention methods
according to Islam for the community to apply in their daily lives.

Bibliography

1. Ryu W-S. Virus structure. In: Molecular virology of human pathogenic viruses.
London, UK: Elsevier Inc.; 2017. p. 125–39.

2. Walsh D, Mathews MB, Mohr I. Tinkering with translation: Protein synthesis. Cold
Spring Harb Lab Press. 2013;1–28.

3. Lodish H, Berk A, Zipursky SL, Matsudaira P, Baltimore D, James D. Viruses:
Structure, function and uses. In: Molecular Cell Biology. 4th ed. New York: W.H.
Freeman; 2000.

4. Schmid M, Speiseder T, Dobner T, Gonzalez A. DNA Virus Replication
Compartments. J Virol. 2014;88(3):1404–20.

5. Sanchez EL, Lagunoff M. Viral activation of cellular metabolism. Virology [Internet].
2015;479–480:609–18. Available from: http://dx.doi.org/10.1016/j.virol.2015.02.038

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1Department of Biomedical Science & 2Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences & 3Department of Biotechnology, Kulliyyah of Science
International Islamic University Malaysia, Kuantan, Pahang, Malaysia | *Correspondence: [email protected]

The available studies showed a connection between mental health features of anxiety, depression, and stress with osteoarthritic patients.
Articular cartilage tissue engineering (ACTE) methods offer potential options to treat joint diseases. It is evident through the increasing trend of
ACTE research and development in local institutions. However, the ethical and legal concerns of such practices which include the issue of cell
sources, biomaterials, signalling factors, and animal study have yet to be addressed systematically. The study aims to formulate an Islamic ethical
and legal framework to facilitate both scientific and social progress of ACTE research in the Malaysian context.

The present work used content analysis of relevant journal articles obtained through a systematic search of Scopus and Web of Science.

Keywords of “articular cartilage” and “tissue engineering” were used. The study then utilised the existing documents on Malaysian laws,
regulations, and guidelines; and fatwā related to the ACTE research. Based on the documents, the ethical and legal framework was formulated.

The framework was proposed to include six steps in handling the ethical and legal issues in ACTE research. There are (1) to select research
design and strategy, (2) to identify the potential issues, (3) to review relevant laws, regulations and guidelines, (4) to review the relevant sharīʿah

rulings and opinions, (5) to consider possible alternatives and its consequences, and (6) to decide and implement the best course of action. The
steps are aligned based on the concept of Maqāṣid al-Sharīʿah (the objectives of Islamic law) and al-Qawāʿid al-Fiqhiyyah (Islamic Legal Maxim).

RESEARCH STEPS MAQĀSID AL-SHARĪ’AH

IN VITRO IN VIVO The protection of faith
The protection of soul
Cell Source Biomaterial Bench-side 1: Selecting research design and strategy The protection of mind
Scaffold 2: Identify the possible issues The protection of wealth

Signalling
Factor

LAWS, REGULATIONS & 3: Review relevant laws, regulations, and Islamic Approach The protection of offspring
GUIDELINES guidelines
Legislation AL-QAWĀ’ID AL-FIQHIYYAH
The researchers and facilities 4: Review the relevant sharīʿah rulings and
The development of construct opinions Acts are judged by intention
The use of human biological samples Harm must be eliminated
5: Consider possible alternatives and its
The biosafety concerns consequences Certainty is not overruled by doubt
The use of animal Hardship begets facility
6: Decide and implement the best course
Research waste management of action Custom is the basis of judgement

The framework can serve as a guide to conduct safe and sound ACTE research based on the Islamic perspective. It is hoped that the findings
can be used to establish a comprehensive healthcare management model for treating osteoarthritis in the future.

This research was made possible by the; Muhammad Aa’zamuddin, A. R. (2020). Analytical study on articular cartilage tissue engineering research: its ethico-legal aspects

- Ministry of Education Malaysia MyBrain15 MyMaster-MyPhD Programme from Islamic perspective (Doctoral thesis, International Islamic University Malaysia, Pahang, Malaysia). [2] Muhammad Aa’zamuddin, A. R., Sha’ban, M.,
- Ministry of Education Malaysia TRGS/1/2016/UIAM/02/8 (TRGS16-02-003-0003) Syamimi, N. M. A., Azhim, A., & Hashi, A. A. (2020). A survey on relevant Malaysian fatwā about cadaver concerning tissue engineering research. Pertanika
- International Islamic University Malaysia (IIUM), Kuantan Campus, Pahang, Malaysia Journal of Social Sciences & Humanities, 28(2), 1451–1466. [3] Muhammad Aa’zamuddin, A. R., Majdah, Z., Munirah, S., Syamimi, N. M. A., Azhim A., &
- Tissue Engineering and Regenerative Medicine Research Team, KAHS, IIUM Hashi, A. A. (2020). Legal aspects of articular cartilage tissue engineering experimentation: A review on Malaysian acts, regulations and guidelines. Malaysian
Journal of Medicine and Health Sciences, 16(3), 272–284. [4] Muhammad Aa’zamuddin, A. R., Syamimi, N. M. A., Hashi, A. A., Azhim, A., & Sha’ban, M.
(2020). Relevant local fatwā on the issues of using human tissues in articular cartilage tissue engineering experimentation. The International Medical
Journal of Malaysia, 20(1), 127–135.