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Multiple polypoid endometriosis--a rare complication following withdrawal of gonadotrophin releasing hormone (GnRH) agonist for severe endometriosis: a case report

Othman NH, Othman MS, Ismail AN, Mohammad NZ, Ismail Z

Aust N Z J Obstet Gynaecol, 1996 May;36(2):216-8.
PMID: 8798320

A 30-year old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.
Serum calcium and parathormone during normal pregnancy in Malay women

Singh HJ, Mohammad NH, Nila A

J Matern Fetal Med, 1999 May-Jun;8(3):95-100.
PMID: 10338062

To ascertain the calcium status in normal pregnant Malay women.
Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC)

Abdullah BJ, Mohammad N, Sangkar JV, Abd Aziz YF, Gan GG, Goh KY, et al.

Br J Radiol, 2005 Jul;78(931):596-600.
PMID: 15961840

The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).
Fulltext Demographic and clinical characteristics of red tag patients and their one-week mortality rate from the emergency department of the Hospital Universiti Sains Malaysia

Ahmad R, Rahmat R, Hisamudin N, Rahman NA, Noh AY, Mohammad N, et al.

Southeast Asian J. Trop. Med. Public Health, 2009 Nov;40(6):1322-30.
PMID: 20578468

Early identification and rapid treatment of red tag patients may decrease morbidity and mortality. We examined the clinical characteristics, etiologies and one week mortality rate of red tag (life threatening and potentially life threatening illness) patients at the Hospital Universiti Sains Malaysai (HUSM). A cross-sectional study was conducted at the Emergency Department of the HUSM from 1 August 2006 to 31 January 2007; 440 eligible patients were analyzed. The group had a mean age of 47.2 +/- 22 years, with 67.3% of the patients being male. Twenty-three percent were trauma cases with motor vehicle accident being the major mechanism of injury. Fifty-four percent of the cases had cardiac related illnesses. The mean duration of stay in the Emergency Department (ED) was 3.9 +/- 1.5 hours. The survival rate at one week was 76.6%. The non-trauma group comprised 74.0% of death cases. Acute coronary syndrome and road traffic accidents comprised 22.0% of total death cases at one week. Red tag patients constitute a large proportion of ED cases and may remain in the ED for significant periods of time.

Study site: Hospital Universiti Sains Malaysia (HUSM)
Fulltext Case series of foreign body aspiration in Paediatric Institute, Hospital Kuala Lumpur

Sahadan DZ, Zainudin NM, Kassim A, Zahari Z, Mahadzir M, Daud CZ, et al.

Med J Malaysia, 2011 Dec;66(5):484-6.
PMID: 22390106 MyJurnal

A retrospective case series was conducted to determine the clinical characteristics and bronchoscopy findings of children with foreign body aspiration in Paediatric Institute, Hospital Kuala Lumpur. Ten boys and two girls were included (range 2-177 months; median 26 months old). They commonly presented with cough (12/100%) and difficulty in breathing (9/75%). All patients had unilateral auscultatory findings and the commonest radiographic findings were unilateral hyperinflation (7/58.3%). The majority of foreign bodies removed was organic (8/66.6%) and more frequently found in the left bronchial tree (7/58.3%). Major complications were pneumonia (11/91.6%) and airway oedema (11/ 91.6%). Eight patients had delayed diagnosis due to parents unawareness (6/50%) and missed diagnosis (2/16.7%).
Fulltext Study of heavy metal levels among farmers of Muda Agricultural Development Authority, Malaysia

Ghazali AR, Abdul Razak NE, Othman MS, Othman H, Ishak I, Lubis SH, et al.

J Environ Public Health, 2012;2012:758349.
PMID: 22536276 DOI: 10.1155/2012/758349

Heavy metals, particularly cadmium, lead, and arsenic, constitute a significant potential threat to human health. This study was conducted to determine the levels of cadmium, lead, and arsenic in nail samples from farmers at Muda Agricultural Development Authority (MADA), Kedah, Malaysia, and evaluate factors that can contribute to their accumulations. A total of 116 farmers participated in this study. Inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze concentration of heavy metals in the nail samples and questionnaires were given to participants to get demographic, health status, and their agricultural activities data. In this paper, the level of heavy metals was within the normal range and varies according to demographic factors. We found that there were significant correlations between working period with level of lead and arsenic (r=0.315 and r=0.242, resp., P<0.01) and age with lead level (r=0.175, P<0.05). Our findings suggested that agricultural activities could contribute to the accumulation of heavy metals in farmers. Hence, the control of environmental levels of and human exposure to these metals to prevent adverse health effects is still an important public health issue.
Fulltext Analysis of selected glutathione S-transferase gene polymorphisms in Malaysian type 2 diabetes mellitus patients with and without cardiovascular disease

Etemad A, Vasudevan R, Aziz AF, Yusof AK, Khazaei S, Fawzi N, et al.

Genet. Mol. Res., 2016 Apr 07;15(2).
PMID: 27173202 DOI: 10.4238/gmr.15025845

Type 2 diabetes mellitus (T2DM) is believed to be associated with excessive production of reactive oxygen species. Glutathione S-transferase (GST) polymorphisms result in decreased or absent enzyme activity and altered oxidative stress, and have been associated with cardiovascular disease (CVD). The present study assessed the effect of GST polymorphisms on the risk of developing T2DM in individuals of Malaysian Malay ethnicity. A total of 287 subjects, consisting of 87 T2DM and 64 CVD/T2DM patients, as well as 136 healthy gender- and age-matched controls were genotyped for selected polymorphisms to evaluate associations with T2DM susceptibility. Genomic DNA was extracted using commercially available kits, and GSTM1, GSTT1, and α-globin sequences were amplified by multiplex polymerase chain reaction. Biochemical parameters were measured with a Hitachi autoanalyzer. The Fisher exact test, the chi-square statistic, and means ± standard deviations were calculated using the SPSS software. Overall, we observed no significant differences regarding genotype and allele frequencies between each group (P = 0.224 and 0.199, respectively). However, in the combined analysis of genotypes and blood measurements, fasting plasma glucose, HbA1c, and triglyceride levels, followed by age, body mass index, waist-hip ratio, systolic blood pressure, and history of T2DM significantly differed according to GST polymorphism (P ˂ 0.05). Genetically induced absence of the GSTT1 enzyme is an independent and powerful predictor of premature vascular morbidity and death in individuals with T2DM, and might be triggered by cigarette smoking's oxidative effects. These polymorphisms could be screened in other ethnicities within Malaysia to determine further possible risk factors.
Pyopneumothorax secondary to Streptococcus milleri infection

Che Rahim MJ, Mohammad N, Wan Ghazali WS

BMJ Case Rep, 2016 Nov 23;2016.
PMID: 27881590 DOI: 10.1136/bcr-2016-217537

We report a case of a 46-year-old Malay woman with underlying hypothyroidism post thyroidectomy who presented with worsening breathlessness, orthopnoea, productive cough and left-sided pleuritic chest pain of 3 days duration. Chest X-ray on admission showed left-sided massive hydropneumothorax. Pleural tapping revealed empyema. A chest tube was inserted immediately. The culture of pleural fluid grew Streptococcus constellatus The patient was treated with antibiotics for a total of 6 weeks and underwent open thoracotomy and decortication during admission. Subsequently, her lung condition improved and there was no evidence of recurrence during follow-up.
Fulltext The association of nuclear abnormalities in exfoliated buccal epithelial cells with the health status of different agricultural activities farmers in Peninsular Malaysia

Abdul Hamid Z, Mohd Zulkifly MF, Hamid A, Lubis SH, Mohammad N, Ishak I, et al.

Genes Environ, 2016;38:7.
PMID: 27350827 DOI: 10.1186/s41021-016-0032-1

Pesticide exposure possesses risk of genotoxicity to humans, particularly farmers. Despite accumulating evidences linking genotoxicity to pesticide exposure, epidemiological studies to address pesticide toxicity in occupationally exposed farmers in Malaysia remain underreported. Thus, this study was aimed to determine the presence of nuclear abnormalities through the assessment of micronucleus (MN) and binucleus (BNu) frequencies in exfoliated buccal epithelial cells from farmers who were exposed to pesticides. A cross-sectional study of farmers among different agricultural activities farmers in Bachok and Pasir Puteh, Kelantan, North East of Peninsular Malaysia was done to evaluate the presence of nuclear abnormalities and its correlation with their health status and farming activities.
Fulltext Rationalizations and identity conflict following smoking relapse: a thematic analysis

Wee LH, Binti Ithnin AA, West R, Mohammad N, Chan CM, Hasan Nudin SS

J Subst Use, 2017 Jan 02;22(1):47-52.
PMID: 28217031 DOI: 10.3109/14659891.2016.1143045

Introduction: Little is known about how smokers respond cognitively and emotionally to the experience of "late" relapse after the acute withdrawal phase. This study assessed the kinds of thoughts and feelings that emerge in order to provide a basis for quantitative research assessing prevalence of different types of response and implications for future quit attempts. Methods: Face-to-face in-depth interviews were conducted among 14 people attending a quit smoking clinic in Malaysia who had relapsed after at least 6 weeks of abstinence. Transcripts were analyzed using thematic analysis to enable emergence of important aspects of the experience. Results: Following relapse, smokers often engaged in rationalizations and activities to minimize worry about the harmful effects of smoking by switching to a lower-tar cigarette, reducing the number of cigarette smoked, attempting to reduce cigarette smoke inhalation, comparing themselves with other smokers, and minimizing the health risks associated with smoking. In some cases, smokers retained a "non-smoker" identity despite having relapsed. Conclusion: Smoking relapsers rationalize their failure to quit and minimize their health risk in order to protect their image as non-smokers while it remains a source of identity conflict.
Study site: Quit Smoking Clinic, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
Fulltext Severe Plasmodium knowlesi with dengue coinfection

Che Rahim MJ, Mohammad N, Besari AM, Wan Ghazali WS

BMJ Case Rep, 2017 Feb 20;2017.
PMID: 28219910 DOI: 10.1136/bcr-2016-218480

We report a case of severe Plasmodium knowlesi and dengue coinfection in a previously healthy 59-year-old Malay man who presented with worsening shortness of breath, high-grade fever with chills and rigors, dry cough, myalgia, arthralgia, chest discomfort and poor appetite of 1 week duration. There was a history mosquito fogging around his neighbourhood in his hometown. Further history revealed that he went to a forest in Jeli (northern part of Kelantan) 3 weeks prior to the event. Initially he was treated as severe dengue with plasma leakage complicated with type 1 respiratory failure as evidenced by positive serum NS1-antigen and thrombocytopenia. Blood for malarial parasite (BFMP) was sent for test as there was suspicion of malaria due to persistent thrombocytopenia despite recovering from dengue infection and the presence of a risk factor. The test revealed high count of malaria parasite. Confirmatory PCR identified the parasite to be Plasmodium knowlesi Intravenous artesunate was administered to the patient immediately after acquiring the BFMP result. Severe malaria was complicated with acute kidney injury and septicaemic shock. Fortunately the patient made full recovery and was discharged from the ward after 2 weeks of hospitalisation.
Eosinophilic granulomatosis with polyangiitis and mononeuritis multiplex responded to induction cyclophosphamide

Mohammad N, Wan Ghazali WS

BMJ Case Rep, 2017 May 27;2017.
PMID: 28551593 DOI: 10.1136/bcr-2016-218252

We report a case of 28-year-old Malay woman who initially presented with multiple joints pain with underlying poorly controlled asthma since her childhood. She was treated as seronegative arthritis. However, the involvement of joints, asthma and high-eosinophil counts raised suspicion of Churg-Strauss syndrome. This disease is undoubtedly rare in Malaysians or even in Asian populations. After appropriate therapy was delivered for the correct diagnosis her clinical condition improved. She is currently receiving maintenance treatment.
Fulltext Deep vein thrombosis as a rare presentation in a female with anti-neutrophil cytoplasmic antibodies-associated vasculitis

Wan Ghazali WS, Mohammad N, Ismail AM

Arch Rheumatol, 2017 Jun;32(2):171-174.
PMID: 30375559 DOI: 10.5606/ArchRheumatol.2017.6108

This article aims to report a case of a young female patient with anti-neutrophil cytoplasmic antibodies-associated vasculitis complicated with pulmonary renal syndrome, multiple relapses, and who later developed venous thromboembolism. Pulmonary renal syndrome is a well- recognized and lethal complication; however, incidence of venous thromboembolism has not been well-described. In this article, we described a 38-year-old Malay female patient admitted in 2008 with three-month history of peripheral neuropathy of lower limbs and right ankle ulcers. Initial inflammatory markers were high and perinuclear Anti-Neutrophil Cytoplasmic Antibodies were positive. She was diagnosed as anti-neutrophil cytoplasmic antibodies-associated vasculitis and started on intravenous methylprednisolone with methotrexate. She presented with relapse of skin vasculitis complicated with pulmonary renal syndrome after being stable for one year. She was intubated and proceeded with plasmapheresis and hemodialysis. She completed six cycles of cyclophosphamide. Renal biopsy revealed chronic changes consistent with end stage renal disease. She further relapsed in 2011 with nasal blockage, epistaxis, and nasal deviation. Chest X-ray revealed lung nodules. Prednisolone was increased, her symptoms settled, and she was discharged with azathioprine. She was readmitted at the end of the same year due to two-day history of right deep vein thrombosis and she later succumbed to methicillin-resistant Staphylococcus aureus sepsis.
Muscular sarcocystosis: an index case in a native Malaysian

Mohammad N, Besari AM, Nair PK, Wan Ghazali WS

BMJ Case Rep, 2017 Jul 26;2017.
PMID: 28747414 DOI: 10.1136/bcr-2017-220490

A previously healthy 20-year-old man presented with prolonged intermittent low grade fever and cough for 6months. He had bilateral calf pain and lower limb weakness 2days prior to admission. Physical examination revealed multiple enlarged lymph nodes with hepatomegaly. There was bilateral calf tenderness with evidence of proximal myopathy. Full blood picture showed lymphocytosis with reactive lymphocytes and eosinophilia. Creatine kinase and lactate dehydrogenase were markedly elevated. Over 2 weeks of admission, patient was treated symptomatically until the muscle biopsy of right calf revealed eosinophilic myositis with muscular sarcocystosis. He was treated with albendazole and high-dose corticosteroids. Symptoms subsided on reviewed at 2weeks and the dose of corticosteroid was tapered down slowly over a month. Due to poor compliance, he was readmitted 1month later because of relapsed. High-dose corticosteroid was restarted and duration for albendazole was prolonged for 1month. His symptom finally resolved over 2weeks.
Fulltext Low-dose intrapleural alteplase (without deoxyribonuclease) in complicated parapneumonic effusion: case series and literature reviews

Lai C, Mohammad N, Hassan TM, Abdul Hamid MF

BMJ Case Rep, 2017 Sep 11;2017.
PMID: 28893806 DOI: 10.1136/bcr-2017-221239

This case series reviews two cases of elderly patients who presented with fever, cough and shortness of breath. Clinical examinations and initial chest radiographs confirmed unilateral pleural effusion. Thoracenteses were consistent with exudative pleural effusion. We commenced intravenous antibiotics treating for parapneumonic effusions. The first case showed persistent effusion despite drainage, and the second case had a little aspirate from pleural tapping. Subsequent ultrasound of the thorax showed multiloculated effusions. We made the decisions for intrapleural fibrinolytic therapy using low-dose alteplase 2.5 mg each time, in view of the elderly patient as sacrosanct for risk of bleeding. Furthermore, DNase was not used, as it is not yet available in our setting. Both of our patients had good clinical and radiological outcomes, without the need for surgical interventions.
Fulltext Metastatic melanoma: a rare cause of central airway obstruction

Abdul Hamid MF, Ban Yu-Lin A, Hassan TM, Mohammad N

BMJ Case Rep, 2017 Nov 04;2017.
PMID: 29103009 DOI: 10.1136/bcr-2017-221545

A middle-aged woman with recurrent malignant melanoma presented initially with massive left pleural effusion. There was a complete obliteration of the left main bronchus on flexible bronchoscopy caused by a mass. Serial cryo-debulking of the tumour was done under rigid bronchoscopy; however, the outcome was not favourable due to the aggressive tumour growth. Vemurafenib was planned after thoracic radiation. She was not keen for the biologics treatment due to financial constraints. We report a case of central airway obstruction due to recurrent aggressive melanoma. More evaluations are needed on the role of interventional pulmonologist for bronchoscopic debulking of this rapidly growing tumour as well as the role of biological agents in treating such cases.
Fulltext Cavitary lung lesions: Melioidosis and pulmonary embolism causing necrotizing pneumonia

Mohammad N, Wan Ghazali WS

IDCases, 2017;10:4-6.
PMID: 28791214 DOI: 10.1016/j.idcr.2017.07.008

Cavitary lung lesions of various etiologies may be encountered in patients with respiratory symptoms associated with fever. Non-malignant cavitary lesions may mimic malignant lung lesions on most of radiographic modalities including chest radiographs or thoracic computed tomography (CT). Primary lung malignancy can be detected in as high as one-fifths of CT thorax as cavitary lesions and the remaining aetiologies may be due to bacterial, parasitic, and invasive fungal infections, as well as Granulomatosis with polyangiitis (GPA), sarcoidosis, septic thrombo-embolism, and lung metastasis from extra-pulmonary primaries. We report an interesting case of melioidosis infection complicated with pulmonary embolism, both of which can lead to cavitary lung lesions and subsequently cause a clinical conundrum.
Fulltext Nigerian pharmacists' self-perceived competence and confidence to plan and conduct pharmacy practice research

Abubakar U, Sulaiman SA, Usman MN, Umar MD

Pharm Pract (Granada), 2018 03 27;16(1):1152.
PMID: 29619141 DOI: 10.18549/PharmPract.2018.01.1152

Background: Recent studies have revealed that pharmacists have interest in conducting research. However, lack of confidence is a major barrier.
Objective: This study evaluated pharmacists' self-perceived competence and confidence to plan and conduct health-related research.
Method: This cross sectional study was conducted during the 89th Annual National Conference of the Pharmaceutical Society of Nigeria in November 2016. An adapted questionnaire was validated and administered to 200 pharmacist delegates during the conference.
Result: Overall, 127 questionnaires were included in the analysis. At least 80% of the pharmacists had previous health-related research experience. Pharmacist's competence and confidence scores were lowest for research skills such as: using software for statistical analysis, choosing and applying appropriate inferential statistical test and method, and outlining detailed statistical plan to be used in data analysis. Highest competence and confidence scores were observed for conception of research idea, literature search and critical appraisal of literature. Pharmacists with previous research experience had higher competence and confidence scores than those with no previous research experience (p<0.05). The only predictor of moderate-to-extreme self-competence and confidence was having at least one journal article publication during the last 5 years.
Conclusion: Nigerian pharmacists indicated interest to participate in health-related research. However, self-competence and confidence to plan and conduct research were low. This was particularly so for skills related to statistical analysis. Training programs and building of Pharmacy Practice Research Network are recommended to enhance pharmacist's research capacity.
Fulltext Bilateral tension pneumothorax after acupuncture

Mohammad N

BMJ Case Rep, 2018 Apr 19;2018.
PMID: 29674395 DOI: 10.1136/bcr-2017-221550

Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces.
Fulltext Catheterisation of a persistent left superior vena cava

Boodhun M, Mohammad N, Adnan A, Wan Ghazali WS

BMJ Case Rep, 2018 Jul 06;2018.
PMID: 29982177 DOI: 10.1136/bcr-2018-224355

We present a case of a 62-year-old woman with end-stage renal disease who displayed a persistent left superior vena cava detected following placement of haemodialysis catheter through the left internal jugular vein (IJV). The diagnosis was confirmed by left internal jugular vein cathetogram, computed tomography (CT) thorax and transthoracic echocardiography. The catheter was removed without immediate complications. She remained well during the outpatient follow-up.

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