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  1. Wen LY, Mohamad NF, Ramli NM
    Trop Doct, 2023 Jan;53(1):97-99.
    PMID: 36380613 DOI: 10.1177/00494755221137628
    We report a clinical case of orbital lymphoma masquerading as orbital cellulitis. Orbital lymphoma and lymphoma of the orbital adnexa are relatively rare types of lymphoma. They represent the malignant end of a spectrum of lymphoproliferative lesions that occur in the orbit, conjunctiva and eyelid. Diffuse large B-cell lymphomas (DLBCL) with variable clinical presentations have a relatively poor prognosis with rapid visual loss. Therefore, thorough evaluation and assessment with a multi-specialty effort are warranted for earlier diagnosis and initiation of treatment to save life and prevent sight loss.
  2. Mohamad NF, Mhd Ali A, Mohamed Shah N
    Int J Clin Pharm, 2015 Feb;37(1):127-32.
    PMID: 25488318 DOI: 10.1007/s11096-014-0049-0
    BACKGROUND: Prescribing medicines in an unlicensed and off-label manner for children is a widespread practice around the world.
    OBJECTIVES: To determine the extent and predictors of off-label respiratory drug prescriptions for children in the outpatient clinics of a hospital in Malaysia.
    SETTING: Outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre, a tertiary teaching hospital in Malaysia.
    METHODS: The pharmacy-based computer system and medical records of the patients were utilized to collect data from 220 pediatric patients who were prescribed at least one respiratory drug from July 2011 to December 2011.
    MAIN OUTCOME MEASURE: Characteristics of the off-label respiratory drug prescriptions were measured.
    RESULTS: A total of 134 children (60.9 %) received at least one respiratory drug prescribed in an off-label manner. The most common reasons for the off-label prescribing of drugs were off-label use by indication (31.5 %), followed by higher than the recommended dose (24.9 %) and lower than the recommended frequency (17.1 %). Diphenhydramine was the most common respiratory drug prescribed off-label. The number of medications prescribed was the only significant predictor of off-label prescription of respiratory drugs. Pediatric patients receiving 4-6 medications were 7.8 times more likely to receive at least one off-label respiratory drug compared to pediatric patients that received 1-3 medications (OR 7.8, 95 % CI 1.74-37.44).
    CONCLUSION: There was substantial prescribing of respiratory drugs for children in an off-label manner at the outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre. This highlights the need for more research to be carried out on respiratory drugs in the pediatric population.

    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
  3. Haque QM, Mohamad NF, Helaluddin AB, Saeed M
    Pak J Pharm Sci, 2010 Oct;23(4):393-7.
    PMID: 20884452
    The cytotoxicity of cell-free culture filtrates of 31 isolates of Vibrio cholerae O1 and O139, 5 reference strains and 26 clinical isolates, was tested on Madin Darby Bovine Kidney (MDBK) cells and Vero cells. The 3-[4,5-dimethylthiazol-2-y]-2, 5-diphenyltetrazolium bromide (MTT) test was used to detect the effect of the filtrates on the proliferation and viability of cultured cell populations. The filtrates were prepared from serial ten-fold dilutions of inoculated AKI and APW broth media with and without the addition of polymyxin B. The APW culture filtrates of both V. cholerae O1 and O139 with and without added polymyxin B showed greater toxicity to MDBK cells as compared to AKI filtrates. The cytotoxicity of AKI-grown V. cholerae O139 to MDBK cells was greater than that of V. cholerae O1 grown in the same medium. The cytotoxicity of APW filtrates on Vero cells was low and only noted when polymyxin was added to the medium.
  4. Sharudin SN, Ismail MF, Mohamad NF, Vasudevan SK
    Neuroophthalmology, 2019 Apr;43(2):102-106.
    PMID: 31312234 DOI: 10.1080/01658107.2018.1482358
    The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing filler injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.
  5. Sharudin SN, Saaid R, Samsudin A, Mohamad NF
    Optom Vis Sci, 2020 02;97(2):81-85.
    PMID: 32011579 DOI: 10.1097/OPX.0000000000001480
    SIGNIFICANCE: To our knowledge, this is the first time a study looking at the association between subfoveal choroidal thickness (SFCT) and the parameters affecting the severity of pre-eclampsia has been reported. We provide evidence that SFCT is thicker in pre-eclamptic (PE) patients and speculate on the possible causes.

    PURPOSE: The purposes of this study were to compare SFCT in PE, normal pregnant, and nonpregnant women using spectral domain optical coherence tomography and to correlate SFCT with severity of pre-eclampsia.

    METHODS: A cross-sectional, observational study was performed. A total of 150 participants were divided into three groups: group 1 (50 PE women), group 2 (50 normal pregnant women), and group 3 (50 nonpregnant healthy women). Subfoveal choroidal thickness was measured using spectral domain optical coherence tomography. Other parameters including mean arterial blood pressure (MABP), central corneal thickness, macular thickness, IOP, ocular perfusion pressure (OPP), and urine protein-to-creatinine ratio were also measured. ANOVA and Pearson correlation analysis were used to look at differences between the groups. P < .05 was considered as statistically significant.

    RESULTS: The MABP was higher in group 1 than in groups 2 and 3 (103.0 ± 12.9 vs. 83.2 ± 9.8 vs. 89.5 ± 7.2 mmHg, respectively; all P < .001). The SFCT of the PE group was higher than in groups 2 and 3 (370.7 ± 23.8 vs. 344.5 ± 30.8 vs. 315.8 ± 49.9 μm, respectively; all P < .001). There were no statistically significant differences in central corneal thickness, macular thickness, or IOP between the PE and healthy pregnant groups (all P > .05). The OPP was greater in PE patients (52.8 ± 8.5 vs. 41.9 ± 6.9 vs. 43.4 ± 5.2 mmHg, respectively; both P < .001). The SFCT was positively correlated with MABP (r = 0.464, P < .001), OPP (r = 0.495, P < .001), and urine protein-to-creatinine ratio (r = 0.635, P < .001) in the PE group.

    CONCLUSIONS: Subfoveal choroidal thickness is higher in pre-eclampsia and is proportional to established markers of severity of the condition. This parameter might serve as a novel predictive marker for the severity of pre-eclampsia.

  6. Lim YW, Lott PW, Mohamad NF, Begam Iqbal T
    Int J STD AIDS, 2021 09;32(10):968-973.
    PMID: 33969754 DOI: 10.1177/09564624211011917
    BACKGROUND: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection.

    METHODS: Case Series.

    RESULTS: In case 1, there was significant improvement in the vision and vitritis after 24 h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1 week after a single intravitreal ceftazidime injection.

    CONCLUSION: The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.

  7. Yeak J, Zahari M, Singh S, Mohamad NF
    Eur J Ophthalmol, 2019 Jul;29(4):NP1-NP4.
    PMID: 30280587 DOI: 10.1177/1120672118803532
    BACKGROUND: Acute ophthalmoparesis without ataxia was designated as 'atypical Miller Fisher syndrome' as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure.

    CASE DESCRIPTION: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive.

    CONCLUSION: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

  8. Naicker P, Sundralingam S, Peyman M, Juana A, Mohamad NF, Win MM, et al.
    Int Ophthalmol, 2015 Aug;35(4):459-66.
    PMID: 25024102 DOI: 10.1007/s10792-014-9970-4
    To determine the accuracy of intraocular lens (IOL) calculations in eyes undergoing phacoemulsification cataract surgery with IOL implantation using immersion A-scan ultrasound (US) and Lenstar LS 900(®) biometry. In this prospective study, 200 eyes of 200 patients were randomized to undergo either Lenstar LS 900(®) or immersion A-scan US biometry to determine the IOL dioptric power prior to phacoemulsification cataract surgery. Post-operative refractive outcomes of these two groups of patients were compared. The result showed no significant difference between the target spherical equivalent (SE) and the post-operative SE value by the Lenstar LS 900(®) (p value = 0.632) or immersion A-scan US biometry (p value = 0.438) devices. The magnitude of difference between the two biometric devices were not significantly different (p value = 0.868). There was no significant difference in the predicted post-operative refractive outcome between immersion A-scan US biometry and Lenstar LS 900(®). Based on the results, the immersion A-scan US technique is as accurate as Lenstar LS 900(®) in the hands of an experienced operator.
  9. Raman P, Suliman NB, Zahari M, Mohamad NF, Kook MS, Ramli N
    J Glaucoma, 2019 11;28(11):952-957.
    PMID: 31688446 DOI: 10.1097/IJG.0000000000001359
    PRECIS: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

    PURPOSE: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

    DESIGN: This was a prospective, longitudinal study.

    METHODS: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

    RESULTS: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

    CONCLUSION: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

  10. Nandakumal G, Ismail F, Mohamad NF, Lott PW, Chew KS, Ab Rahman S, et al.
    J Pediatr Hematol Oncol, 2021 04 01;43(3):101-103.
    PMID: 33560075 DOI: 10.1097/MPH.0000000000002077
    Hemolacria is a rare condition that causes a person to produce tears that are partially composed of blood. It can be a presenting feature of certain ocular and systemic conditions. Here, the authors describe an interesting case of a 12-year-old boy with an underlying beta-thalassemia trait, who presented with a 2-day history of bilateral blood-stained tears, and an episode of epistaxis. Ocular examination was normal, and syringing showed no nasolacrimal duct blockage. Systemic examination was unremarkable. Laboratory investigations confirmed type 2 von Willebrand disease. Management of hemolacria remains a clinical challenge given the rare occurrence of the disease. In this case report, the authors discuss the differential diagnosis and management approach to hemolacria.
  11. Teh D, Mohamad NF, Lim E, Zulkiflee AB, Narayanan P, Kamalden TA
    Comput Assist Surg (Abingdon), 2016 Dec;21(1):25-28.
    PMID: 27973957
    Foreign bodies lodged in the intraconal space of the orbit pose a surgical challenge due to its deep location behind the globe. Image-guided endoscopic transnasal surgery facilitates the localization of the metallic foreign bodies and enables its safe removal with minimal surrounding tissue damage and optic nerve injury.
  12. Sharudin SN, Govindasamy G, Mohamad NF, Kanesalingam R, Vasudevan SK
    Can J Ophthalmol, 2018 04;53(2):e55-e58.
    PMID: 29631841 DOI: 10.1016/j.jcjo.2017.07.024
  13. Sharudin SN, Tan SW, Mohamad NF, Vasudevan SK, Khairan H, Mun YC, et al.
    Orbit, 2018 Jun;37(3):196-200.
    PMID: 29058523 DOI: 10.1080/01676830.2017.1383474
    A 25-year-old Chinese woman presented with recurrent painless swelling over the left medial canthus region for 3 months and intranasal mass for an indeterminate duration. Initial incision biopsy of the mass was reported as nodular fasciitis but the lesion recurred 3 weeks later. Intraoperative findings during repeat biopsy showed a mass extending from the deep dermal tissue into the anterior orbit and polyp-like nasal mass. Histopathology findings were that of dermatofibrosarcoma protuberans (DFSP). The mass recurred 4 months later without orbital or intranasal recurrence. Wide excision biopsy under frozen section guidance was attempted however; clear surgical margins could not be achieved despite extensive resection. She was subsequently referred for adjuvant radiotherapy. We report an exceptionally rare case of local recurrence of DFSP in an unusual anatomic location. This case was surgically challenging in achieving negative margins, and thus neoadjuvant therapy may improve overall outcome to prevent local relapse.
  14. Chan JS, Nurul-Ain M, Mohamad NF, Wan Hitam WH, Thavaratnam LK
    Neuroophthalmology, 2022;46(4):258-263.
    PMID: 35859635 DOI: 10.1080/01658107.2021.2014892
    Optic neuritis associated with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis poses a novel challenge and is recognised as being part of overlapping antibody-associated demyelinating syndromes. We report a case of a 10-year-old girl who first presented with anti-NMDAR encephalitis and later developed four episodes of left optic neuritis. Blurring of vision, pain on eye movement, and headache were the striking features in all episodes of optic neuritis. For each recurrent episode of optic neuritis she was treated with intravenous methylprednisolone, following which visual acuity, colour vision, and visual field improved to normal. Neuroimaging was unremarkable. Myelin oligodendrocyte glycoprotein and aquaporin-4 antibody tests were negative. She developed a relapse of anti-NMDAR encephalitis after recurrent episodes of optic neuritis despite being on azathioprine. Intravenous immunoglobulin and cycles of cyclophosphamide were started, and she has been free from optic neuritis and encephalitis for more than one year since. Optic neuritis and anti-NMDAR encephalitis are reversible with intensive immunotherapy. Early and accurate diagnosis can lead to better management of this condition.
  15. Wen LY, Wah LP, Mohamad NF, Singh S, Toong LY
    J Fam Pract, 2023 Mar;72(2):E1-E7.
    PMID: 36947782 DOI: 10.12788/jfp.0563
    A patient's age, clinical presentation, medical history, and circumstances at time of palsy onset suggest likely underlying causes and help prioritize choice of imaging.
  16. Abdol Jani WNF, Suja' F, Sayed Jamaludin SI, Mohamad NF, Abdul Rani NH
    Bioinorg Chem Appl, 2023;2023:4011670.
    PMID: 37033717 DOI: 10.1155/2023/4011670
    An effective recovery technology will be valuable in the future because the concentration of the precious metal contained in the source can be a key driver in recycling technology. This study aims to use response surface methodology (RSM) through Minitab software to discover the optimum oxygen level (mgL-1), e-waste pulp density (% w/v), and glycine concentration (mgL-1) for the maximum recovery of gold (Au) and silver (Ag). The method of precious metals recovery used for this study was taken from the bioleaching using 2 L of batch stirred tank reactor (BSTR). A Box-Behnken of RSM experimental statistical designs was used to optimize the experimental procedure. The result of the RSM optimization showed that the highest recovery was achieved at an oxygen concentration of 0.56 mgL-1, a pulp density of 1.95%, and a glycine concentration of 2.49 mgL-1, which resulted in the recovery of 62.40% of Au. The pulp density and glycine concentration greatly impact how much Au is bioleached by C. violaceum. As a result, not all of the variables analyzed seem crucial for getting the best precious metals recovery, and some adjustments may be useful in the future.
  17. Mohd Jais MF, Wan Dien T, Ang WJ, Raja Omar RN, Mohamad NF
    Cureus, 2023 Mar;15(3):e36086.
    PMID: 37065317 DOI: 10.7759/cureus.36086
    Ocular manifestations are common associations of ectrodactyly-Ectodermal dysplasia-cleft palate (EEC) syndrome. We would like to report a case of a 48-year-old patient with EEC syndrome who manifested ocular and extraocular signs and symptoms. The ophthalmic findings in this patient included chronic blepharitis and absence of meibomian gland. There was also a presence of hazy cornea with vascularized corneal stroma and symblepharon involving the lower lid. Systemic conditions showed generalized dry and scaly skin with hand-foot split deformity. Therefore, ophthalmologists should be alert to spot and diagnose this condition as prompt treatment should be commenced considering this can be sight-threatening.
  18. Mohamad NF, Mansor Z, Mahmud A, Mohamed Ghazali IM, Sarimin R
    Int J Technol Assess Health Care, 2024 Feb 28;40(1):e18.
    PMID: 38415300 DOI: 10.1017/S0266462324000102
    OBJECTIVES: To determine the level of awareness of health technology assessment (HTA) and its predictors among clinical year medical students in public universities in Klang Valley, Malaysia.

    METHODS: A cross-sectional study using the stratified random sampling method was conducted among clinical year medical students in four public universities in Klang Valley, Malaysia. Data on the level of awareness of HTA and its associated factors were collected using a self-administered online questionnaire. Descriptive, bivariate, and multivariate analyses were performed using IBM SPSS version 27 to determine the level of awareness of HTA and its predictors.

    RESULTS: Majority (69 percent) of participants had a low level of awareness of HTA. The predictors of high-level awareness of HTA were attitude toward HTA (adjusted odds ratio (AOR) = 7.417, 95 percent confidence interval (CI): 3.491, 15.758), peer interaction on HTA (AOR = 0.320, 95 percent CI: 0.115, 0.888), and previous training on HTA (AOR = 4.849, 95 percent CI: 1.096, 21.444).

    CONCLUSIONS: Most future doctors in public universities exhibit a low awareness of HTA. This study highlights the interplay between attitudes toward HTA, peer interaction, and previous training as influential predictors of HTA awareness. An integrated and comprehensive educational approach is recommended to cultivate a positive attitude and harness the positive aspects of peer interaction while mitigating the potential negative impact of misconceptions. Emphasizing early exposure to HTA concepts through structured programs is crucial for empowering the upcoming generation of healthcare professionals, enabling them to navigate HTA complexities and contribute to evidence-based healthcare practices in Malaysia and beyond.

  19. Sahathevan R, Mohd Ali K, Ellery F, Mohamad NF, Hamdan N, Mohd Ibrahim N, et al.
    Int Psychogeriatr, 2014 May;26(5):781-6.
    PMID: 24472343 DOI: 10.1017/S1041610213002615
    Many stroke research trials do not include assessment of cognitive function. A Very Early Rehabilitation Trial (AVERT) is an international multicenter study that includes the Montreal Cognitive Assessment (MoCA) as an outcome. At the Malaysian AVERT site, completion of the MoCA has been limited by low English proficiency in some participants. We aimed to develop a Bahasa Malaysia (BM) version of the MoCA and to validate it in a stroke population.
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