A diagnostic challenge of neuromyelitis optica spectrum disorder in a young woman with recurrent urinary symptoms Abdul Rahman Mohammad, Juliawati Muhammad, Ying Ying Ng, Ahmad Hadif Zaidin Samsudin Electronic Journal of General Medicine, 2026 Neuromyelitis optica spectrum disorder (NMOSD) is a rare, severe inflammatory autoimmune disease of the central nervous system, identified with the discovery of aquaporin-4 immunoglobulin G antibodies. Its ability to mimic other conditions often leads to misdiagnosis and delayed treatment. We report a 25-year-old woman with recurrent urinary tract infection symptoms. Despite antibiotics, her condition worsened with progressive myelitis symptoms such as urinary retention, back pain and lower limbs weakness. She was admitted to further imaging and blood investigations that confirmed NMOSD diagnosis. With appropriate treatment, she improved significantly. This is the diagnostic challenges of NMOSD in primary care. It is important to explore other symptoms such as neurological features as myelitis, in patients with recurrent urinary symptoms. Early recognition and intervention can substantially improve outcomes and quality of life.
Endometrial cancer in a young nulliparous woman: a case report Herfiana Mohd Rapi, Azlina Ishak, Juliawati Muhammad, Engku Ismail Engku-Husna Korean Journal of Family Medicine, 2026 Prolonged or irregular menstrual bleeding is common in women, particularly in the early years after menarche. Over time, menstrual cycles often become regular; however, persistently irregular menstruation warrants further investigation. Serious conditions, such as endometrial cancer, which is often linked to prolonged unopposed estrogen exposure, can be prevented with timely detection. We report a case involving a 27-year-old obese, nulliparous woman with a history of prolonged irregular menstrual bleeding since menarche. She had not undergone regular health checkups and had never been properly evaluated until multiple admissions for severe anemia prompted further investigation, which confirmed the diagnosis of endometrial carcinoma. Delays in seeking care for abnormal menstrual bleeding resulted in serious outcomes. Endometrial carcinoma may significantly reduce future fertility potential. Therefore, primary healthcare providers play a pivotal role in educating and raising public awareness about this frequently under-recognized issue, as timely investigation for early recognition is paramount.
A case of femoral-facial syndrome in a newborn of a Malay diabetic mother: Lessons for primary care Nik Khadijah Nik Mustaffa Shapri, Juliawati Binti Muhammad, Azlina Ishak, Shimilaaida Mohamad Ali Janaf, Mohd Haikal Bin Abdullah Zawavi, Jusoh Awang Senik Electronic Journal of General Medicine, 2026 Femoral-facial syndrome (FFS) is a rare congenital disorder characterized by femoral hypoplasia and distinctive craniofacial anomalies, and it is frequently associated with maternal diabetes. We report the first documented Malaysian case of FFS in a neonate born to a 36-year-old Malay woman with gestational diabetes and obesity. Early antenatal ultrasound examinations did not detect any abnormalities. Fetal anomalies only became evident later in pregnancy when breech presentation and anhydramnios were noted, highlighting the difficulty of early prenatal diagnosis, particularly among high-risk mothers. A female infant was delivered via caesarean section at 35 weeks’ gestation. She exhibited multiple dysmorphic features, including micrognathia, cleft palate, low-set ears, absence of the femur, hemivertebrae, and polydactyly. Despite multidisciplinary neonatal management, the infant died at two months of age due to severe nosocomial infection.
Job Satisfaction Among Medical Officers in a University Hospital: A Qualitative Study Juliawati Muhammad, Natasha Miswan, Nur Suhaila Idris, Rosediani Muhamad Iium Medical Journal Malaysia, 2025 INTRODUCTION: Job satisfaction among medical officers (MOs) in university hospitals is crucial for both healthcare delivery and medical education. High job satisfaction is linked to improved productivity and mental well-being, while dissatisfaction can lead to errors, lower patient satisfaction, and higher employee turnover. Although many studies have examined job satisfaction in Malaysian healthcare settings, most have focused on public hospitals. This qualitative study aimed to explore the experiences of MOs actively working in a Malaysian university hospital to gain a better understanding into the factors influencing their job satisfaction. MATERIALS & METHODS: Using a phenomenological approach, 18 MOs were interviewed through semi-structured, in-depth interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Guided by Herzberg’s Two-Factor Theory, we explored motivators and dissatisfiers in the MOs' work environment. RESULTS: Four main themes emerged: (1) enjoyment in patient care including aspects of diagnosing, treating, and communicating with patients, (2) personal fulfilment in relations to family time and educational responsibilities, (3) positive work culture comprising of teamwork and hospital facilities, and (4) distress related to hospital systems, salary, and career advancement. CONCLUSION: This study elucidated how different factors contribute to job satisfaction and dissatisfaction among service and postgraduate MOs. These findings underscore the need for targeted strategies by hospital management and policymakers to address these dynamics, in order to sustain a motivated medical workforce in university hospitals.
Infected patent urachus in a young male: Primary care perspective Siti Asiah Ahmad Sabri, Juliawati Muhammad, Rosediani Muhamad Electronic Journal of General Medicine, 2024 Abdominal pain is a common presenting complaint in a primary care setting. Umbilical discharge secondary to umbilical anomalies is usually diagnosed in children and is rare in adults. This case highlights the possibilities of umbilical anomalies as causes of undifferentiated abdominal pain and umbilical discharge in adults. A 24-year-old male presented with a recurrent history of undifferentiated lower abdominal pain and umbilical discharge but was not diagnosed appropriately, leading to multiple visits to general practitioners and emergency departments for four years. An abdominal ultrasound was done, which revealed a hypoechoic tubular structure at the midline of the abdomen. A diagnosis of patent urachus was made and he was then referred to the surgical team for excision of the patent urachus.
Diabetes self-care and its associated factors among type 2 diabetes mellitus with chronic kidney disease patients in the East Coast of Peninsular Malaysia Siti Aisyah Ramli, Nani Draman, Juliawati Muhammad, Siti Suhaila Mohd Yusoff Peerj, 2024 Introduction Diabetes self-care among diabetic patients is crucial as it determines how patients care for their illness in their daily routine for better diabetes control. This study aims to calculate the average score for diabetes self-care among patients with type 2 diabetes mellitus and chronic kidney disease and to identify factors that are associated with this score. Materials and Methods This cross-sectional study enrols patients over 18 years old with type 2 diabetes mellitus and chronic renal disease with an eGFR of less than 60 mL/min/1.73 m2 in a tertiary hospital in Malaysia. The Malay version of the Summary of Diabetic Self-Care Activities (SDSCA) was used to assess diabetes self-care, the Malay version of the diabetes-related distress questionnaire (DDS-17) was used to assess diabetes distress, and the Malay version of the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Data analysis was performed using both simple and multiple linear regression models to determine the associations between variables. Result One hundred and seventy-six eligible patients were recruited for this study. The mean score for diabetes self-care is 3.62. The eGFR (p = 0.002) and diabetes distress (p = 0.004) are the significant associated factors for diabetes self-care among type 2 diabetes mellitus patients with chronic kidney disease. Conclusion The mean score for diabetes self-care indicated a moderate level of self-care. The eGFR level and diabetes distress were important factors influencing diabetes self-care practices.
Continuity of care in acromegaly: Detecting and managing recurrence after surgical intervention Alia Fahizha Fahimi, Juliawati Muhammad, Faridah Mohd Zin, Nur Suhaila Idris Electronic Journal of General Medicine, 2023 Acromegaly is a rare disease being followed up by primary care team. It is usually caused by pituitary adenoma and the treatment would be resection of the tumour. But is surgical intervention the end of treatment for acromegalic patient? This case highlighted the continuity of care in a 65-year old gentleman who had been diagnosed acromegaly since the age of 31. He had undergone a transseptal transsphenoidal resection of his pituitary adenoma when he was 45-year-old. Postoperatively, there were still residual growth hormone (GH) and insulin like growth factor (IGF-1) secretions. However, during 20 years follow up after operation, despite the increasing level of GH and IGF-1, the management of acromegaly were neglected as the focus of treatment were shifted towards his other medical problem, which is diabetes and atrial fibrillation. During his latest follow up, his complaint of unspecified headache and expressed his worry regarding the recurrence of his condition. Repeated GH level showed an increase in its level and postulated the possibility of recurrent acromegaly. This case emphasizes the important of recognizing the level of GH and IGF-1 after surgical intervention in order to detect recurrence acromegaly by primary care and early referral to endocrine team.
Effect of yoga on anthropometry, quality of life, and lipid profile in patients with obesity and central obesity: A systematic review and meta-analysis Ahmad Sabri Siti Asiah, Mohd Noor Norhayati, Juliawati Muhammad, Rosediani Muhamad Complementary Therapies in Medicine, 2023 OBJECTIVE: This systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity. METHODOLOGY: The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. RESULTS: 15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD -0.84, 95% CI [-5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD -3.47, 95% CI [-6.20 to -0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD -7.58, 95% CI [-11.51 to -3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD -17.12, 95% CI [-32.24 to -2.00]) and triglycerides (MD -21.75, 95% CI [-38.77 to -4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence. CONCLUSION: From our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.
