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Value of subcutaneous fat in predicting ovulation day

Jamaludin J, Nordin NM, Mohamad N, Etta KM

Malays J Reprod Health, 1988 Jun;6(1):65-9.
PMID: 12281593

Subcutaneous body fat and Quetelet's Indices (QI) of 52, 18-29 year old normal female volunteers were determined. These body mass indices were then grouped according to the phase of each subject's menstrual cycle, early or late follicular and early or late luteal phase. The subcutaneous body fat is 27.07 +or- 1.0% in the early follicular but drops to 24.68 +or- 1.84% in the late follicular phase. The value then rises significantly higher than that in the late follicular phase to 30.14 +or- 1.15% (P0.02) in the early luteal drops to 27.17 +or- 0.55% towards the level of the early follicular phase (P0.05). Variations in the values of QI during each menstrual cycle exactly mirror those for subcutaneous body fat. The fall in the 2 body mass indices during the late follicular phase coincides somewhat with the established preovulatory LH and FSH surges as well as the high levels of estrogen of this period. On the other hand the significant rise in the 2 parameters during the early luteal phase coincides with the marked rise in the ratio of progesterone to estrogen. Clearly, increased levels of progesterone relative to estrogen appear to cause an increase in the body fat during each menstrual cycle. The implication of this finding for women on contraceptive pills which are predominantly progesterone and those whose normal menstrual cycle is "interrupted" at the early luteal phase by a successful fertilization raises very interesting questions with regards to prediction of ovulation.
Differential effect of adrenocorticosteroids on 11 beta-hydroxysteroid dehydrogenase bioactivity at the anterior pituitary and hypothalamus in rats

Idrus RB, Mohamad NB, Morat PB, Saim A, Abdul Kadir KB

Steroids, 1996 Aug;61(8):448-52.
PMID: 8870163

11 beta-Hydroxysteroid dehydrogenase (11 beta-OHSD) is a microsomal enzyme that catalyzes the dehydrogenation of cortisol (F) to cortisone (E) in man and corticosterone (B) to 11-dehydrocorticosterone (A) in rats. 11 beta-OHSD has been identified in a wide variety of tissues. The differential distribution of 11 beta-OHSD suggests that this enzyme has locally defined functions that vary from region to region. The aim of this study was to investigate the effects of the glucocorticoids B and dexamethasone (DM), the mineralocorticoid deoxycorticosterone (DOC), and the inhibitors of 11 beta-OHSD glycyrrhizic acid (Gl) and glycyrrhetinic acid (GE) on 11 beta-OHSD bioactivity at the hypothalamus (HT) and anterior pituitary (AP). Male Wistar rats were treated with GI or were adrenalectomized (ADX) and treated with either B, DM, or DOC for 7 days. All treatments were in vivo except GE, which was used in vitro. At the end of treatment, homogenates of HT and AP were assayed for 11 beta-OHSD bioactivity, expressed as the percentage conversion of B to A in the presence of NADP, 11 beta-OHSD bioactivity is significantly higher (P < 0.0001) in the AP compared with the HT. Adrenalectomy significantly increased the enzyme activity in the AP (P < 0.05), an effect reversed by B or DM. ADX rats treated with DOC showed decreased enzyme activity in the AP (P < 0.001) but increased the activity in the HT (P < 0.0001). Gl increased activity in both HT and AP, whereas GE decreased activity significantly. We conclude that the modulation of 11 beta-OHSD is both steroid specific and tissue specific.
Fulltext Acceptability of epidural analgesia for pain relief during labour among Kelantanese women

Sharma S, Mohamad NA, Monga D, Achana S

Med J Malaysia, 1996 Dec;51(4):453-6.
PMID: 10968033

Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.
Fulltext Dengue haemorrhagic fever with unusual prolonged thrombocytopaenia

Kamil SM, Mohamad NH, Narazah MY, Khan FA

Singapore Med J, 2006 Apr;47(4):332-4.
PMID: 16572249

We describe a case of dengue haemorrhagic fever with prolonged thrombocytopaenia. A 22-year-old Malay man with no prior illness presented with a history of fever and generalised macular rash of four days duration. Initial work-up suggested the diagnosis of dengue haemorrhagic fever based on thrombocytopaenia and positive dengue serology. Patient recovered from acute illness by day ten, and was discharged from the hospital with improving platelet count. He was then noted to have declining platelet count on follow-up and required another hospital admission on day 19 of his illness because of declining platelet count. The patient remained hospitalised till day 44 of his illness and managed with repeated platelet transfusion and supportive care till he recovered spontaneously.
Post-impact disaster surveillance - a medical reconnaissance team at tsunami-struck sri lanka

Mohamad N, Abu Bakar NH, Mohamed NA, Baharudin KA, Noh AY, Ahmad R, et al.

Malays J Med Sci, 2007 Jan;14(1):79-83.
PMID: 22593659 MyJurnal

Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31(st) 2004 until January 8(th) 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.
Fulltext Health major incident : the experiences of mobile medical team during major flood

Ahmad R, Mohamad Z, Noh AY, Mohamad N, Hamzah MS, Mohammed NA, et al.

Malays J Med Sci, 2008 Apr;15(2):47-51.
PMID: 22589626 MyJurnal

Disaster is a sudden event that associated with ecological changes, disruption of normal daily activities, destruction of infrastructures, loss of properties, and medical disabilities. In disaster, there is a mismatch between available resources and patients need for healthcare service. During flood disaster, the victims were predisposed to different type of illnesses for various reasons such as inadequate supply of clean water, poor sanitation or drainage system, unhealthy foods, and over-crowded relief centers. Mobile clinic is an option for delivering medical care for the disaster victims who often have a difficulty to access to the medical facilities. In this article we would like to share our experiences during the provision of humanitarian services for flood victims at District of Muar Johor. Common illnesses among the flood victims at visited relief centers and advantages of Mobile Medical Relief Team were also highlighted and discussed.
Assessment of medical graduates competencies

Salam A, Zainuddin Z, Latiff AA, Ng SP, Soelaiman IN, Mohamad N, et al.

Ann Acad Med Singap, 2008 Sep;37(9):814-6.
PMID: 18989506
Fulltext Early onset muscarinic manifestations after wild mushroom ingestion

Chew KS, Mohidin MA, Ahmad MZ, Tuan Kamauzaman TH, Mohamad N

Int J Emerg Med, 2008 Sep;1(3):205-8.
PMID: 19384518 DOI: 10.1007/s12245-008-0054-y

Despite being a favorite delicacy, only 200-300 of the 5,000 known mushroom species have been clearly established to be safe for consumption. Cases of mushroom poisoning have been reported with diverse clinical syndromes. A syndromic classification of mushroom poisoning has recently been developed to facilitate early interventions. We present a series of five cases of mushroom poisoning with muscarinic manifestations to highlight the difficulties we faced with exact species and toxin identification and the importance of this syndromic classification. The common symptoms in our case series are blurred vision, diarrhea, vomiting, and abdominal cramps.
Fulltext Theophylline toxicity: A case report of the survival of an undiagnosed patient who presented to the emergency department

Mohamad N, Abd Halim NN, Ahmad R, Baharuddin KA

Malays J Med Sci, 2009 Apr;16(2):33-7.
PMID: 22589656 MyJurnal

Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.
Fulltext A traditional Malay myth leading to unintentional self intoxication with kecubung fruit

Mohamad N, Baharuddin KA, Ahmad R

Southeast Asian J. Trop. Med. Public Health, 2009 Nov;40(6):1331-4.
PMID: 20578469

Traditional Malay herbal medicine is still used in Malaysia especially in rural areas, instead of using modern medicine. Datura or "kecubung" has been used to treat allergic rhinitis in certain places. Inaccurate doses can potentially cause severe or fatal neurologic anti-cholinergic toxidromes. A good knowledge of toxidromes with optimization of supportive care can prevent fatal complications and lead to a more speedy recovery. We present a case of kecubung poisoning.
Fulltext Assessing patient pain scores in the emergency department

Baharuddin KA, Mohamad N, Nik Abdul Rahman NH, Ahmad R, Nik Him NA

Malays J Med Sci, 2010 Jan;17(1):17-22.
PMID: 22135521 MyJurnal

BACKGROUND: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined.
METHODS: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients' pain scores, based on their observations.
RESULTS: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9.
CONCLUSIONS: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.
KEYWORDS: emergency medicine; neurosciences; pain assessment; pain management; pain score
Study site: Emergency department, Hospital Kuala Lumpur
A study on the magnitude and the effectiveness of the observation ward of hospital universiti sains malaysia

Ahmad R, Nik Abdul Rahman NH, Mohd Noh AY, Nik Abdul Rahman NA, Mohamad N, Baharudin KA

Malays J Med Sci, 2010 Jan;17(1):38-43.
PMID: 22135524 MyJurnal

BACKGROUND: The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management.
METHODS: Patients were selected randomly by convenience sampling. One hundred and twenty-four patients were included in the study. The mean age was 40.3 ± 18.5 years (95% CI: 37.2 to 43.8).
RESULTS: Among the common clinical problems were abdominal discomfort (23%), diarrhoea and vomiting (13%) and fever (13%). Reasons for OW admission included diagnostic uncertainty (63%) and short course of treatment (33%). The mean length of stay was 4.1 ± 1.8 hours (95% CI=3.8 to 4.4 hours). Most of the patients (85%) were discharged.
CONCLUSIONS: The OW of HUSM is effective in managing adult patients as determined by the hospitalisation rate and the length of stay.
Piloting a psycho-education program for parents of pediatric cancer patients in Malaysia

Othman A, Blunden S, Mohamad N, Mohd Hussin ZA, Jamil Osman Z

Psychooncology, 2010 Mar;19(3):326-31.
PMID: 19462470 DOI: 10.1002/pon.1584

To evaluate a psycho-educational program (PeP) for parents of children with cancer (PoCwC) in Malaysia.
Fulltext Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Mohamad N, Bakar NH, Musa N, Talib N, Ismail R

Harm Reduct J, 2010;7:30.
PMID: 21167035 DOI: 10.1186/1477-7517-7-30

BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.
Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors

Salam A, Siraj HH, Mohamad N, Das S, Rabeya Y

Iran J Med Sci, 2011 Mar;36(1):1-6.
PMID: 23365470

Bedside teaching is a vital component of medical education. It is applicable to any situation where teaching is imparted in the presence of patients. In teaching in the patients' presence, learners have the opportunities to use all of their senses and learn the humanistic aspect of medicine such as role modeling, which is vital but difficult to communicate in words. Unfortunately, bedside teaching has been on the decline. To investigate the reasons for the decline in bedside teaching, its importance and its revival, a review of literature was carried out using PubMed and other data bases. The review revealed that the major concerns of bedside teaching were time constraint, false preceptors' concern about patients' comfort, short stay of patients in hospitals, learner distraction by technology, lack of experience and unrealistic faculty expectation. Whatsoever the reasons, bedside teaching cannot be replaced with anything else. There are newer approaches of effective bedside teaching, and the core focus of all such approaches is educational process. A bedside teacher must learn how to involve patients and learners in the educational processes. Moreover, bedside teaching is the process through which learners acquire the skills of communication by asking patients' permission, establishing ground rules, setting time limit, introducing the team, diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. It is most important to ensure a comfortable environment for all participants, the learner, the patient and the bedside teacher. Ongoing faculty development programs on educational processes and realistic faculty expectations may overcome the problems.
Fulltext A Preliminary Study on the Reliability of the Malay Version of PedsQL™ Family Impact Module among Caregivers of Children with Disabilities in Kelantan, Malaysia

Rahman AA, Mohamad N, Imran MK, Ibrahim WP, Othman A, Aziz AA, et al.

Malays J Med Sci, 2011 Oct;18(4):63-8.
PMID: 22589674 MyJurnal

No previous study has assessed the impact of childhood disability on parents and family in the context of Malaysia, and no instrument to measure this impact has previously been available. The objective of this cross-sectional study was to determine the reliability of a Malay version of the PedsQL™ Family Impact Module that measures the impact of children with disabilities (CWD) on their parents and family in a Malaysian context.
Cytochrome P450 3A4 genetic polymorphisms and post-operative fentanyl requirements

Tan PC, Hassan SK, Mohamad NA, Gan SH

J Clin Pharm Ther, 2012 Feb;37(1):100-4.
PMID: 21128989 DOI: 10.1111/j.1365-2710.2010.01232.x

WHAT IS KNOWN AND OBJECTIVE: Interindividual variability in drug responses may be attributable to genetically determined alteration in enzyme activity. In this study, we investigated the association between cytochrome P450 3A4 (CYP3A4) genetic polymorphisms and post-operative fentanyl requirements.
METHODS: Patients (n = 94) scheduled for gynaecological laparotomy received i.v. fentanyl infusion (3 μg/kg/h) after induction of general anaesthesia. Post-operative fentanyl requirements were quantified by using a patient-controlled analgesia and the number of i.v. fentanyl rescue analgesia required were recorded. Pain control was assessed using visual analogue scores (VAS) and fentanyl's adverse effects were documented. CYP3A4*4, CYP3A4*5 and CYP3A4*18 alleles of cytochrome P450 3A4 were identified by polymerase chain reaction-restriction fragment length polymorphism. Differences in fentanyl requirements, VAS scores and adverse effects among the various genotypes were compared.
RESULTS AND DISCUSSION: No CYP3A4*4 and CYP3A4*5 alleles were detected. Eighty-nine patients (94·7%) were wild-type, five (5·3%) were heterozygous and none was homozygous. No significant difference was demonstrated between the genotype groups in terms of fentanyl consumption, pain control and adverse effects.
WHAT IS NEW AND CONCLUSION: CYP3A4*4 and CYP3A4*5 are rare in the Malaysian Malay population. Genetic polymorphism of CYP3A4*18 may not play an important role in influencing postoperative fentanyl requirements.
Polymorphism of ITPA 94C>A and risk of adverse effects among patients with acute lymphoblastic leukaemia treated with 6-mercaptopurine

Wan Rosalina WR, Teh LK, Mohamad N, Nasir A, Yusoff R, Baba AA, et al.

J Clin Pharm Ther, 2012 Apr;37(2):237-41.
PMID: 21545474 DOI: 10.1111/j.1365-2710.2011.01272.x

Genetic polymorphisms of thiopurine S-methyltransferase (TPMT) and inosine triphosphate pyrophosphohydrolase (ITPA 94C>A) contribute to variable responses, including fatal adverse effects, among subjects treated with 6-mercaptopurine (6-MP). Our objectives were to investigate the distribution of specific TPMT and ITPA genotypes in healthy subjects and patients with acute lymphoblastic leukaemia (ALL) from the three main ethnic groups (Malays, Chinese and Indians) in Malaysia and the association of the polymorphisms with adverse effects of 6-MP.
Protective effects of Tualang honey on bone structure in experimental postmenopausal rats

Zaid SS, Sulaiman SA, Othman NH, Soelaiman IN, Shuid AN, Mohamad N, et al.

Clinics (Sao Paulo), 2012 Jul;67(7):779-84.
PMID: 22892923

OBJECTIVE: The objective of this study was to evaluate the effects of Tualang honey on trabecular structure and compare these effects with those of calcium supplementation in ovariectomized rats.
METHODS: Forty female, Sprague-Dawley rats were randomly divided into five groups (n =8): four controls and one test arm. The control arm comprised a baseline control, sham-operated control, ovariectomized control, and ovariectomized calcium-treated rats (receiving 1% calcium in drinking water ad libitum). The test arm was composed of ovariectomized, Tualang honey-treated rats (received 0.2 g/kg body weight of Tualang honey). Both the sham-operated control and ovariectomized control groups received vehicle treatment (deionized water), and the baseline control group was sacrificed without treatment.
RESULTS: All rats were orally gavaged daily for six weeks after day one post-surgery. The bone structural analysis of rats in the test arm group showed a significant increase in the bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th) and trabecular number (Tb.N) and a significant decrease in inter-trabecular space (Tb.Sp) compared with the ovariectomized control group. The trabecular thickness (Tb.Th) in the test arm group was significantly higher compared with the ovariectomized-calcium treated group, and the inter-trabecular space (Tb.Sp) in the test arm group was significantly narrower compared with the ovariectomized-calcium treated group.
CONCLUSION: In conclusion, ovariectomized rats that received Tualang honey showed more improvements in trabecular bone structure than the rats that received calcium.
Infantile fibrosarcoma of the penis in a 2-year-old boy

Taib F, Mohamad N, Mohamed Daud MA, Hassan A, Singh MS, Nasir A

Urology, 2012 Oct;80(4):931-3.
PMID: 22854139 DOI: 10.1016/j.urology.2012.05.021

Fibrosarcoma is rare in the pediatric age group. It generally involves the extremities and the trunk but rarely involves the genital area. We report a case of a large fungating infantile fibrosarcoma of the penis in a 2-year-old Malay boy. Partial recovery of the penile structure was achieved after chemotherapy. The difficulty in managing the social and surgical aspect of this case is discussed in our report. To the best of our knowledge, this is the first case report of infantile fibrosarcoma involving the penis in an Asian region.

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