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Acute pulmonary thromboembolism in a case of fatal child abuse

Rahimi R, Zulkifli ZF, Omar E, Ismail H, Md Noor S

Malays J Pathol, 2017 Apr;39(1):83-87.
PMID: 28413210 MyJurnal

Child abuse is a worldwide problem. The four major types of abuse include physical abuse, child neglect, psychological maltreatment and sexual violence. We describe a fatal case of child abuse which presented with numerous old and recent soft tissue injuries all over the body. The injuries on the legs have immobilized the victim for quite some time, giving rise to deep vein thrombosis, leading to death as a result of acute pulmonary thromboembolism. This case demonstrates presence of both elements of abuse and neglect in one victim. As this category of crime involves a helpless child, we would also like to reiterate that the community has an obligation to prevent such tragedies and educating the public to recognize the signs and symptoms of abuse would be of utmost important. Ultimately, the community must also be responsible for reporting such offences and the act of silence is akin to condoning a crime witnessed.
Fulltext Renal autotransplantation after an iatrogenic left ureteric injury

Neo EN, Zulkifli Z, Sritharan S, Lee BC, Nazri J

Med J Malaysia, 2007 Jun;62(2):164-5.
PMID: 18705455

We report a case of renal autotransplantation performed successfully for an iatrogenic ureteric injury with loss of 9 cm of ureteric length. The surgical options available for management of ureteric injuries are discussed, varying from a simple re-anastomosis to the more complex renal autotransplantation.
Fulltext Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia

Haque M, Rahman NI, Zulkifli Z, Ismail S

Ther Clin Risk Manag, 2016;12:413-26.
PMID: 27042083 DOI: 10.2147/TCRM.S102013

The innovation of penicillin by Dr Alexander Fleming in 1928 and its use in clinical practice saved many lives, especially during the Second World War. Tuberculosis still carries a significant public health threat and has re-emerged over the past two decades, even in modern countries where tuberculosis was thought to be eliminated. The World Health Organization defines antimicrobial resistance as the resistance of a microorganism to an antimicrobial drug that was initially effective for treatment of infections caused by the microbe. Therefore, the findings of the current study will provide data to enable the design of a new educational program to better equip our students in confronting antimicrobial resistance. This study was a cross-sectional, questionnaire-based survey, which was undertaken in the Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia. The study participants were students of the Bachelor of Medicine and Bachelor of Surgery program (MBBS) of Year III, IV, and V. A total of 142 out of 164 (86%) medical students returned the questionnaire. Specifically, the year-wise breakdown of responses was 29% (41), 39% (55), and 32% (45) for Year III, IV, and V, respectively. Among the study respondents, 28% (40) were male, and the remaining 72% (102) were female. In all, 67% of the participants felt more confident in "making an accurate diagnosis of infection/sepsis." The majority (88%) of the study participants stated that they would like more training on antibiotic selection. This research has found that there is a gap between theoretical input and clinical practice; the students are demanding more educational intervention to face the threat of antimicrobial resistance.
The Development and Validation of Job Satisfaction Questionnaire for Health Workforce

Ahmad NFD, Ren Jye AK, Zulkifli Z, Bujang MA

Malays J Med Sci, 2020 Dec;27(6):128-143.
PMID: 33447140 DOI: 10.21315/mjms2020.27.6.12

Background: This study aims to develop and validate a job satisfaction questionnaire (JS-Q) for health workforce who are employed by a healthcare institution.
Methods: The study consists of six phases which begins with eliciting a conceptual understanding of the subject matter which is then followed by questions development, designing the overall structure and format of the questionnaire, assessing both its content validity and face validity, conducting a pilot study and finally a field test. A sample of study respondents who were permanent hospital staff above 18 years of age had been recruited from three government hospitals in Kuching, Sarawak, Malaysia.
Results: The finalised JS-Q consists of a total of 34 questions that were based on 8 domains. For all these 8 domains, the minimum loading of each item on the factors was calculated to be at least 0.500, its coefficient of Cronbach's alpha was calculated to be at least 0.750 and its corrected item-total correlation was calculated to be at least 0.500. The goodness of fit of the model was determined to be satisfactory with a value of Chi-square/df < 3.0, and a value of root mean square error approximation (RMSEA) < 0.8 and finally with both Tucker Lewis index (TLI) and comparative fit index (CFI) > 0.9.
Conclusion: This newly developed and validated questionnaire (JS-Q) is found to be a valid and reliable study instrument for assessing job satisfaction among health workforce.
Clinical features and risk factors for HIV encephalopathy in children

Hamid MZ, Aziz NA, Zulkifli ZS, Norlijah O, Azhar RK

Southeast Asian J. Trop. Med. Public Health, 2008 Mar;39(2):266-72.
PMID: 18564712

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.
Fulltext Highly Sensitive and Selective Sol-Gel Spin-Coated Composite TiO2-PANI Thin Films for EGFET-pH Sensor

Kamarozaman NS, Zainal N, Rosli AB, Zulkefle MA, Nik Him NR, Abdullah WFH, et al.

Gels, 2022 Oct 26;8(11).
PMID: 36354598 DOI: 10.3390/gels8110690

A highly selective and sensitive EGFET-pH sensor based on composite TiO2-PANI had been developed in this work. A sol-gel titanium dioxide (TiO2) and the composite of TiO2 with semiconducting polyaniline (PANI) were deposited using a simple spin-coating method on an indium tin oxide (ITO) substrate. The films have been explored as a sensing electrode (SE) of extended gate field-effect transistor (EGFET) for pH applications in the range of pH 2 to 12. The pH sensitivities between TiO2, TiO2-PANI bilayer composite, and TiO2-PANI composite thin films were discussed. Among these, the TiO2-PANI composite thin film showed a super-Nernstian behavior with high sensitivity of 66.1 mV/pH and linearity of 0.9931; good repeatability with a standard deviation of 0.49%; a low hysteresis value of 3 mV; and drift rates of 4.96, 5.54, and 3.32 mV/h in pH 4, 7, and 10, respectively, for 6 h. Upon applying the TiO2-PANI composite as the SE for nitrate measurement, low sensitivity of 12.9 mV/dec was obtained, indicating that this film is a highly selective sensing electrode as a pH sensor. The surface morphology and crystallinity of the thin films were also discussed.
Fulltext Professionalism perspectives among medical students of a novel medical graduate school in Malaysia

Haque M, Zulkifli Z, Haque SZ, Kamal ZM, Salam A, Bhagat V, et al.

Adv Med Educ Pract, 2016;7:407-22.
PMID: 27524927 DOI: 10.2147/AMEP.S90737

Defining professionalism in this constantly evolving world is not easy. How do you measure degrees of benevolence and compassion? If it is so obvious to our profession, what professionalism is, then why is it so difficult to teach it to medical students and residents? Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. However, medical professionalism is defined as the basis for the trust in the patient-physician relationship, caring and compassion, insight, openness, respect for patient dignity, confidentiality, autonomy, presence, altruism, and those qualities that lead to trust-competence, integrity, honesty, morality, and ethical conduct. The purpose of this study is to explore professionalism in terms of its fundamental elements among medical students of Universiti Sultan Zainal Abidin (UniSZA). This was a cross-sectional study carried out on medical students of UniSZA. The study population included preclinical and clinical medical students of UniSZA from Year I to Year V of academic session 2014/2015. The simple random sampling technique was used to select the sample. Data were collected using a validated instrument. The data were then compiled and analyzed using SPSS Version 21. Out of 165 questionnaires distributed randomly among Year I to Year V medical students of UniSZA, 144 returned, giving a response rate of 87%. Among the study participants, 38% (54) and 62% (90) were males and females, respectively. The grand total score was 170.92±19.08. A total of 166.98±20.15 and 173.49±18.09 were the total professionalism score of male and female study participants, respectively, with no statistically significant (P=0.61) differences. This study found almost similar levels of familiarity with all fundamental issues of professionalism with no statistically (P>0.05) significant differences. Medical faculty members should give more effort for the professional development of medical doctor. Henceforth, researchers believe and expect that the country will produce more rational and holistic medical doctors.
Fulltext Perceptions of students in different phases of medical education of the educational environment: Universiti Sultan Zainal Abidin

Rahman NI, Aziz AA, Zulkifli Z, Haj MA, Mohd Nasir FH, Pergalathan S, et al.

Adv Med Educ Pract, 2015;6:211-22.
PMID: 25848333 DOI: 10.2147/AMEP.S78838

The Dundee Ready Education Environment Measure (DREEM) was planned and designed to quantify the educational environment precisely for medical schools and health-related professional schools. DREEM is now considered a valid and reliable tool, which is globally accepted for measuring the medical educational environment. The educational environment encountered by students has an impact on satisfaction with the course of study, perceived sense of well-being, aspirations, and academic achievement. In addition to being measurable, the educational environment can also be changed, thus enhancing the quality of medical education and the environment, and the medical education process. The objective of this study was to assess the educational environment of the Universiti Sultan Zainal Abidin (UniSZA) undergraduate medical program from the students' perspective. The study expected to explore UniSZA medical students' overall perceptions, perceptions of learning, teachers, atmosphere, academic self-perception, and social self-perception using the DREEM questionnaire.
A cross-sectional study evaluating the knowledge and beliefs about, and the use of antibiotics amongst Malaysian university students

Haque M, Rahman NAA, McKimm J, Binti Abdullah SL, Islam MZ, Zulkifli Z, et al.

Expert Rev Anti Infect Ther, 2019 04;17(4):275-284.
PMID: 30761920 DOI: 10.1080/14787210.2019.1581607

BACKGROUND: The introduction of antibiotics into modern medicine has changed clinical care by saving millions of lives. However, misuse of antibiotics has led to their benefits being overshadowed by the development of antimicrobial resistance.
AIMS OF STUDY: This study aimed to assess university students' knowledge and beliefs about and their use of antibiotics.
METHODS: This cross-sectional study was conducted among 674 medical and non-medical students of the National Defence University of Malaysia, using universal and convenience sampling methods. The data was collected using a validated questionnaire and analyzed using IBM SPSS 24, and the MANOVA test and Logistic Regression were used to explore the associated factors.
RESULTS: More than half of the respondents' knowledge was low and their health beliefs outdated. Age, race and program were significantly associated with up-to-date knowledge and beliefs about antibiotic use, factors associated with finishing a course of antibiotics were studying medicine, personal health, and ethnicity. The significant factors associated with antibiotic self-prescribing were beliefs having been prescribed antibiotics during the last one year, and trusting the doctors who did not prescribe antibiotics.
CONCLUSION: This study has identified a concerning low knowledge about antibiotics amongst some Malaysian university students, reflected in use of un-prescribed antibiotics and a lack of adherence to treatment. There is a need for educational interventions for students regarding antibiotic usage and resistance issues.
Fulltext Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University

Haque M, Rahman NAA, McKimm J, Kibria GM, Azim Majumder MA, Haque SZ, et al.

Infect Drug Resist, 2019;12:1333-1351.
PMID: 31190922 DOI: 10.2147/IDR.S203364

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.