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  1. Sakthiswary R., Radhika S., Syahrul Sazliyana, S., Abdul Wahab, A.
    Medicine & Health, 2019;14(2):203-211.
    MyJurnal
    The most common extra-articular manifestation of rheumatoid arthritis (RA) is interstitial lung disease (ILD). RA related ILD (RA-ILD) is associated with significant morbidity and mortality. The main objective of this study was to determine the correlation between the rheumatoid factor (RF) serotypes and the severity of RA-ILD based on computed tomography (CT) findings. We recruited a total of 100 RA patients who were tested for IgA RF, IgG RF and IgM RF and had high resolution CT chest performed. Seventy-two patients had ILD changes on HRCT of the chest and were included in this study. We found that the the CT scores for ground glass showed significant positive correlation with disease duration and IgA RF levels whereas the fibrosis scores had significant relationship with multiple clinical covariates i.e age, disease duration, IgA RF levels, IgG RF levels and anti-CCP levels. On multivariate analysis, only IgA levels remained significantly (p
  2. Abdul Wahab A, Rahman MM, Mohammad M, Hussin S
    Pak J Med Sci, 2013 May;29(3):856-8.
    PMID: 24353643
    Syphilis and HIV co-infection are indeed dangerous combinations. The present communication describes three different cases of syphilis and HIV co-infection in young men. The first case is a 25-year-old medical graduate with a primary and secondary syphilis lesions at time of presentation. The second case is a 24-year-old government officer with right eye posterior uveitis where the serology tests for syphilis were reactive. His HIV tests were also positive. The final case is a 25-year-old homosexual who was admitted to the medical ward because of Mycobacterium tuberculosis infection. The HIV and syphilis serology tests were noted to be positive.
  3. Abdul Wahab A, Mohammad M, Rahman MM, Mohamed Said MS
    Pak J Med Sci, 2013 May;29(3):773-7.
    PMID: 24353626
    Objectives: Anti-cyclic citrullinated peptide (CCP) antibody has recently been used in the classification
    of rheumatoid arthritis (RA). This antibody is more specific than rheumatoid factor (RF) for the diagnosis of RA. The study objectives were to determine the sensitivity, specificity, positive and negative predictive values of anti-CCP in RA diagnosis.
    Methodology: Eighty RA patients and 80 non-RA individuals were included in the study. Blood was collected from both arms of study subjects and tested for anti-CCP and RF antibodies. Relevant clinical information and laboratory profiles of the RA patients were evaluated using patients’ medical records and Integrated Laboratory Management System (ILMS), respectively.
    Results: The sensitivity and specificity of anti-CCP were 35% and 100% respectively. The positive and
    negative predictive values were 100% and 61%, respectively. Positive anti-CCP was found significantly
    associated with multiple joint pain (p < 0.001) and hand’s joints pain (p=0.01), symmetrical joints
    involvement (p=0.015) and high CRP value (p < 0.001). Anti-CCP was also found to have positive association with RF (p < 0.001).
    Conclusion: Anti-CCP is highly specific for the diagnosis of RA. High positive predictive value should be taken into consideration for effective treatment.
    KEY WORD: Rheumatoid arthritis, anti-CCP, Rheumatoid factor, Sensitivity, Specificity, Positive predictive value, Negative predictive value.
    Study site: Rheumatology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  4. Balakrishnan N, Md Monoto EM, Mohd Tohit N, Abdul Wahab A
    J Infect Dev Ctries, 2021 08 31;15(8):1205-1211.
    PMID: 34516430 DOI: 10.3855/jidc.12891
    INTRODUCTION: Tuberculosis is a disease of public health concern. It can be treated effectively with good knowledge about the disease and complete adherence to the recommended treatment regime. This study is intended to assess the level of knowledge and perception of treatment among tuberculosis patients attending primary care clinics.

    METHODOLOGY: We conducted a cross-sectional study using a validated self-administered questionnaire among tuberculosis patients attending primary care clinics in Johor Bahru district. A total of 208 tuberculosis patients were enrolled in this study through convenience sampling. We assessed the general knowledge, transmission, causes, and prevention of tuberculosis, where higher scores indicated better knowledge. For the perception of treatment, a higher mean score indicated a more negative perception.

    RESULTS: The mean score for knowledge on tuberculosis was 54.33 ± 12.78, ranging from 25 to 88.9%. The mean score for perception was 2.75±0.52, ranging from 2.15-3.39. We found that although 88.9% of respondents knew a person could be infected with TB through inhalation of tuberculosis bacilli, a majority believed that smoking (68.2%), sharing food (69.2%), and eating from the same plate (66.8%) are causes of tuberculosis. Moreover, there was still a negative perception regarding the treatment of tuberculosis with the highest mean score for the statement 'I am afraid if I am told I am tuberculosis positive'.

    CONCLUSIONS: We found that there were gaps in knowledge among tuberculosis patients. Intermittent counseling during the treatment re-enforces the knowledge of tuberculosis. An updated standardized counseling sheet of tuberculosis Health Education should be included along with staff training to update their knowledge as part of their important role in health education in tuberculosis prevention.

  5. Muttaqillah NA, Abdul Wahab A, Ding CH, Mohammad M, Biswas S, Rahman MM
    EXCLI J, 2015;14:175-8.
    PMID: 26648811 DOI: 10.17179/excli2014-660
    Primary biliary cirrhosis in combination with autoimmune hepatitis has been termed "overlap syndrome", but its diagnosis is challenging. We report a case of a 43-year-old lady who presented with a six-month history of jaundice and pruritus. She subsequently developed gum bleeds. Laboratory investigations revealed hypochromic microcytic anemia, abnormal coagulation profiles, elevated serum alanine transferase and alkaline phosphatase levels, and raised serum IgG and IgM levels. Her serum was also positive for anti-nuclear and anti-mitochondrial antibodies. The findings from her abdominal CT scan were suggestive of early liver cirrhosis and the histopathological examination results of her liver biopsy were consistent with primary biliary cirrhosis. The patient was treated with ursodeoxycholic acid and her liver function test parameters normalized after six months.
  6. Chua KB, Mustafa B, Abdul Wahab AH, Chem YK, Khairul AH, Kumarasamy V, et al.
    Malays J Pathol, 2011 Jun;33(1):13-20.
    PMID: 21874746
    A prospective study was carried out to evaluate the sensitivity of dengue NS1 antigen-capture ELISA in comparison with dengue virus isolation, conventional RT-PCR and real-time RT-PCR for laboratory confirmation of acute dengue based on single-acute serum samples. Four primary healthcare centres were involved to recruit patients with clinical diagnosis of dengue illness. Patient's demographic, epidemiological and clinical information were collected on a standardized data entry form and 5 ml of venous blood was collected upon consent. In the laboratory, six types of laboratory tests were performed on each of the collected acute serum sample. Of the 558 acute serum samples collected from 558 patients with clinical diagnosis of dengue from mid-August 2006 to March 2009, 174 serum samples were tested positive by the dengue NS1 antigen-capture ELISA, 77 by virus isolation, 92 by RT-PCR and 112 by real-time RT-PCR. A total of 190 serum samples were tested positive by either one or a combination of the four methods whereas, only 59 serum samples were tested positive by all four methods. Thus, based on single-acute serum samples, 190 of the 558 patients (34.1%) were laboratory-confirmed acute dengue. The overall test sensitivity was 91.6%, 40.5%, 48.4% and 58.9% for dengue NS1 antigen-capture ELISA, virus isolation, conventional RT-PCR and real-time RT-PCR respectively. Statistically, dengue NS1 antigen-capture ELISA was the most sensitive and virus isolation was the least sensitive test for the laboratory confirmation of acute dengue based on single-acute serum specimens. Real-time RT-PCR was significantly more sensitive than the conventional RT-PCR.
  7. Othman SN, Zainol Rashid Z, Abdul Wahab A, Abdul Samat MN, Ding CH, Ali UK
    Malays J Pathol, 2018 Dec;40(3):295-302.
    PMID: 30580360
    INTRODUCTION: Infant hepatitis B vaccination was introduced into the Expanded Programme on Immunisation (EPI) in Malaysia in 1989. This study aimed to investigate seroprevalence of hepatitis B among UKM pre-clinical medical students, born between 1991 and 1995, and had their infant vaccination more than 20 years ago.

    MATERIALS AND METHODS: A prospective, cross-sectional study involving 352 students, comprising 109 (31.0%) males and 243 (69.0%) females. Blood specimens were tested for anti-HBs, where levels of ≥10 mIU/mL was considered reactive and protective. Students with non-reactive levels were given a 20 μg HBV vaccine booster. Anti-HBs levels were tested six weeks after the first booster dose. Those with anti-HBs <10 mIU/mL were then given another two booster doses, at least one month apart. Anti-HBs levels were tested six weeks after the third dose.

    RESULTS: Ninety-seven students (27.6%) had anti-HBs ranging from 10 to >1000 mIU/mL while 255 (72.4%) had anti-HBs <10 mIU/mL. After one booster dose, 208 (59.1%) mounted anti-HBs ≥10 mIU/mL. Among the remaining 47 (13.3%), all except two students (0.6%) responded following completion of three vaccination doses. They were negative for HBsAg and anti-HBcore antibody, thus regarded as non-responders.

    CONCLUSIONS: Anti-HBs levels waned after 20 years post-vaccination, where more than 70% were within non-reactive levels. For healthcare workers, a booster dose followed by documenting anti-HBs levels of ≥10 mIU/mL may be recommended, to guide the management of post-exposure prophylaxis. Pre-booster anti-HBs testing may not be indicated. Serological surveillance is important in long-term assessment of HBV vaccination programs. No HBV carrier was detected.

  8. Ramlee MH, Gan HS, Daud SA, Abdul Wahab A, Abdul Kadir MR
    J Foot Ankle Surg, 2020 7 1;59(4):664-672.
    PMID: 32600559 DOI: 10.1053/j.jfas.2019.09.006
    Osteoporosis and osteoarthritis are common pathological problems of the human bone tissue. There are some cases of pilon fractures associated with these 2 pathological conditions. In terms of treatment, for a normal and healthy bone with pilon fracture, the use of the Delta external fixator is a favorable option because it can allow early mobilization for patients and provide stability for the healing process. However, the stability of the external fixator differs when there is low bone stiffness, which has not been previously investigated. Therefore, this study was conducted to determine the stability of the external fixator to treat pilon fracture associated with osteoporosis and osteoarthritis, particularly to differentiate the stress distribution and micromovement of fracture fragment. Three-dimensional finite element models of the ankle and foot bones were reconstructed based on the computed tomography datasets. The bones consisted of 5 metatarsal, 3 cuneiform, and 1 each of cuboid, navicular, calcaneus, talus, fibula, and tibia bones. They were assigned with linear isotropic behavior. The ankle joint consisted of ligament and cartilage, and they were assigned with the use of linear links and the Mooney-Rivlin model, respectively. During simulation of the gait cycle, 70 N and 350 N were applied axially to the tibia bone to represent the swing and stance phases, respectively. The metatarsal and calcaneus bones were fixed to prevent any movement of the rigid body. The study found that the greatest von Mises stress value was observed at the pin-bone interface for the osteoporosis (108 MPa) model, followed by the osteoarthritis (87 MPa) and normal (44 MPa) models, during the stance phase. For micromovement, the osteoporosis model had the largest value at 0.26 mm, followed by the osteoarthritis (0.09 mm) and normal (0.03 mm) models. In conclusion, the greatest magnitudes of stress and micromovement were observed for the osteoporosis bone and extra care should be taken to treat pilon fracture associated with this pathological condition.
  9. Tzar MN, Meor Jamaludin WHB, Abdul Wahab A, Ding CH
    IDCases, 2022;27:e01428.
    PMID: 35127454 DOI: 10.1016/j.idcr.2022.e01428
    The second wave of the COVID-19 pandemic in India had brought with it a surge of 'black fungus' co-infection, which is a misnomer for mucormycosis. The present case illustrates the 'real black fungus' infection in a 50-year old male patient with COVID-19 pneumonia, who otherwise had no significant previous medical history. He was admitted on day 8 of COVID-19 illness and was intubated due to persistently low oxygen saturation. Blood cultures were positive for flask-shaped dematiaceous budding yeasts with pseudohyphae formation, which grew as brown-black fuzzy colonies on Sabouraud dextrose agar. The isolate was identified as Exophiala dermatitidis based on phenotypic characterization. Despite antifungal therapy with amphotericin B and itraconazole, the patient deteriorated rapidly and succumbed to acute respiratory distress syndrome and multiorgan failure. A review of reported cases of Exophiala dermatitidis fungemia over the last 5-years is discussed.
  10. Khoo MS, Ahmad Azman AH, Ismail NAS, Abdul Wahab A, Ali A
    Heliyon, 2024 Apr 15;10(7):e28574.
    PMID: 38596105 DOI: 10.1016/j.heliyon.2024.e28574
    OBJECTIVES: Rotavirus (RoV) infections have emerged as a significant public health concern around the world. Understanding the relationship between climatic conditions and hospitalisations due to RoV infections can help engage effective prevention strategies. This study aims to investigate the potential associations between meteorological variability and RoV-related hospitalisations in Kuala Lumpur, Malaysia.

    METHODS: Hospitalization data from a tertiary teaching hospital in Kuala Lumpur over a twelve-year period were retrospectively collected. Concurrently, meteorological data were obtained from the Malaysian Meteorological Department (MetMalaysia) including variables of temperature, humidity, precipitation, and atmospheric pressure to further demonstrate relationship with RoV-associated hospitalisations.

    RESULTS: The results indicated positive correlations between increased rainfall, rainy days, humidity, and RoV-related hospitalisations, suggesting the influence of environmental factors on the transmission of RoV.

    CONCLUSIONS: This study highlights positive associations between meteorological variations and hospitalizations for RoV infections in Kuala Lumpur, Malaysia. Further investigations, including national-level data, are needed to deepen our understanding of these associations, particularly within the context of Malaysia and to develop targeted interventions for disease prevention and control.

  11. Syed Mohamed Suhail SM, Nur Atiqah I, Nur Salimi Zakirah ZA, Lailatul Syazwani Z, Batis WW, Md Monoto EM, et al.
    Malays J Pathol, 2019 Dec;41(3):259-265.
    PMID: 31901910
    INTRODUCTION: Rheumatoid arthritis is diagnosed based on the 2010 Rheumatoid Arthritis Classification Criteria whereby rheumatoid factor and anti-citrullinated protein antibody are the serological markers included in these criteria. Anti-RA33 antibody has the potential to provide additional diagnostic value in rheumatoid arthritis. The aim of this study is to determine the diagnostic performance of anti-RA33 antibody as a serological marker for rheumatoid arthritis.

    MATERIAL AND METHODS: Thirtyfour patients with rheumatoid arthritis and 34 non-rheumatoid arthritis individuals were included in this cross-sectional study. Anti-RA33 antibody and rheumatoid factor were performed on all samples.

    RESULTS: The sensitivity, specificity, positive and negative predictive value for anti-RA33 antibody and rheumatoid factor were 41.1%, 97.1%, 93.3%, 62.3% and 64.7%, 79.4%, 75.9%, 69.2% respectively. The overall sensitivity and specificity if either anti-RA33 antibody or rheumatoid factor are positive were 79.4% and 76.47% respectively.

    CONCLUSION: Anti-RA33 antibody showed good specificity and positive predictive value and could be considered as a potential serological marker for rheumatoid arthritis diagnosis.

  12. Nordin F, Shaharir SS, Abdul Wahab A, Mustafar R, Abdul Gafor AH, Mohamed Said MS, et al.
    Int J Rheum Dis, 2019 Aug;22(8):1419-1426.
    PMID: 31179646 DOI: 10.1111/1756-185X.13615
    OBJECTIVES: This study examined the correlations of both serum and urine interleukin-17A (IL-17A) levels with disease activity in systemic lupus erythematosus (SLE). This study was also aimed at determining their sensitivity and specificity as biomarkers of disease activity in SLE.

    METHODS: A cross-sectional study was performed involving SLE patients (n = 120 patients) from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Serum and urinary IL-17A levels were determined by immunoassay while disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) and British Isles Lupus Assessment Group's 2004 index (BILAG 2004) scores. The correlations between serum and urinary IL-17A levels with total SLEDAI-2K and BILAG 2004 scores were determined using bivariate correlation analyses. Receiver operating characteristic curves were calculated to determine their sensitivity and specificity as disease activity biomarkers.

    RESULTS: Both serum and urinary IL-17A levels correlated with total scores of BILAG 2004, BILAG renal, BILAG mucocutaneous, and SLEDAI-2K (P 

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