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Fulltext Clozapine-induced fatal bowel ischaemia - a neglected side effect?

Razak, N.A., Mohd Nor, F., Shafie, M.S., Hwang, I.S.

Malaysian Journal of Psychiatry, 2017;26(1):0-0.
MyJurnal

There have been previous reported deaths due to clozapine-induced
constipation. In all these cases, patients have experienced prior abdominal
symptoms over a period of weeks or months. Clozapine is an anti-psychotic
drug, and it is widely used for treatment of schizophrenia. The important
side-effects of clozapine include postural hypotension, weight gain,
tachycardia, cardiomyopathy, cardiomyositis, seizures, hypersalivation and
agranulocytosis. However, constipation induced by clozapine need to be
addressed since it may cause fatal consequences. Constipation associated with
clozapine is thought to be mediated by the drugs' pronounced dosedependent
cholinergic and serotonergic antagonism. Hence, a clozapineinduced
rapidly fatal bowel ischaemia is the highlight of this report and this
risky side-effect should be aware by the psychiatrist or physician before
commencing the treatment.
Fulltext Hanging: a ten-year retrospective review of Malaysian forensic cases

Md Naziri S.Z., Abu Bakar S.N., Alias A., Ibrahim A., Mohamed Swarhib D.M.J., Mohd Nor F.

International Medical Journal Malaysia, 2018;17(2):27-32.
MyJurnal

Introduction: Hanging is one of the most common methods of suicide in Malaysia, and to date, there is a rise in the number of deaths by hanging among adults. The purpose of this study was to determine the pattern of hanging in Malaysia from the year 2000 till 2009. Methods: The sample comprised 108 cases received at the Universiti Kebangsaan Malaysia Medical Centre, and five parameters, namely, age, sex, racial affiliation, marital status, and medical history were studied. Results: Of the 108 cases, 56% was reported to be Chinese. Suicide by hanging was more predominant in males (81%), and a high number of cases were seen in age groups of 21 to 30, 31 to 40 and 41 to 50 years. Of the cases studied, half of them were married, and previous history of physical and mental illness and alcohol intoxication were reported. Conclusions: In brief, this data would help the higher authorities in detecting the causes of suicide by hanging, as well as detecting the high risk groups with suicidal tendencies. In this way, suicide can be prevented and thus, the rate of suicide by hanging could be reduced in Malaysian.
Fulltext Genetic barriers in transplantation medicine

Edinur HA, Manaf SM, Che Mat NF

World J Transplant, 2016 Sep 24;6(3):532-41.
PMID: 27683631 DOI: 10.5500/wjt.v6.i3.532

The successful of transplantation is determined by the shared human leukocyte antigens (HLAs) and ABO blood group antigens between donor and recipient. In recent years, killer cell receptor [i.e., killer cell immunoglobulin-like receptor (KIR)] and major histocompatibility complex (MHC) class I chain-related gene molecule (i.e., MICA) were also reported as important determinants of transplant compatibility. At present, several different genotyping techniques (e.g., sequence specific primer and sequence based typing) can be used to characterize blood group, HLA, MICA and KIR and loci. These molecular techniques have several advantages because they do not depend on the availability of anti-sera, cellular expression and have greater specificity and accuracy compared with the antibody-antigen based typing. Nonetheless, these molecular techniques have limited capability to capture increasing number of markers which have been demonstrated to determine donor and recipient compatibility. It is now possible to genotype multiple markers and to the extent of a complete sequencing of the human genome using next generation sequencer (NGS). This high throughput genotyping platform has been tested for HLA, and it is expected that NGS will be used to simultaneously genotype a large number of clinically relevant transplantation genes in near future. This is not far from reality due to the bioinformatics support given by the immunogenetics community and the rigorous improvement in NGS methodology. In addition, new developments in immune tolerance based therapy, donor recruitment strategies and bioengineering are expected to provide significant advances in the field of transplantation medicine.
Combination mode of antimalarial drug mefloquine and human serum albumin: Insights from spectroscopic and docking approaches

Musa KA, Ridzwan NFW, Mohamad SB, Tayyab S

Biopolymers, 2020 Feb;111(2):e23337.
PMID: 31691964 DOI: 10.1002/bip.23337

The interaction between mefloquine (MEF), the antimalarial drug, and human serum albumin (HSA), the main carrier protein in blood circulation, was explored using fluorescence, absorption, and circular dichroism spectroscopic techniques. Quenching of HSA fluorescence with MEF was characterized as static quenching and thus confirmed the complex formation between MEF and HSA. Association constant values for MEF-HSA interaction were found to fall within the range of 3.79-5.73 × 104 M-1 at various temperatures (288, 298, and 308 K), which revealed moderate binding affinity. Hydrogen bonds and hydrophobic interactions were predicted to connect MEF and HSA together in the MEF-HSA complex, as deduced from the thermodynamic data (ΔS = +133.52 J mol-1 K-1 and ΔH = +13.09 kJ mol-1 ) of the binding reaction and molecular docking analysis. Three-dimensional fluorescence spectral analysis pointed out alterations in the microenvironment around aromatic amino acid (tryptophan and tyrosine) residues of HSA consequent to the addition of MEF. Circular dichroic spectra of HSA in the wavelength ranges of 200-250 and 250-300 nm hinted smaller changes in the protein's secondary and tertiary structures, respectively, induced by MEF binding. Noncovalent conjugation of MEF to HSA bettered protein thermostability. Site marker competitive drug displacement results suggested HSA Sudlow's site I as the MEF binding site, which was also supported by molecular docking analysis.
Gunshot wound in skeletonised human remains with partial adipocere formation

Mohd Nor F, Das S

J Forensic Leg Med, 2012 Jan;19(1):42-5.
PMID: 22152448 DOI: 10.1016/j.jflm.2011.07.008

We present a case of skeletonised human remains. In the present case report, a body was exhumed from the ground above a cemetery. On exhumation, the body was partially-skeletonised with adipocere formation on the upper part of the body. Autopsy of the body showed two bullets in the right thigh muscle and lumbar vertebrae between L4 and L5. Postmortem changes and destruction of soft tissue made it impossible to determine direction of fire through the body, even in a careful complete autopsy.
Fulltext Chronic Osteomyelitis Revisited: A Case Report

Chuah SK, Bajuri MY, Mohd Nor F

Cureus, 2019 Jun 28;11(6):e5023.
PMID: 31501722 DOI: 10.7759/cureus.5023

Chronic osteomyelitis treatment is always a challenge to orthopaedic surgeons which requires great dedication and perseverance. We report a successful limb salvage case of a 46-year-old man who suffered from a left tibia chronic osteomyelitis with soft tissue defect. The treatment approach was a thorough wound debridement of devitalized tissues and necrotized bone, commencement of culture-directed antibiotics, reconstruction with vascularized osteomyocutaneous fibula flap, and skeletal stabilization with internal fixation. As compared to below knee amputation, the result we obtained in this case is more promising with regard to mobility and function.
Fatal penetrating neck injury due to defective airbag inflator

Jothee S, Shafie MS, Mohd Nor F

Forensic Sci Int, 2018 Aug 31.
PMID: 30217665 DOI: 10.1016/j.forsciint.2018.08.038

We present a case of a fatal motor vehicle collision of a 22-year-old car driver, who died at the scene after losing control of his car, and subsequently collided with a tree by the roadside. The subsequent autopsy revealed penetrating injuries on the neck, severing the larynx, carotid artery, jugular vein and fracturing the cervical vertebrae. Internal examination showed the offending material to be a semi-cylindrical metal fragment, which had lodged within the paravertebral muscle. Examination of the car with the authorities found that the metal fragment originated from a defective airbag booster cannister, which shattered upon deployment.
It is tuberculosis or melioidosis? A clinical diagnostic dilemma

Jamani NA, Mohd Nor FH, Yatim Y

Med J Malaysia, 2021 Sep;76(5):734-736.
PMID: 34508384

Pulmonary Tuberculosis (PTB) is an endemic disease in Malaysia and continues to cause great morbidity and mortality. However, the diagnosis and treatment may pose a challenge to the attending physician since other diseases such as melioidosis can mimic tuberculosis. Hence, the final diagnosis should be done thorough history of illness, physical examination, investigations, and interpretation of findings. We present here a case of a 27-year-old man who presented at our primary care clinic with underlying diabetes mellitus whose symptoms were suggestive of PTB, and who was treated with anti-tuberculosis but later his sputum grew culture Burkholderia pseudomallei.
Distribution of cytokine gene polymorphisms in six Orang Asli subgroups in Peninsular Malaysia

Norhalifah HK, Syafawati WU, Che Mat NF, Chambers GK, Edinur HA

Hum Immunol, 2016 Apr;77(4):338-9.
PMID: 26820937 DOI: 10.1016/j.humimm.2016.01.015

Cytokines are involved in immune responses and the pathogenesis of various diseases. Allelic variations within the genes coding for various ∼30kDa cytokine protein/glycoproteins have been reported for many populations and have been the subjects of many ancestry and health analyses. In this study, we typed 22 single nucleotide polymorphisms (SNPs) in 13 cytokine genes of 165 Orang Asli individuals by using sequence specific primer-polymerase chain reaction (SSP-PCR) assay. The volunteers came from all across the Peninsular of Malaysia and belong to six Orang Asli subgroups; Batek, Kensiu, Lanoh, Che Wong, Semai and Orang Kanaq. Here we report our general findings and original genotype data and their associated analyses (Hardy-Weinberg proportions, estimation of allele and haplotype frequencies) can be found in the supplementary files and will be held at Allele Frequency Net Database (AFND).
Fulltext Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Mohamed NF, Ghazali SR, Yaacob NA, Rahim AAA, Maskon O

Sultan Qaboos Univ Med J, 2018 Nov;18(4):e494-e500.
PMID: 30988969 DOI: 10.18295/squmj.2018.18.04.011

Objectives: Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient's quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting.
Methods: This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument's construct validity. Cronbach's alpha coefficients were used to determine internal consistency.
Results: A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors-psychological, physical-social and spiritual wellbeing-resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450-0.718 for psychological wellbeing (12 items), 0.394-0.740 for physical-social wellbeing (14 items) and 0.449-0.727 for spiritual wellbeing (seven items). The overall Cronbach's alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively.
Conclusion: The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF.
Meningitis Caused by Rhodotorula mucilaginosa in HIV-Infected Patient: A Case Report and Review of the Literature

Mohd Nor F, Tan LH, Na SL, Ng KP

Mycopathologia, 2015 Aug;180(1-2):95-8.
PMID: 25739670 DOI: 10.1007/s11046-015-9879-0

Rhodotorula species are increasingly being identified as a cause of fungal infection in the central nervous system, especially in patients with compromised immunity. The diagnosis could easily be missed due to low index of suspicion, as cryptococcus meningitis and cerebral toxoplasmosis are more common amongst immunocompromised hosts. To date, there are six cases of Rhodotorula-related meningitis reported, and three are associated with human immunodeficiency virus infection. In this report, a case of a Malaysian male with underlying human immunodeficiency virus infection who developed Rhodotorula mucilaginosa meningitis is presented. High-grade fever and severe headaches were the complaints presented in three previous case reports. India ink and nigrosin stainings were performed in the two previous reports and both revealed positive results. R. mucilaginosa were isolated from the culture of the patient's cerebrospinal fluid in all three previous reports. Predominant lymphocyte infiltration in the cerebrospinal fluid examination was documented in two reports. CD4 counts were above 100/µl in two previously published reports, while another report documented CD4 count as 56/µl. Amphotericin B and itraconazole are identified to be the first line of antifungal used and as the maintenance therapy, respectively. The possibility of relapse cannot be excluded as it was reported in the first report. It was also revealed that the current case has almost similar clinical presentation and therapeutic outcome as compared to the published reports, but some differences in diagnostic details were to be highlighted.
Stature estimation in the South-East Asian population: A systematic review

Ismail NA, Abu Bakar SN, Abdullah N, Shafie MS, Mohd Nor F

Malays J Pathol, 2019 Aug;41(2):83-89.
PMID: 31427544

INTRODUCTION: Stature estimation is population dependent, and population-specific regression equations should be generated for accurate anthropological assessments. Nevertheless, stature estimation data was inaccessible and limited in some of the South-East Asian countries. The systematic review was conducted to analyse the regression equations of stature estimations developed in South-East Asian region.
MATERIALS AND METHODS: A systematic literature search was performed through SCOPUS database and Google Scholar from January till March 2018. All published articles which developed stature estimation from different types of bone, methods and type of statures (i.e. living stature, forensic stature and cadaveric stature) were included in this study. Risks of biases were also assessed. Population studies with no regression equations were excluded from the study.
RESULTS: Seven studies that met the inclusion criteria were identified. In the South-East Asia region, regression equations for stature estimation were developed in Thailand and Malaysia. In these studies, bone measurements were done either by radiography, direct bone measurement, or palpation on body surface for anatomical bony prominence. All of these studies used various parts of bones for stature estimation.
CONCLUSION: The most widely used regression equations for stature estimation in South-East Asian population were from the Thailand population. Further research is recommended to develop regression equations for other South-East Asian countries.
Melioidosis mimicking miliary tuberculosis

Tan RZ, Mohd Nor F, Shafie S, Tan LJ

Forensic Sci Med Pathol, 2019 03;15(1):151-154.
PMID: 30293222 DOI: 10.1007/s12024-018-0026-3

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a gram-negative intracellular bacillus. Tuberculosis, also an infectious disease, is caused by Mycobacterium tuberculosis, an acid fast bacillus. In both diseases, patients commonly present with fever and respiratory symptoms due to sepsis which might lead to respiratory failure or sudden death if left untreated. Not only are these two entities similar in clinical presentation, but the autopsy findings may mimic each other, giving rise to difficulties in determining the cause of death. We report a case of melioidosis and compare it to a typical case of miliary tuberculosis. Similarities between the cases on gross and histopathological examinations are discussed. In such circumstances, microbiological culture of bodily fluids and internal organs should be performed to ascertain the correct cause of death.
Fulltext Ocular manifestation of vitamin A deficiency among Orang asli (Aborigine) children in Malaysia

Ngah NF, Moktar N, Isa NH, Selvara S, Yusof MS, Sani HA, et al.

Asia Pac J Clin Nutr, 2002;11(2):88-91.
PMID: 12074186

This study determined the prevalence of ocular manifestation of vitamin A deficiency in Orang Asli (Aborigine) children. Night blindness was found in 16.0% of the children, conjunctiva xerosis in 57.3%, Bitot's spot in 2.8%, corneal xerosis in 0.5% and corneal scars in 5.6%. These findings show that history of night blindness had sensitivity, specificity and predictive value (positive) of 47.2, 98.1 and 96.2%, respectively, compared with the standard diagnosis procedure using luxometer readings.
Fulltext The Evaluation of Ordinal Regression Model's Performance Through the Implementation of Multilayer Feed-Forward Neural Network: A Case Study of Hypertension

Adnan MN, Ahmad WMAW, Shahzad HB, Awais F, Aleng NA, Noor NF, et al.

Cureus, 2024 Feb;16(2):e54387.
PMID: 38505445 DOI: 10.7759/cureus.54387

Background Hypertension, or high blood pressure, is a common medical condition that affects a significant portion of the global population. It is a major risk factor for cardiovascular diseases (CVD), stroke, and kidney disorders. Objective The objective of this study is to create and validate a model that combines bootstrapping, ordered logistic regression, and multilayer feed-forward neural networks (MLFFNN) to identify and analyze the factors associated with hypertension patients who also have dyslipidemia. Material and methods A total of 33 participants were enrolled from the Hospital Universiti Sains Malaysia (USM) for this study. In this study, advanced computational statistical modeling techniques were utilized to examine the relationship between hypertension status and several potential predictors. The RStudio (Posit, Boston, MA) software and syntax were implemented to establish the relationship between hypertension status and the predictors. Results The statistical analysis showed that the developed methodology demonstrates good model fitting through the value of predicted mean square error (MSE), mean absolute deviance (MAD), and accuracy. To evaluate model fitting, the data in this study was divided into distinct training and testing datasets. The findings revealed that the results strongly support the superior predictive capability of the hybrid model technique. In this case, five variables are considered: marital status, smoking status, systolic blood pressure, fasting blood sugar levels, and high-density lipoprotein levels. It is important to note that all of them affect the hazard ratio: marital status (β1, -17.12343343; p < 0.25), smoking status (β2, 1.86069121; p < 0.25), systolic blood pressure (β3, 0.05037332; p < 0.25), fasting blood sugar (β4, -0.53880322; p < 0.25), and high-density lipoprotein (β5, 5.38065556; p < 0.25). Conclusion This research aims to develop and extensively evaluate the hybrid approach. The statistical methods employed in this study using R language show that regression modeling surpasses R-squared values in predicting the mean square error. The study's conclusion provides strong evidence for the superiority of the hybrid model technique.
Fulltext Complete Genome Sequence of Salmonella enterica subsp. enterica Serovar Typhi Isolate B/SF/13/03/195 Associated with a Typhoid Carrier in Pasir Mas, Kelantan, Malaysia

Muhamad Harish S, Sim KS, Mohd Nor F, Mat Hussin H, Hamzah WM, Najimudin N, et al.

Genome Announc, 2015;3(6).
PMID: 26564035 DOI: 10.1128/genomeA.01285-15

We report here the complete genome sequence of Salmonella enterica subsp. enterica serovar Typhi B/SF/13/03/195 obtained from a typhoid carrier, who is a food handler in Pasir Mas, Kelantan.
Fulltext Assessment of Knowledge, Attitude, Practise and Health Literacy (KAPH) Towards COVID-19 in Post-COVID-19 New Reality: The Need and Its Challenges in Malaysia

Dalawi I, Chen XW, Isa MR, Azhar ZI, Mohd Nor F

Front Public Health, 2021;9:704115.
PMID: 34368066 DOI: 10.3389/fpubh.2021.704115
Fulltext Community-acquired bacteremia in Paediatrics: Epidemiology, aetiology and patterns of antimicrobial resistance in a tertiary care centre, Malaysia

Nor Azizah A, Mohd Nor F, Mohamad M, Zainal Abidin AS, Ariza A, Mohd Nor NS, et al.

Med J Malaysia, 2016 Jun;71(3):117-21.
PMID: 27495884 MyJurnal

Bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.
Stature Estimation from Lower Limb Anthropometry using Linear Regression Analysis: A Study on the Malaysian Population

Abu Bakar SN, Aspalilah A, AbdelNasser I, Nurliza A, Hairuliza MJ, Swarhib M, et al.

Clin Ter, 2017 Mar-Apr;168(2):e84-e87.
PMID: 28383619 DOI: 10.7417/CT.2017.1988

INTRODUCTION: Stature is one of the characteristics that could be used to identify human, besides age, sex and racial affiliation. This is useful when the body found is either dismembered, mutilated or even decomposed, and helps in narrowing down the missing person's identity.

AIM: The main aim of the present study was to construct regression functions for stature estimation by using lower limb bones in the Malaysian population.

MATERIALS AND METHODS: The sample comprised 87 adult individuals (81 males, 6 females) aged between 20 to 79 years. The parameters such as thigh length, lower leg length, leg length, foot length, foot height and foot breadth were measured. They were measured by a ruler and measuring tape. Statistical analysis involved independent t-test to analyse the difference between lower limbs in male and female. The Pearson's correlation test was used to analyse correlations between lower limb parameters and stature, and the linear regressions were used to form equations. The paired t-test was used to compare between actual stature and estimated stature by using the equations formed.

RESULTS: Using independent t-test, there was a significant difference (p< 0.05) in the measurement between males and females with regard to leg length, thigh length, lower leg length, foot length and foot breadth. The thigh length, leg length and foot length were observed to have strong correlations with stature with p= 0.75, p= 0.81 and p= 0.69, respectively. Linear regressions were formulated for stature estimation. Paired t-test showed no significant difference between actual stature and estimated stature.

CONCLUSIONS: It is concluded that regression functions can be used to estimate stature to identify skeletal remains in the Malaysia population.
Feeding behavior of Mimomyia (Etorleptiomyia) luzonensis (Ludlow, 1905) (Diptera, Culicidae) in Peninsular Malaysia

Braima KA, Muslimin M, M Ghazali AR, Wan-Nor F, Wilson JJ, Jeffery J, et al.

Acta Trop, 2017 Jul;171:138-140.
PMID: 28359829 DOI: 10.1016/j.actatropica.2017.03.025

Mosquitoes are vectors of various human diseases in the tropics including yellow fever, dengue, malaria and West Nile virus. Mosquitoes can act as vectors between wildlife and humans, which is particularly important for diseases where wild animals serve as reservoirs of parasites in the absence of human infections. Research has mainly focused on the medical impacts of Anopheles, Aedes, Mansonia and Culex, however, very little attention has been directed towards other mosquito genera, especially those which act as vectors of diseases of wildlife. We have observed adults of Mimomyia (Etorleptiomyia) luzonensis (Ludlow, 1905) feeding on a toad, Ingerophrynus parvus, near an oil palm plantation settlement in Setia Alam, Selangor state, Peninsular Malaysia. Mimomyia is known to feed on reptiles and amphibians, and is a documented vector of several arboviruses, including West Nile virus. The observation of Mimomyia feeding on a common toad near a human settlement highlights a need to understand the relationships between mosquitoes, toads and humans from an ecological perspective. We report on-site observations of the feeding habit of Mimomyia; the first records from Malaysia.

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