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Fulltext Transient abnormal myelopoiesis with life-threatening complications

Abdul-Wahab, J., Naznin, M, Norlelawati, A.T., Amir Hamzah, A.R.

International Medical Journal Malaysia, 2006;5(2):1-6.
MyJurnal

Transient abnormal myelopoiesis (TAM) occurs in approximately 10% of neonates with Down syndrome. In most cases it resolves spontaneously. Life threatening complications such as cardiopulmonary and liver diseases have been described. We present here two cases which suggest that management of TAM in selected cases will have to be more aggressive.
Fulltext Problem Based Learning As Perceived By Medical Students in a Non-Problem Based Medical Curriculum

Naznin, M., Pakeer-Oothuman, Nasuruddin, B.A., Abdul-Wahab, J.

International Medical Journal Malaysia, 2008;7(1):0-0.
MyJurnal

Background: The Medical Faculty of the International Islamic University Malaysia (IIUM) runs an undergraduate medical programme which is a combination of the traditional and the newer trends of medical curriculum. The IIUM curriculum in Phase I (Years 1, 2: preclinical) is integrated organ system based, with lectures being the main method of curriculum delivery and also incorporating problem-based learning (PBL) as one of the teaching-learning approaches. Methods: The aim of this study is to examine the effectiveness of PBL teaching-learning method in IIUM in achieving the aims of the medical school as viewed by the students. A total of 287 students from Phase I and Phase II (Year 3: clinical) participated in this study at the end of academic session 2006/2007. The questionnaires distributed consisted of 33 items with four different aspects of PBL being evaluated namely; i) PBL objectives, ii) assessment of performance of the facilitators, iii) assessment of the PBL packages and iv) preferred teaching-learning approach. Results: An average of 86.4 % of students agreed that PBL sessions achieved its aims of preparing students for professional training in the clinical years. Also approximately 80% of students felt that the facilitators fulfilled their roles as PBL tutors. Students were generally satisfied with the PBL packages prepared. However about 50% of Year 2 students did not look forward to PBL sessions and only about 20% of preclinical students wanted more PBL sessions to be scheduled. This latter finding differed as 60% of the clinical (Year 3) students wanted more PBL sessions to be implemented. A significant proportion of the students also believed that they needed some prior information about the PBL case in question in order to generate lively exchange of ideas in the first sessions. Preclinical students preferred lectured-based approach as compared to PBL in contrast to the clinical (Year 3) students of whom 57% (62) preferred the PBL teaching-learning approach. Nearly 80% of the Year 3 students found the exposure to PBL sessions during their preclinical years beneficial during the clinical year. Discussion: Although our findings supported the effectiveness of PBL as one of the teaching-learning approaches (as perceived by our students) there are a few areas of concern. These include believing that a prior knowledge of the topic in question is needed to generate a lively discussion; the group not being motivated; the group members confining themselves to individual assignments only; PBL not being supportive of on-going self- assessment; the consequence of a facilitator being too dominant; and cases constructed do not reflect real clinical scenarios. Despite agreeing to its effectiveness preclinical students still preferred lecture-based approach to the PBL as they are more confident with the knowledge as obtained through the former learning modality. Conclusion: PBL is an effective learning strategy and it contributes to the teaching-learning process of IIUM undergraduate preclinical medical programme which implements a non-Problem Based Curriculum. We are of the opinion that a combination of lecture sessions and PBL best suit the IIUM medical students.
A 2-year prospective study on childhood acute bacterial meningitis in Tengku Ampuan Afzan Hospital, Kuantan, Pahang

Wahab, J.A., Fadzil, A.A., Zainab, K., Affendi, A.M., Naznin, M.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):48-54.
MyJurnal

During a 24-month period, 21 children with acute bacterial meningitis were identified and studied. The majority of the children was from low socio-economic group and the male:female sex ratio was equal. Seventeen children (81%) were aged twelve months or below. In 15 (71.5%) of the children. Haemophilus influenzae type b was recovered, while Streptococcus pneumoniae was isolated from 4 children. Neisseria spp and Salmonella spp were identified respectively in each of the other two cases. The case fatality was four (19.0%) with nine others (42%) exhibiting neurological sequelae. Except for the Salmonella spp strain that was resistant to the cephalosporin, the rest of the bacterial species were sensitive to the commonly used antibiotics. As Haemophilus influenzae type b is still the most prevalent cause of acute bacterial meningitis, it is therefore strongly recommended that the national immunisation programme in this country should include the vaccine for it in our effort to minimise the mortality and morbidity caused by this organism.
Fulltext A Descriptive Study of Blood Films of Patients Serologically Positive for Dengue in Hospital Tengku Ampuan Afzan, Kuantan.

Rusmawati, I., Asma Hanim, H., Naznin, M., Salman, M.S., Norlelawati, A.T.

International Medical Journal Malaysia, 2010;9(2):35-37.
MyJurnal

Introduction: Dengue is one of the commonest infections in Malaysia and it is a notiﬁ able disease. Even
though the diagnosis of classical dengue fever and dengue haemorrhagic fever can be recognized clinically, the diagnosis remains a challenge in areas where it could not be differentiated with other febrile illnesses. The aim of this study was to focus on the speciﬁ c and consistent morphological features observed in blood ﬁ lms of dengue infection. Materials and Methods: In all 400 cases of dengue infection serologically diagnosed in the Tengku Ampuan Afzan Hospital (HTAA) during May to October 2007, only a total of 27 cases had blood ﬁ lms examined, and thus were included in this study. These blood ﬁ lms were re-examined by two pathologists from HTAA. The full blood count parameters were also retrieved and studied. Results: We consistently found typical reactive lymphocytes [n= 23 (85%)] and thrombocytopenia [n=21, (77.8%)] in the cases. However, leucopenia was present only in 9 cases (33%). Conclusion: The presence of typical reactive lymphocyte is a consistent ﬁ nding in dengue fever and thus could have a signiﬁ cant role in supporting the diagnosis of dengue infection.
Fulltext The Impact of the Teaching of Ethics in a Medical and Allied Health Sciences Curriculum in International Islamic University Malaysia

Naznin, M, Abdul Rahman, S., Ariff, O., Ahmad Mansur, M, Kasule, O.H.

International Medical Journal Malaysia, 2008;7(1):0-0.
MyJurnal

Background: The approach to the teaching of ethics and professionalism in the Faculty of Medicine (FM) of International Islamic University Malaysia (IIUM) is unique. A specifically designed package is incorporated designated as the Islamic Input into the Medical Programme (IIMP). The IIMP spans over the entire 5 years of the medical programme. In the Faculty of Allied Health Sciences (FAHS) students do not go through a similar Islamic Input module but exposed to ethical issues specific to health sciences. Method: The aim of this study is to assess the impact of the teaching of ethics through the IIMP. A cross-sectional study was conducted in medical and allied health sciences faculties of IIUM. In total 259 students volunteered and were allocated to 4 groups, Years 2 and 5 students of FM and Years 2 and 4 of FAHS. A set of questionnaire consisting of 20 vignettes related to medical ethics was distributed to all students. An independent t-test was used to compare the mean total scores between the groups. Results: A significant difference (p < 0.05) was seen between the mean total scores for the Year 2 and Year 5 students of FM; Year 2 students of FM and Year 2 students of FAHS; and between the Year 5 students of FM and Year 4 students of FAHS. Also there was significant difference between the two medical and allied health sciences groups as a whole. Discussion: This study suggests that the IIMP of the IIUM has a positive impact on the medical students when dealing with ethical issues. The Year 5 medical students were expected to have obtained a higher mean total score. The probable reason for the lower mean total score include the teaching-learning approach utilized which is mainly lecture with minimal small group approach. Also the allocation of marks for medical ethics in summative assessment in the IIUM medical curriculum is minimal compared to the core medical subjects which would have some influence on the weight given by students. Conclusion: The Medical Faculty of IIUM believes that the approach to the teaching of medical ethics by incorporating the Islamic Input module is effective, practical and relevant. However the teaching-learning method and the assessment will have to be re-addressed to achieve greater impact.
Fulltext Screening for thalassaemia among group of students of a higher institution – our experience

Norlelawati, A.T., Siti Hadijah, M., Siti Nor Haiza, H., Rusmawati, I., Abdul Wahab, J., Naznin, M., et al.

International Medical Journal Malaysia, 2011;10(1):3-6.
MyJurnal

Introduction: Thalassaemia is an inherited blood disorder and is a significant public health alarm in Malaysia with many not knowing they are carriers of this haemoglobin disorders. Materials and methods: This study conducted a one off collection of blood samples from 72 Malays students of International Islamic University Malaysia (IIUM) in Kuantan. Blood samples were subjected to conventional haemoglobin analyses that include full blood count and picture, HPLC, Haemoglobin electrophoresis and H-inclusion test. All samples were also genotyped for alpha thalassaemia–1 of Southeast Asia (a-Thal1SEA). Result: There were 17(23.6%) students who were diagnosed as thalassaemia carriers. Out of this, four (5.5 %) and six (8.3 %) students were presumptive β-thalassaemia trait and Haemoglobin-E trait as determined by the HPLC assay respectively. Nine (12.5%) students were genotyped a-Thal1SEA among whom two were also β-thalassaemia carriers. All thalassaemia cases had MCH of < 27pg. Nonetheless, two out of six Haemoglobin-E trait and three out of nine a-Thal1SEA carrier had MCV value of >80fL. Two out of four (50%) presumptive β -thalassaemia trait and one out of six (17%) students of presumptive Haemoglobin-E trait had family history of thalassaemia respectively. Conclusion: The high occurrence of the three common types of thalassaemia carrier (β, Hb-E and a-Thal1SEA thalassaemia) in our small group of subjects could be due to better participation of students who had family history of thalassaemia. The study reaffirmed the importance of molecular study for detection of alpha-thalassaemia and the use of MCH value of
Fulltext Favourable response to splenectomy in familial myelodysplastic syndrome

Abdul-Wahab J, Naznin M, Suhaimi A, Amir-Hamzah AR

Singapore Med J, 2007 Jul;48(7):e206-8.
PMID: 17609817

Familial myelodysplastic syndrome occurring at a young age is a very rare childhood haematological malignancy. Two siblings, aged three and 18 years, from a consanguineous marriage, presented with pancytopenia and was subsequently diagnosed to have myelodysplastic syndrome. Both remained clinically stable throughout the illness. Splenectomy appeared to have fully corrected the cytopenia in one of them.
Fulltext Inherited Anti-Thrombin Deficiency in A Malay-Malaysian Family: A Missense Mutation at Nucleotide g.13267C>A aka anti-thrombin Budapest 5 (p.Pro439Thr) of the SERPINC 1 gene

Norlelawati AT, Rusmawati I, Naznin M, Nur Nadia O, Rizqan Aizzani R, Noraziana AW

Med J Malaysia, 2014 Feb;69(1):27-30.
PMID: 24814625 MyJurnal

OBJECTIVE: Inherited anti-thrombin deficiency is an autosomal dominant disorder which is associated with increased risk for venous thromboembolism (VTE). This condition is very rare in Malaysia and there has been no documented report. Thus, the aim of the present study is to investigate the type of an inherited anti-thrombin deficiency mutation in a 25-year-old Malay woman who presented with deep vein thrombosis in her first pregnancy.

METHODS: DNA was extracted from the patient's blood sample and buccal mucosal swabs from family members. Polymerase chain reaction(PCR) assays were designed to cover all seven exons of the serpin peptidase inhibitor, clade C (antithrombin), member 1 (SERPINC1) gene; and the products were subjected to DNA sequencing. Sequences were referred to NCBI Reference Sequence: NG_012462.1.

RESULTS: A heterozygous substitution mutation at nucleotide position 13267 (CCT->ACT) was identified in the patient and two other family members, giving a possible change of codon 439 (Pro→Thr) also known as anti-thrombin Budapest 5. The genotype was absent in 90 healthy controls.

CONCLUSION: The study revealed a heterozygous antithrombin Budapest 5 mutation in SERPINC 1 giving rise to a possible anti-thrombin deficiency in a Malay-Malaysian family.
Fulltext Detection of SYT-SSX mutant transcripts in formalin-fixed paraffin-embedded sarcoma tissues using one-step reverse transcriptase real-time PCR

Norlelawati AT, Mohd Danial G, Nora H, Nadia O, Zatur Rawihah K, Nor Zamzila A, et al.

Malays J Pathol, 2016 Apr;38(1):11-8.
PMID: 27126659 MyJurnal

Synovial sarcoma (SS) is a rare cancer and accounts for 5-10% of adult soft tissue sarcomas. Making an accurate diagnosis is difficult due to the overlapping histological features of SS with other types of sarcomas and the non-specific immunohistochemistry profile findings. Molecular testing is thus considered necessary to confirm the diagnosis since more than 90% of SS cases carry the transcript of t(X;18)(p11.2;q11.2). The purpose of this study is to diagnose SS at molecular level by testing for t(X;18) fusion-transcript expression through One-step reverse transcriptase real-time Polymerase Chain Reaction (PCR).
Fulltext Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh

Khatun MR, Alam KMF, Naznin M, Salam MA

Pak J Med Sci, 2021 6 10;37(3):821-826.
PMID: 34104172 DOI: 10.12669/pjms.37.3.3942

Objectives: Chronic suppurative otitis media is a major cause of acquired hearing impairment, especially in children of developing countries. The study sought to explore the bacteriological profile and their antimicrobial susceptibility among patients of chronic suppurative otitis media from a tertiary care hospital in Bangladesh.
Methods: A cross sectional microbiological study was conducted at the Department of Microbiology, Rajshahi Medical College, Bangladesh from January to December 2019. Aural swabs were collected aseptically from clinically suspected patients irrespective of age and gender attending the ear, nose and throat outpatient department of Rajshahi Medical College Hospital. Aerobic bacterial culture was done and isolates were identified through standard bacteriological identification scheme. Antimicrobial susceptibility testing of isolates was done by modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines.
Results: Of 96 swabs, culture yielded a total of 73 bacterial isolates from 68(70.8%) culture-positive plates including 63 (65.6%) unimicrobial and 5 (5.2%) polymicrobial (mixed growth of a pair of bacteria) growths. Frequency distribution revealed, 40(55%) gram-negative and 33(45%) gram-positive bacteria with Staphylococcus aureus was the leading isolate (37%) followed by Pseudomonas aeruginosa (31.5%), Escherichia coli (13.7%), coagulase-negative Staphylococcus (8.2%), Klebsiella pneumoniae (5.5%) and Proteus spp. (4.1%). Gram-positive bacteria were found to be highly susceptible (100%) to Linezolid and Vancomycin followed by Imipenem (83 to 96.3%), while moderate to high resistance (44 to 67%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime, Amoxicillin/Clavulanate and Clindamycin. For gram-negative bacteria, susceptibility ranged from 67 to 100% to Imipenem, 67 to 96% to Piperacillin/Tazobactam and 67 to 83% to Gentamicin, while moderate to high resistance (50 to 75%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime and Amoxicillin/Clavulanate.
Conclusion: Moderate to high level of multidrug-resistance especially to 3rd generation cephalosporins, Ciprofloxacin and Amoxicillin/Clavulanate is an alarming situation. It warns reinforcement of judicious antibiotic prescription and introduction of antibiotic stewardship program in the tertiary care hospitals.
Fulltext Thalassaemia: a study on the perception of patients and family members

Wahab IA, Naznin M, Nora MZ, Suzanah AR, Zulaiho M, Faszrul AR, et al.

Med J Malaysia, 2011 Oct;66(4):326-34.
PMID: 22299552 MyJurnal

Marked improvement in the management of thalassaemia has not been matched by progress in psychosocial rehabilitation as thalassaemia continues to pose challenges to patients and their family members. Few studies have been carried out in Malaysia to look at such issues. This study is therefore to explore the concerns, beliefs and feelings about thalassaemia. It was conducted in the year 2009 over 7 months on "focus groups", in patients aged 8-22 years and parents attending Paediatric Clinic of Tengku Ampuan Afzan Hospital, Kuantan, Pahang. Results showed that concerns and adverse impact were related to lower grades in education, poor self-image, less chance of employment, marriage, financial burden and social integration. Compliance to subcutaneous iron chelator was poor. There were various concerns related to blood transfusion therapy. It is evident that thalassaemia greatly affects the psychosocial dimensions and a more structured long term psychosocial support is needed to improve quality of life of patients.

Study site: Paediatric Clinic of Tengku Ampuan Afzan Hospital, Kuantan, Pahang.

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