MyMedR

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 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.

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.

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.

Fulltext Bilateral Sudden Sensorineural Hearing Loss Following Head Trauma

Misron K, Tengku Kamalden TMI, Mohammad N

Oman Med J, 2021 Jul;36(1):e280.

PMID: 34367684 DOI: 10.5001/omj.2021.42

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.

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.

Fulltext Slicc damage index score in systemic lupus erythematosus patients and its associated factors

Ghazali WSW, Daud SMM, Mohammad N, Wong KK

Medicine (Baltimore), 2018 Oct;97(42):e12787.

PMID: 30334968 DOI: 10.1097/MD.0000000000012787

The aims of this study were to determine damage index in systemic lupus erythematosus (SLE) patients based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and to determine the laboratory and clinico-demographic factors affecting SDI.This is a retrospective cohort study of 94 SLE patients attending rheumatology clinics in 2 local hospitals in Kelantan, Malaysia. The patients were divided into 2 groups based on SDI score assigned by the attending physician, 0 (without damage) or ≥1 (with damage). Newly diagnosed SLE patients with disease duration less than 6 months were excluded.A total of 45 (47.9%) SLE patients showed damage by SDI score. Majority of the subjects had neuropsychiatric damages (21/94; 22.3%) followed by skin (12/94; 12.8%) and musculoskeletal (6/94; 6.4%) damage. SDI score was significantly associated with higher disease duration (6.2 ± 6.57 years vs 4.5 ± 3.7 years; P = .018), lower prednisolone dose (8.74 ± 10.89 mg vs 4.89 ± 3.81 mg; P

Haemolytic anaemia precipitated by dengue fever

Abdullah NH, Mohammad N, Ramli M, Wan Ghazali WS

BMJ Case Rep, 2019 Aug 28;12(8).

PMID: 31466966 DOI: 10.1136/bcr-2018-226760

We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.

Fulltext An Evaluation on Deep Caries Removal Method and Management Performed by Undergraduate Dental Students: A Malaysia Experience

Othman NI, Ismail HU, Mohammad N, Ghazali N, Alauddin MS

Eur J Dent, 2021 May;15(2):281-289.

PMID: 33368068 DOI: 10.1055/s-0040-1721546

OBJECTIVES: The aim of this study was to investigate the current knowledge and attitude of deep caries removal method among dental students in Malaysia.

MATERIALS AND METHODS: A total of 303 students (n = 303) responded to the online questionnaire. The first part of questionnaire was to evaluate the demographic data of the respondents and focused on the technique and management approach used for deep caries lesion. The second part investigated the preferred treatment used for deep caries based on the designated clinical case, while the third part assessed the factors that affected the decision on deep caries management.

STATISTICAL ANALYSIS: Independent t-test was used to compare difference between the two groups.

RESULTS: Seventy four percent of the students have the knowledge of the different methods of caries removal, while 25.8% were only familiar with complete caries removal. The preferred method for deep caries removal in permanent teeth was partial caries removal (53%). For primary dentition, 45.6% of the students prefer to perform pulpotomy as compared with other techniques. There was no significant difference in caries removal method for permanent teeth between undergraduate year of study (p > 0.05), which was partial caries removal at 52.7 and 53.5%, respectively. For primary dentition, the preferred caries removal method was pulpotomy for year 4 (39.8%) and year 5 (52%) students. The popular material to restore deep caries was resin composite (42%) followed by glass ionomer cement (23.3%).

CONCLUSIONS: This study showed that partial caries removal was the preferred method despite partial understanding on the identification of the clinical indicators of the technique.

Fulltext Systemic lupus erythematosus and melioidosis

Che Rahim MJ, Mohammad N, Kamaruddin MI, Wan Ghazali WS

BMJ Case Rep, 2019 Jul 01;12(7).

PMID: 31266760 DOI: 10.1136/bcr-2019-229974

We reported a case of a young female patient presented with sepsis and diagnosed with melioidosis and systemic lupus erythematosus (SLE) within the same admission. She presented with 1-week history of productive cough, progressive dyspnoea together with prolonged fever, arthralgia, rashes and oral ulcers. She had septicemic shock, respiratory failure requiring intubation and ventilation in intensive care unit and subsequently developed acute renal failure requiring haemodialysis. Antibiotics and immunosuppressive treatment including low-dose intravenous cyclophosphamide were commenced. She had a remarkable recovery and was discharged after 6 weeks. There was no evidence of active SLE or relapse of melioidosis during clinic follow-ups.

Subtype distribution of Blastocystis isolated from humans and associated animals in an indigenous community with poor hygiene in Peninsular Malaysia

Mohammad NA, Al-Mekhlafi HM, Anuar TS

Trop Biomed, 2018 Dec 01;35(4):849-860.

PMID: 33601835

Blastocystis is one of the most common parasites inhabiting the intestinal tract of human and animals. Currently, human Blastocystis isolates are classified into nine subtypes (STs) based on the phylogeny of their small subunit ribosomal RNA (SSU rRNA) gene. Although its pathogenicity remains controversial, the possibility of zoonotic transmission was recognized since eight of the nine STs (except for ST9) have been reported in both humans and animals. A cross-sectional study was conducted to determine the prevalence and subtype distribution of Blastocystis isolated from humans and associated animals in an indigenous community with poor hygiene in Malaysia, where the risk of parasitic infection is high. A total of 275 stool samples were collected, subjected to DNA extraction and amplified by PCR assay. The Blastocystis-positive amplicons were then purified and sequenced. Phylogenetic tree of positive isolates, reference strains and outgroup were constructed using maximum likelihood method based on Hasegawa-KishinoYano+G+I model. The prevalence of Blastocystis infection among humans and domestic animals by PCR assay were 18.5% (45/243) and 6.3% (2/32), respectively. Through molecular phylogeny, 47 isolates were separated into five clusters containing isolates from both hosts. Among human isolates, ST3 (53.3%) was the predominant subtype, followed by ST1 (31.1%) and ST2 (15.6%). Chicken and cattle had lower proportions of ST6 (50%) and ST10 (50%), that were barely seen in humans. The distinct distributions of the most important STs among the host animals as well as humans examined demonstrate that there is various host-specific subtypes in the lifecycle of Blastocystis.

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.

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 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.

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.

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 ArASL: Arabic Alphabets Sign Language Dataset

Latif G, Mohammad N, Alghazo J, AlKhalaf R, AlKhalaf R

Data Brief, 2019 Apr;23:103777.

PMID: 31372425 DOI: 10.1016/j.dib.2019.103777

A fully-labelled dataset of Arabic Sign Language (ArSL) images is developed for research related to sign language recognition. The dataset will provide researcher the opportunity to investigate and develop automated systems for the deaf and hard of hearing people using machine learning, computer vision and deep learning algorithms. The contribution is a large fully-labelled dataset for Arabic Sign Language (ArSL) which is made publically available and free for all researchers. The dataset which is named ArSL2018 consists of 54,049 images for the 32 Arabic sign language sign and alphabets collected from 40 participants in different age groups. Different dimensions and different variations were present in images which can be cleared using pre-processing techniques to remove noise, center the image, etc. The dataset is made available publicly at https://data.mendeley.com/datasets/y7pckrw6z2/1.

Fulltext Intracranial bleeding (ICB) as a catastrophic complication of Streptococcus gordonii infective endocarditis (IE) in an immunocompetent patient

Pairan MS, Mohammad N, Abdul Halim S, Wan Ghazali WS

BMJ Case Rep, 2018 Sep 10;2018.

PMID: 30206067 DOI: 10.1136/bcr-2018-225265

We present an interesting case of late-onset intracranial bleeding (ICB) as a complication of Streptococcus gordonii causing infective endocarditis. A previously healthy young woman was diagnosed with infective endocarditis. While she was already on treatment for 2 weeks, she had developed seizures with a localising neurological sign. An urgent non-contrasted CT brain showed massive left frontoparietal intraparenchymal bleeding. Although CT angiogram showed no evidence of active bleeding or contrast blush, massive ICB secondary to vascular complication of infective endocarditis was very likely. An urgent decompressive craniectomy with clot evacuation was done immediately to release the mass effect. She completed total 6 weeks of antibiotics and had postoperative uneventful hospital stay despite having a permanent global aphasia as a sequel of the ICB.

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