Mohamad Nasir Shafiee

• MD, MOG, MRCOG, PhD
• National University of Malaysia

Checkpoint programmed death-1 (PD-1) and programmed cell death ligands (PD-Ls) are negative immunoregulatory molecules that assist tumour cells in evading the immune system. The interaction of PD-1 and PD-Ls inhibits T cells and tumour-infiltrating lymphocytes (TILs) while increasing the function of immunosuppressive regulatory T cells (Tregs). Thi...

Endometrial cancer (EC) is a common gynaecological malignancy associated with metabolic dysfunctions such as obesity, diabetes and insulin resistance, as well as hormonal imbalances, particularly involving oestrogen and progesterone. These factors disrupt normal cellular metabolism, heightening the risk of developing endometrioid EC (EEC), the most...

Endometrial hyperplasia (EH) poses significant challenges in clinical management, particularly concerning the choice of medical modalities and their efficacy in achieving symptom resolution and regression of hyperplastic changes. To address this, we conducted a retrospective study at Hospital Canselor Tuanku Muhriz (HCTM) to investigate the outcome...

Introduction: IGF-1 isoforms exhibit varying activities in different types of malignancies, as evidenced by their diverse expression patterns in in-vitro models. Their expression has not been thoroughly studied clinically. Objective: This study aimed to determine the IGF-1Ea isoform in endometrioid endometrial carcinoma (EEC) patients, we also inve...

The objective of this research endeavour was to ascertain whether there existed a distinction in the protein expression levels of phosphatase and tensin homolog (PTEN), phosphatidylinositol-4,5-biphosphate3-kinase (PI3K), macrophage (CD68), and interleukin-6 (IL-6) among women who had been diagnosed as having ovarian carcinoma (endometrioid and cle...

Objective: Insulin-like growth factor 1 (IGF1) influences numerous cancers development, including endometrioid endometrial cancer (EEC). In recent years, phosphatase and tensin homolog (PTEN) functions as a tumour suppressor and has gained considerable interest in EEC. This study aimed to investigate the expression of IGF1 and PTEN in endomet...

Simple Summary This review significantly contributes to the research community by providing insights into the role of serum-based biomarkers for the diagnosis of ovarian cancer. It also provides a comprehensive overview of recent advancements in immunoassay detection and employing multiplex technology and SPR biosensors to identify CA125 and HE4 bi...

The landscape of diagnosing and treating endometrial cancer is undergoing a profound transformation due to the integration of molecular analysis and innovative therapeutic approaches. For several decades, the cornerstone treatments for endometrial cancer have included surgical resection, cytotoxic chemotherapy, hormonal therapy, and radiation thera...

Simple Summary The programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway controls the induction and maintenance of immune tolerance within the tumor microenvironment. Hence, immunotherapy is an exciting approach, and tremendous strides have recently been made in our perception of the role of the host immune response...

Endometriosis affects the sexual functioning and marital satisfaction of couples in a complex manner due to its clinical presentation of the disease. This study aimed to evaluate the prevalence of sexual dysfunction and marital disharmony among women with endometriosis beyond their diagnosis and treatment. A cross-sectional online survey was conduc...

Introduction: The diverse expression pattern of IGF-1 isoforms shown by in vitro models demonstrates that pro-peptides have a unique and distinct role in different types of cancer; however, their expression is not extensively reported in clinical studies. The study aimed to determine the mRNA expression patterns of IGF-1 and its isoforms in endomet...

Endometriosis affects approximately 6 to 10% of reproductive-age women globally. Despite much effort invested, the pathogenesis that promotes the development, as well as the progression of this chronic inflammatory disease, is poorly understood. The imbalance in the microbiome or dysbiosis has been implicated in a variety of human diseases, especia...

Background: The programmed cell death protein 1 (PD-1)/Programmed cell death ligand 1 (PD-L1) pathway has a crucial role in the immune escape mechanism and growth of cancer cells in various cancer types, including endometrial cancer [1]. In exploring better treatment options, immune checkpoint inhibitor studies of PD-1/PD-L1 in endometrial cancer a...

Background Insulin-like growth factor-1 (IGF-1) and the IGF binding protein 1 (IGFBP-1) expressions have been shown to play a vital role in cancer biology, including endometrioid endometrial cancer (EEC). We examined the prognostic value of these locally expressed biomarkers in endometrial biopsies and correlated them with clinicopathological data...

Objectives To investigate the expression of IGF1, IGFBP1, PTEN, and SGK2 in endometrium tissue among EEC patients and correlate with the clinicopathological characteristics and the prognosis. Methods A total of 121 participants were recruited from 2014 to 2020 in Universiti Kebangsaan Malaysia Medical Centre (UKKMC), including the EEC (n=96) and c...

Background: Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors. Methods: A cross-sectional study was conducted of 116 married women with gynaecological cancer who attende...

Background: Venous thromboembolism (VTE) remains one of the leading causes of maternal morbidity and mortality, with postpartum period carrying the greatest risk. Perinatal thromboprophylaxis is often administered based on risk-factor assessment. Low molecular weight heparin has a proven safety profile in the obstetrics population, however, its por...

Endometriosis is a gynecologic disorder characterized by the presence of endometrial tissues outside the uterine cavity affecting reproductive-aged women. Previous studies have shown that microRNAs and their target mRNAs are expressed differently in endometriosis, suggesting that this molecule may play a role in the development and persistence of e...

Pregnancy is a complex phenomenon during which women undergo immense immunological change throughout this period. Having an infection with the SARS-CoV-2 virus leads to an additional burden on the highly stretched immune response. Some studies suggest that age-matched pregnant women are more prone to SARS-CoV-2 infection compared with normal health...

Endometrial cancer (EC) is one of the most common malignancies of the female genital tract and its current treatment mainly relies on surgical removal of the tumour bulk, followed by adjuvant radiotherapy with or without chemotherapy/hormonal therapy. However, the outcomes of these approaches are often unsatisfactory and are associated with severe...

The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnan...

In Malaysia, the HPV immunization program has been introduced since 2010 as part of the national immunization plan for female students aged 13 years old. It was a very successful immunization program with good responses from students and parents until the start of COVID-19 pandemic in 2020. The COVID-19 pandemic caused the schools to be closed and...

Extragastrointestinal tumour of rectovaginal septum (rvGIST) is a rare malignancy that affects rectovaginal septum. We present a case of rvGIST that was initially managed as cervical eGIST based on clinical assessment. A 66-year-old woman presented with postmenopausal bleeding and constipation. Bimanual pelvic examination revealed an irregular mass...

Bone metastasis from endometrial cancer is rare. Most of the early stage endometrial cancers with endometrioid histology are confined to the uterus at the time of diagnosis and confer a good prognosis. Endometrial metastases to the bone are generally restricted to the axial skeleton, including the pelvis and thoracolumbar vertebrae. Skeletal metast...

A successful pregnancy outcome is dependent on a delicate balance between inflammatory and anti-inflammatory processes throughout the different trimesters. Interruption in this balance can lead to an adverse outcome resulting in pregnancy loss. Since late 2019, the emergence of the new SARS-CoV-2 virus has affected lives worldwide, including pregna...

This exploratory study aimed to evaluate the effects of antenatal corticosteroids in singleton pregnancies of Asian women prior to elective cesarean section (CS) at early term on neonatal respiratory outcomes. Methods: This is a pilot and pragmatic randomized trial conducted at a university hospital in Malaysia. Women with singleton pregnancies p...

Objective To assess the perception and knowledge of cervical cancer prevention among fully vaccinated female university students in the era of human papillomavirus (HPV) vaccination. Design Cross-sectional using a validated questionnaire. Setting Face-to-face interview at a public university in Malaysia. Participants 384 fully vaccinated female...

Objectives: To determine the significance of tumour PTEN protein expression in endometrioid endometrial carcinoma (EEC) and it is correlation with tumour characteristics. Methods: A total of 30 eligible archived paraffin-embedded tissue blocks from 61 EEC cases (January 2015-December 2017) were retrieved from the Histopathology Laboratory in Uni...

Objectives: Endometrial cancer is the sixth most common cancer among women and recurrence of after 10 years is extremely rare. Case presentation: We reported a comprehensive review of histopathology, investigations and treatment regarding a woman with distant recurrence of endometrial cancer to rectus abdominis muscle after 23 years from the pri...

Background: A Movement Control Order (MCO) was imposed as a control measure to curb the spread of COVID-19 virus in Malaysia, eventually led to the closing of all public premises including educational institutions nationwide. The purpose of this study is to offer an understanding of undergraduate medical students’ perception towards the occurrence...

The implementation of oncofertility services is of great importance among cancer survivors of reproductive age to ensure a good quality of life. However, the uptake of this service among Muslim patients is very challenging because of inconclusive laws or evidence based on the Islamic perspective. Hence, we summarized the limited evidence available...

High-grade serous ovarian cancer (HGSC) is the most common ovarian cancer with highly metastatic properties. A small non-coding RNA, microRNA (miRNA) was discovered to be a major regulator in many types of cancers through binding at the 3′-untranslated region (3′UTR), leading to degradation of the mRNA. In this study, we sought to investigate the u...

Objectives: Gestational trophoblastic disease comprises of a spectrum of pregnancy-related tumours which includes complete (CHM) and partial hydatidiform moles (PHM). Accurate diagnosis and subclassification of HM subtypes are crucial as prognosis differs. Histopathological examination using haemotoxylin and eosin (H&E) staining remains the basis...

Objective: The aim of this study is to determine the differential protein expression of Phosphatase and tensin homolog (PTEN), Phosphatidylinositol-4,5-biphosphate3-kinase, catalytic subunit alpha (PI3K), macrophage (CD68) and interleukin-6 (IL-6) in women diagnosed with endometrioid adenocarcinoma or clear cell carcinoma of the ovary underlying wi...

This study’s goal was to determine the protein expression level of tumour necrosis factor receptor 2 (TNFR2) and signal transducer and activator of transcription 3 (STAT3) in high-grade serous ovarian cancer (HGSC) tissues in relation to the platinum-based chemotherapy response and the prognosis outcome. A total of 25 HGSC patients underwent primar...

Ovarian cancer is the eighth-most common cause of death among women worldwide. In the absence of distinctive symptoms in the early stages, the majority of women are diagnosed in advanced stages of the disease. Surgical debulking and systemic adjuvant chemotherapy remain the mainstays of treatment, with the development of chemoresistance in up to 75...

Background Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and hi...

Endometriosis is an inflammatory condition characterised by the presence of endometrial growth beyond the uterine cavity. It is a debilitating disease requiring multiple modalities of treatment. In considering surgery as the option of treatment, the benefits should outweigh the risk. Besides direct surgical risk, intervention may lead to a reductio...

Endometrial cancer (EC) has been found to have a strong association with overweight and obesity. The aim of this study was to evaluate the link between metabolic syndrome and EC among patients. A total of 119 patients with histologically confirmed EC were recruited. About 102 cases of endometrioid carcinoma (Type I) and serous (n = 7), clear cell (...

The COVID-19 pandemic has resulted in a Movement Control Order (MCO) in Malaysia and the subsequent closure of all educational institutions. We aimed to examine the psychological impact of the MCO among clinical undergraduates. A cross-sectional study was conducted using self-reported questionnaires that were distributed online using the Depression...

Objective To determine the relationship between TNFR2 and STAT3 in high-grade serous ovarian cancer (HGSC) tissues with chemotherapy response and prognosis outcome. Methods This is a retrospective cohort study involving HGSC patients underwent primary cytoreduction followed by first-line adjuvant platinum-based chemotherapy with a minimum follow-u...

As the obesity rates dramatically increased across the globe, the risk of endometrial cancer (EC) has substantially increased. Measures to improve the EC outcome is utmost important, especially data have shown that women at their reproductive age are commonly affected. No doubt, surgical intervention is a standard treatment for EC. However, the fac...

Women with polycystic ovary syndrome (PCOS) are more likely to develop endometrial cancer (EC). The molecular mechanisms which increase the risk of EC in PCOS are unclear. Derangements in lipid metabolism are associated with EC, but there have been no studies, investigating if this might increase the risk of EC in PCOS. This was a cross-sectional s...

Poor maternal vitamin D status is associated with adverse pregnancy outcomes such as preeclampsia, gestational diabetes. And increased risk of caesarean delivery. The authors conducted a prospective observational study to determine the association between maternal serum vitamin D levels and spontaneous preterm delivery. Pregnant women between 26 an...

Introduction: Neisseria meningitidis infections often cause severe meningitis as well as bacteraemia. However, cellulitis in meningococcal diseases have rarely been described. Here, we report a case of right lower limb cellulitis caused by N. meningitidis. Case report: A 69-year-old woman presented with fever and lower limb swelling. She had dia...

Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE. Materials and methods We...

Uterine leiomyosarcoma (LMS) is rare but primary ovarian LMS is even rarer constituting less than 0.1% of all gynecologic disorders. Neither histologic features nor immunohistochemistry could be utilized to distinguish between uterine or ovarian origin. We illustrate a clinical case of metastatic LMS to the ovary in a woman with underlying uterine...

Endometriosis is a benign, chronic inflammatory condition characterized by the presence and growth of endometrial implants outside the uterine cavity. The cause of endometriosis is multifactorial. It is due to the diversity of hypothesis and plausibility of hormonal alterations which could play a major role. Evidence has shown that progesterone res...

Objective This study aims to describe the menstrual pattern and menstrual care of girls with intellectual disabilities and to evaluate the impact of menstruation and awareness of parents/guardians on girls with intellectual disabilities. Methodology Parents/guardians of girls aged 9–17 years with known intellectual disabilities who attended a sche...

MicroRNA (miRNA) is a small non-coding RNA with an established function to regulate genes at the post-transcriptional level leading to suppression or degradation of its messenger RNA expression (mRNA). Its dysregulation plays a vital role in a variety of biological and pathological processes including cancer. A lot of algorithms have been establish...

Aim: Sodium pentosan polysulfate (Na-PPS) is a plant-based agent that has similar action with low-molecular-weight heparin. It inhibits factor Xa, preventing blood clot formation. To date, its use in clinical practice as thromboprophylaxis agent is still limited. In addition, the efficacy and safety profile of this agent was not robustly reported...

Mycobacterium tuberculosis spread from the external genitalia into the pelvic cavity mainly via hematogenous spread. Pelvic tuberculosis can be asymptomatic or remained unrecognized or mimics other gynaecological pathology. We illustrate a case of pelvic tuberculosis which was diagnosed retrospectively, whereby ovarian carcinoma was the initial dia...

This was a prospective observational study to determine the predictive factors for a successful vaginal birth after caesarean section (VBAC) and to develop a relevant antenatal scoring system. Patients with one previous caesarean section were included in this study. All data including maternal demographics, obstetric history, pregnancy progress and...

Objective: Women with a prior history of polycystic ovary syndrome (PCOS) have an increased risk of endometrial cancer (EC). Aim: To investigate whether the endometrium of women with PCOS possess gene expression changes similar to those found in EC. Design and methods: Patients with EC, PCOS and control women unaffected by either PCOS or EC we...

Introduction: Women with polycystic ovary syndrome (PCOS) have a 3-fold higher risk of endometrial cancer (EC). Insulin resistance and hyperlipidaemia may be pertinent factors in the pathogenesis of both conditions. The aim of this study was to investigate endometrial Sterol Regulatory Element Binding Protein-1 gene (SREBP1) expression in PCOS and...

Pre-eclampsia (PE) contributes to poor maternal morbidity and mortality. Progesterone is hypothesised to reduce the risk of PE. To determine the effect of progestogen supplementation during assisted reproductive technique (ART) in reducing the incidence of PE. A retrospective comparative analysis among 1140 pregnancies between January 2006 and Marc...

Background: Endometrial cancer (EC) is the most common gynaecological cancer amongst women in the UK. Although previous studies have found that women with polycystic ovary syndrome (PCOS) have at least a three-fold increase in endometrial cancer (EC) risk compared to women without PCOS, the precise molecular mechanisms which link between PCOS and...

Adenomyosis is a common gynaecological disorder that is associated with infertility and miscarriage. We report a case of adenomyosis presented with urinary retention and infertility. The patient successfully conceived spontaneously following GnRHa followed by progestogen therapy. This treatment option might provide a synergistic effect in improving...

Congenital uterine anomalies have been associated with poor reproductive outcome, which include recurrent miscarriage, abruptio placenta, intra-uterine growth restriction and preterm delivery. Here, we report a case: 36 years old, G3P2, known case of uterine didelphys, with history of preterm birth, who successfully carried her pregnancy till term...

Haemoglobin (Hb) Lepore is a variant Hb consisting of two α-globin and two δβ-globin chains. In a heterozygote, it is associated with clinical findings of thalassaemia minor, but interactions with other haemoglobinopathies can lead to various clinical phenotypes and pose diagnostic challenges. We reported a pair of siblings from a Malay family, who...

The aim of this proof-of-concept study was to determine the effects of three-month Metformin therapy on the expression of tumor-regulatory genes (p53, cyclin D2 and BCL-2) in the endometrium of women with polycystic ovary syndrome (PCOS). A total of 40 women, aged between 21 and 45 years with PCOS (Rotterdam criteria) were recruited. The participan...

Aim: To examine the factors associated with placenta praevia in primigravidas and also compare the pregnancy outcomes between primigravidas and nonprimigravidas. Method: A retrospective cohort study was conducted in women who underwent caesarean section for major placenta praevia in a tertiary university hospital from January 2007 till December...

Reduced fetal movement is a worrisome common complaint, not only for mothers but also for the attending medical personnel. The aim of this study was to analyse the pregnancy outcomes of women who presented primarily with reduced fetal movements (RFM). A retrospective study was performed based on patients' perception alone. Obstetric, past medical h...

Spontaneous rupture of uterine surface varicose veins is rare but may result in serious complication of pregnancy, as it is associated with high perinatal and maternal mortality. We report a 24-year-old primigravida who presented with this rare condition mimicking placenta abruption, which was successfully managed. A review of reported cases was pe...

Purpose: To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth. Methods: The ECV data over a period of three years at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1 September 2008 and 30 September 2010 was reviewed. Sixty-seven patients who had succ...

Purpose To determine the impact of time interval between debulking surgery to adjuvant chemotherapy on the short term morbidity and CA125 level. Methods A total of 43 patients with primary debulking surgery for operable stage epithelial ovarian cancer (stage IB to IIIC) from January 2008 to January 2010 were analyzed prospectively. The participant...

Introduction: Human papillomavirus (HPV) is a major factor for cervical cancer. However, routine HPV vaccination to combat the disease is not widely available in most developing countries, and the uptake is poor. Lack of knowledge or awareness may be a factor. This study assessed the perception, knowledge and attitude of university students toward...

Gestational trophoblastic disease (GTD) is a common problem among Asian ethnics. A total of 102 women with molar pregnancies between 1 January 2005 and 31 December 2010, were analysed. The aim of the study was to determine the outcome of all molar pregnancies in our institution. The local incidence of molar pregnancy was 2.6 per 1,000 deliveries. A...

Objective. To determine the diagnostic accuracy of placental alpha microglobulin-1 assay and standard diagnostic methods for detecting rupture of membrane. Study Design. Prospective diagnostic study, between June 2011 to November 2011 at a tertiary centre. Initial evaluation included both the standard diagnostic methods for rupture of membranes and...

Complications that may occur while performing myomectomy in pregnancy can be prevented in a well-optimised surgery. Counselling and comprehensive peri-operative preparations are mandatory to minimise litigations and untoward events. Myomectomy in pregnancy remains a contentious issue. Degeneration of fibroid during pregnancy is common. However, con...

The aim of the present study was to identify differentially expressed genes and their related biological pathways in the secretory phase endometrium from patients with recurrent miscarriage (RM) and fertile subjects. Endometrial samples from RM and fertile patients were analyzed using the Affymetrix GeneChip® ST Array. The bioinformatic analysis us...

A 33 year-old woman had an emergency caesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroid. The utero-cutaneous communication was demonstrated by an examination under anaesthesia using dye test. She then underwent excision of the fistula tract and myomectomy. She re...

Choriocarcinoma is a rare neoplasia with a tendency of distant metastasis although highly sensitive to chemotherapy renders a good prognosis and outcome. Lungs, liver and cerebral metastasis are commonly implicated with maxillofacial region rarely involved. We illustrate a case of overwhelming metastatic choriocarcinoma to lungs, liver, brain and t...

Vulvo-vaginal haematomas are not an uncommon obstetric complication. Despite advances in obstetric care, practice and technique, vulvo-vaginal haematomas do occur especially in complicated vaginal deliveries. Various management options are available for vulvo-vaginal haematomas. We describe three cases of vulvo-vaginal haematomas with different sev...

Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at seve...