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Fulltext An Older Woman in Early Pregnancy: What Antenatal Screening is Appropriate?

Syed Aznal SS

Malays Fam Physician, 2008;3(3):137-9.
PMID: 25606138 MyJurnal
Fulltext I am hot, irritable and feeling low; what alternatives do I have besides hormone replacement therapy?

Sharifah Sulaiha SA, Nazimah I, Zainurrashid Z

Malays Fam Physician, 2010;5(3):126-129.
PMID: 25606203 MyJurnal

Women at the end of their reproductive age often complain of climacteric symptoms which can be quite debilitating at times. Physiological changes due to deficient oestrogen have received global attention in the search for an acceptable and safe measure to improve quality of life for women with these complaints. Hormone replacement therapy (HRT) used to be the main treatment for menopausal symptoms. Lately there are concerns about its possible adverse effects of increasing risks of breast malignancy, heart diseases, etc. Complementary Alternative Medicine (CAM) plays a significant role in relieving these climacteric symptoms especially in women with contraindications to hormonal therapy and in those who are worried of its adverse effects. It is important for women to be aware of these CAM to provide them with options to improve their quality of life. This paper explores other pharmacological and non-pharmacological measures as alternatives to hormone replacement therapy (HRT), to assess how useful and reliable they are according to available scientific evidence.
Fulltext Chickenpox in pregnancy: still a feared complication

Zainur Rashid, Z., Sharifah Sulaiha, S.A., Darnina, A.J.

International Medical Journal Malaysia, 2007;6(2):1-11.
MyJurnal

Varicella or chickenpox is an infectious disease caused by Varicella Zoster Virus (VZV), which commonly affects the children. It is a mild, self-limiting disease and rarely complicate to serious conditions except in adults. Decreasing incidence of chickenpox among children, probably owing to improved living conditions ,prevention and health care, is worrisome as growing number of adults are being infected. This creates disturbing concerns in many parties as women at childbearing age might get infected and not only are them at a great risk of serious complications, but also their unborn fetus or their newborn babies.
Neuroendocrine carcinoma of the cervix: Review of classification and current developments in diagnosis and management

Kavitha Nagandla, Sharifah Sulaiha, Sivalingam Nalliah, Norfadzilah Mohd Yusof

International e-Journal of Science, Medicine & Education, 2017;11(1):2-11.
MyJurnal

Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.
Fulltext Task-based learning: student’s perception of their skill in participating in small group discussions

Syed Aznal SA, Nurjahan MI, Lee N

International e-Journal of Science, Medicine & Education, 2009;3(1):-.
MyJurnal

Introduction: Task-based learning (TBL) has been accepted as an effective tool in teaching and learning activities in most medical schools. Many studies have looked at competencies and learning outcomes essential for undergraduates. Among the essential competencies are interpersonal skills and the ability to engage in a group discussion which this study has focused on. The evidence supporting higher interpersonal skills is however limited because many relevant competencies are hard to measure and require long observational periods.
Objective: To determine students’ self-perceived value of TBL in enhancing their interpersonal skills during the clinical phase.
Material and Methods: All students’ (semesters 6-10) in the clinical school of International Medical University (IMU) were invited to participate in this cross-sectional study done in December 2007 utilising a self-administered questionnaire with a 5-point Likert scale. It assessed the students’ perception on TBL sessions conducted during their clinical attachments in the various disciplines. Mean-scores, standard deviations, and confidence interval were used.
Results: Response rate was 62%. The results indicated that students were favorable in their opinion on TBL as a suitable forum for active communication and participation in group discussion. The results also show that both male and female students’ have similar perception. As for the comparison according to semesters, this showed that students’ maturity does not influence their perception as well.
Conclusion: In conclusion, the study has shown positive students’ perception on the effect of TBL on acquired skills such as interpersonal communication. Our findings are consistent with many earlier studies which show students’ perception of the method of learning as important factor in the enhancement of their interpersonal skills which is fundamental to clinical practice. Further research is necessary; long-term and larger scale observational studies would undoubtedly be optimal to minimise response bias.
Evolution of Clinical Simulation Training and Pandemic-Led Acceleration: The International Medical University (IMU), Malaysia Journey

Subramaniam T, Aznal SSS, Ikram MA

Med Sci Educ, 2024 Feb;34(1):201-208.
PMID: 38510413 DOI: 10.1007/s40670-023-01916-7

In many universities, simulation-based learning has finally been inducted as a member of 'the accepted teaching modality community'. This paper is to share the challenges and successes in the journey towards the inclusion of simulation-based learning in the medical curriculum at the authors' university which saw a steep surge during the COVID-19 pandemic. Our teaching and learning that was heavily traditional based went through a dramatic change to adapt to the new norm when the actual environment and patients became out of reach. We followed five factors (5 Fs) that significantly influenced the successful change: fast, force, fellowship, flexibility, and favourable reception.
Fulltext Risk factors of peripheral venous catheterization thrombophlebitis

Yoong, Wilkinson Jian Tan, Jo Wearn Yeap, Sharifah Sulaiha Syed Aznal

International e-Journal of Science, Medicine & Education, 2012;6(1):24-30.
MyJurnal

Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
Fulltext Assessment effects of maintenance therapy on quality of life of opiate abusers

Lim, Dwee Shion, Sambamoorthy, Vijayrama Rao, Ling, Diana Soon Ying, Sharifah Sulaiha Syed Aznal

ASEAN Journal of Psychiatry, 2014;15(2):131-139.
MyJurnal

Objective: This study was conducted to assess the effects of Methadone Maintenance Therapy (MMT) and buprenorphine-naloxone Maintenance Therapy (BNX) on the Quality of life (QoL) of opiate abusers. Methods: The QoL status of opioid-dependent patients was assessed using the WHOQOL-BREF questionnaire. It is a cross-sectional study involving a total of 108 patients who received MMT or BNX therapy in Malaysia from May 2011 to September 2011. Results: A statistically significant difference in the overall QoL and psychological aspect among patients on MMT was observed. On the contrary, the scores of overall QoL and quality of social relationship for BNX group were higher in patients with lower dosage. Conclusion: The comparison between patients on high dose MMT and high dose BNX exhibited significant difference in the overall QoL especially in psychological, social relationship and environment domains, with the high dose MMT group having better mean score. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 131-139.
Mother’s mental preparedness for pregnancy : The affecting factors and its effect on birth outcomes

Sharifah Sulaiha Syed Aznal, Chee Yoong Wong, Pamela Lee Ling Tan, Vee Vee See, Chui King Wong

International e-Journal of Science, Medicine & Education, 2014;8(3):19-27.
MyJurnal

Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes.

Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected.

Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery.

Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.
Fulltext Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women

Aznal SS, Meng FG, Nalliah S, Tay A, Chinniah K, Jamli MF

Indian J Pathol Microbiol, 2012 Oct-Dec;55(4):450-5.
PMID: 23455778 DOI: 10.4103/0377-4929.107778

Pelvic organ prolapse (POP) is associated with menopause and changes in the proteins of the pelvic supporting system, but there is scant data on the precise alterations in Malaysian women.
Fulltext Development of and First Experiences with a Framework (EASI) for Options and Implementation Opportunities for Online Clinical and Communication Skills Learning

Nadarajah VD, Sow CF, Syed Aznal SS, Montagu A, Boursicot K, Er HM

J Med Educ Curric Dev, 2020 11 19;7:2382120520970894.
PMID: 33283046 DOI: 10.1177/2382120520970894

A preparatory framework called EASI (Evaluate, Align, Student-centred, Implement and Improve) was developed with the aim of creating awareness about interim options and implementation opportunities for online Clinical and Communication Skills (CCS) learning. The framework, when applied requires faculty to evaluate current resources, align sessions to learning outcomes with student-centred approaches and to continuously improve based on implementation experiences. Using the framework, we were able to generate various types of online CCS learning sessions for implementation in a short period of time due to the recent Covid-19 pandemic. Importantly we learnt a few lessons post-implementation from both students and faculty perspective that will be used for planning and delivery of future sessions. In summary, the framework was useful for creating or redesigning CCS sessions which were disrupted during the pandemic, however post-implementation experience suggests the framework can also be used for future solutions in online CCS learning as healthcare systems and delivery are increasingly decentralised and widely distributed.
Fulltext Quality of life assessment of opioid substance abusers on methadone maintenance therapy (MMT) in University Malaya Medical Centre

Lim DS, Sambamoorthy VR, Ling DSY, Syed Aznal SS

ASEAN Journal of Psychiatry, 2009;10(1):8-18.
MyJurnal

Objective: In Malaysia, opioid abuse is an acknowledged problem with severe health and economic repercussions. Until recently, drug addicts were mainly criminalised and forcefully rehabilitated in correctional facilities. However, the high relapse rates of this approach, coupled with the high rates of blood borne infections among drug users, led to increasing acceptance of a healthcare-based approach in the rehabilitation of drug addicts. Methadone was among the medications introduced as substitution maintenance therapy in 2005 and Universiti Malaya Medical Centre (UMMC) is a centre for MMT. This study aimed to determine the effects of MMT on quality of life in patients here. Methods: The sample was 46 patients who attended the Psychiatric outpatient clinic in fill in UMMC. The instrument used to assess quality of life was the WHOQOL-BREF. Results: The study design was cross-sectional with retrospective elements. Baseline QOL scores were obtained from case records and follow-up scores from the month of September 2007. Statistically significant improvements in all four domains of WHOQOL-BREF were found. Physical: p

Study site: Psychiatric outpatient clinic, Universiti Malaya Medical Centre (UMMC
Fulltext Acute coronary syndrome in women of reproductive age

Idris N, Aznal SS, Chin SP, Wan Ahmad WA, Rosman A, Jeyaindran S, et al.

Int J Womens Health, 2011;3:375-80.
PMID: 22140324 DOI: 10.2147/IJWH.S15825

There is scarce or no data on prevalence and presentation of acute coronary syndrome (ACS) among women of reproductive age. Furthermore, whether women of reproductive age presenting with ACS have the same risk factors as men and older women is not known.
Validation of a 'Work Readiness Scale' for health professional (HP) graduates

Syed Aznal SS, Nadarajah VDV, Kwa SK, Seow LL, Chong DW, Molugulu N, et al.

Med Teach, 2021 Jul;43(sup1):S33-S38.
PMID: 31854254 DOI: 10.1080/0142159X.2019.1697434

BACKGROUND: There is a continuing concern about how graduate work readiness (WR) reflects on the success of universities meeting the requirements of employment. This study is to establish a valid and reliable instrument measuring WR in health professions (HP) graduates of medicine, pharmacy and dentistry.
METHODS: The study from March 2016 to April 2017 was conducted to validate the 'Work Readiness Scale' (WRS; Deakin University) using Principal Component Analysis and Cronbach - α for internal consistency. It was modified to a four-item even-point scale and distributed as an online survey to 335 final year students of the three programs.
RESULTS: A reduction from 64 to 53 items provided good internal consistency in all factors: WC 0.85, OA 0.88, SI 0.88 and PC 0.71. The PC domain had the greatest item reduction from 22 to 6, whilst the SI domain increased in items from 8 to 19. These changes may be associated with difference in understanding or interpretation of the items in the SI domain.
CONCLUSION: The modified WRS can be used to evaluate job readiness in HP graduates. However, it needs further refinement and validation in specific educational and employment contexts.

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