Browse publications by year: 2018

Fulltext Influence of discrete fibers and mesh elements on the behaviour of lime stabilized soil

Kaniraj, Shenbaga R., Fung, Y. C.

Pertanika Journal of Science & Technology, 2018;26(4):1547-1570.
MyJurnal

Addition of chemical binders such as lime and cement improves the strength and stiffness
of fine grained soils. However, the treated soils exhibit brittle stress-strain behaviour.
Inclusion of randomly oriented discrete fibers in the soil-binder mixture changes its brittle
behaviour into ductile behaviour. Most synthetic fibers, however, tend to get entangled
and cannot be easily separated from one another. Therefore, it is difficult to realize soilbinder-
fiber mixtures in which the fibers are distributed uniformly throughout the mass.
This issue has been an impediment in the utilization of the positive modification in the
behaviours of soils and soil-binder mixtures by the fibers. The present study aims to address
the limitations in using fibers as soil reinforcement. Further, it also aims to investigate
the use of synthetic mesh or net elements as an alternative type of soil reinforcement.
The paper presents the experimental study on a fine grained soil. Lime has been chosen
as the binder due to its low cost and the scarcity of fiber reinforced soil studies in which
lime has been used as a binder. The main experimental program is a series of unconfined
compression tests on samples prepared using untreated soil, soil-reinforcement mixture,
soil-lime mixture, and soil-lime-reinforcement mixture. The lime treated samples were
cured up to 120 days at laboratory temperature. The results demonstrate the combinational
effects of lime and discrete reinforcement
elements on the behaviour and mechanical
properties of the soil. The performances of
the fiber and mesh element reinforcements
have also been compared.

MeSH terms: Construction Materials; Dental Cements; Oxides; Soil; Temperature; Calcium Compounds
Combined extract of Moringa oleifera and Centella asiatica modulates oxidative stress and senescence in hydrogen peroxide-induced human dermal fibroblasts

Abdul Hisam EE, Rofiee MS, Khalid AM, Jalaluddin AF, Mohamad Yusof MI, Idris MH, et al.

Turk J Biol, 2018;42(1):33-44.
PMID: 30814868 DOI: 10.3906/biy-1708-23

Moringa oleifera Lam. and Centella asiatica (L.) Urb. leaves have been previously reported to exhibit antioxidant activity. The objective of the present study is to determine the in vitro antioxidant activity of the combined extracts of M. oleifera and C. asiatica (TGT-PRIMAAGE) and its effect on hydrogen peroxide (H 2O2)-induced oxidative stress in human dermal fibroblasts. TGTPRIMAAGE acted on the mechanism of hydrogen transfer as it showed scavenging activity in the DPPH assay. This is due to the presence of phenolics and flavonoids in TGT-PRIMAAGE. TGT-PRIMAAGE effectively reduced cellular generation of reactive oxygen species induced by H O2. The activities of superoxide dismutase and catalase were also increased in cells treated with TGT-PRIMAAGE. 2 Treatment with TGT-PRIMAAGE showed significant reduction (P < 0.05) in the number of senescent cells. Significant reduction (P < 0.05) of malondialdehyde was also seen in cells treated with TGT-PRIMAAGE. The p53 protein level was reduced in TGT-PRIMAAGEtreated cells, which indicates its potential in protecting the cells from oxidative stress induced by H2O2.

MeSH terms: Catalase; Fibroblasts; Flavonoids; Humans; Hydrogen; Hydrogen Peroxide; Malondialdehyde; Phenols; Superoxide Dismutase; Tumor Suppressor Protein p53; Reactive Oxygen Species; Oxidative Stress; Plant Leaves; Centella; Moringa oleifera
Fulltext In vitro and in silico studies of chalcone synthase variant 2 in Boesenbergia rotunda and its substrate specificity

Sanmugavelan R, Teoh TC, Roslan N, Mohamed Z

Turk J Biol, 2018;42(3):213-223.
PMID: 30814883 DOI: 10.3906/biy-1710-107

In this study, transformation of BrCHS var 2 into B. rotunda cell suspension culture, followed by chalcone synthase enzymatic assay and HPLC analysis was conducted to investigate whether the substrate specificity for BrCHS var 2 is either cinnamoyl-CoA or p-coumaroyl-CoA. The HPLC profile showed an increase in the amount of pinocembrin chalcone when cinnamoyl-CoA and malonyl-CoA were added but not p-coumaroyl-CoA. Molecular docking was performed to explore the binding of cinnamoyl-CoA and p-coumaroyl-CoA to BrCHS var 2 receptor and the docking results showed that cinnamoyl-CoA formed numerous hydrogen bonds and more negative docked energy than p-coumaroyl-CoA. Cinnamoyl-CoA showed good interactions with Cys 164 to initiate the subsequent formation of pinocembrin chalcone, whereas the hydroxyl group of p-coumaroyl-CoA formed an unfavorable interaction with Gln 161 that caused steric hindrance to subsequent formation of naringenin chalcone. Docked conformation analysis results also showed that malonyl-CoA formed hydrogen bonding with Cys 164, His 303, and Asn 336 residues in BrCHS var 2. The results show that cinnamoyl-CoA is the preferred substrate for BrCHS var 2.

MeSH terms: Acyl Coenzyme A; Acyltransferases; Chromatography, High Pressure Liquid; Hydrogen; Hydrogen Bonding; Malonyl Coenzyme A; Substrate Specificity; Rumex; Chalcones; Enzyme Assays; Molecular Docking Simulation
Fulltext Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Thomas BAWM, Kaur S, Hairol MI, Ahmad M, Wee LH

F1000Res, 2018;7:1834.
PMID: 30815251 DOI: 10.12688/f1000research.17006.1

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

MeSH terms: Child; Child Behavior/psychology*; Color Vision Defects/congenital*; Color Vision Defects/psychology*; Emotions*; Female; Humans; Malaysia; Male; Schools*; Students*; Odds Ratio; Case-Control Studies
Fulltext Coughing on palpation: A rare complication of vagal schwannoma

Samarakkody ZM, Sayuti KA, Mat Zin AA, Wan Abdul Wahab W, Mohamad I

Malays Fam Physician, 2018;13(3):40-43.
PMID: 30800234

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.

MeSH terms: Cough; Deglutition Disorders; Dyspnea; Hoarseness; Humans; Neurilemmoma; Palpation; Vagus Nerve; Dysphonia; Conservative Treatment
Fulltext Young Lady with Bilateral Yellowish Lesions on Her Eyelids

Ishak A, Mohd Yusoff SS, Wan Abdullah W

Malays Fam Physician, 2018;13(3):44-46.
PMID: 30800235 MyJurnal

A 26-year-old woman with an unknown medical illness presented with yellowish skin lesions around both eyes, visible for the past 4 years. The lesions were neither itchy nor tender and had increased gradually in size. She had neither constitutional nor hyperthyroidism symptoms. She is the youngest out of four siblings, and none of her family members have cardiovascular disease or similar problems. Upon examination, there were bilateral yellowish plaques over the periorbital region. Her body mass index (BMI) was 23.8 kg/m2. Her vital signs were all normal at every visit.

MeSH terms: Adult; Cardiovascular Diseases; Eye; Family; Female; Humans; Hyperthyroidism; Pruritus; Skin Diseases; Body Mass Index; Siblings
Fulltext Comparison of antimicrobial activity of crude extracts of piper betle, aloe vera, solanum lycopersicum, cinnamomum zeylanicum and cucumis sativus against acne inducing bacteria

Aiza Izyani Aminuddin, Siti Suraiya, Ruzilawati Abu Bakar

Asian Journal of Medicine and Biomedicine, 2018;2(1):0-0.
MyJurnal

Acne vulgaris is a typical skin disorder among adolescence, causing inflammation of pilosebaceous follicle
which characterized by comedones, papules, pustules, cysts, nodules and often scars in face, neck, upper trunk
and arms. Propionibacterium acnes and Staphylococcus epidermidis have been recognized that play as a major
role in acne formation. This study was conducted to compare the antimicrobial activity of five plant extracts
namely Piper betle, Aloe vera, Solanum lycopersicum, Cinnamomum zeylanicum and Cucumis sativus against P.
acnes and S. epidermidis. The well diffusion assay was used to determine the sensitivity of the samples, while
the liquid dilution method was used for the determination of the minimal inhibition concentration (MIC). The
result showed a remarkable antibacterial activity of Piper betle extract compared to other plant extracts and
Doxycycline (positive control) against both of acne-inducing bacteria, P. acnes and S. epidermidis.

MeSH terms: Acne Vulgaris; Adolescent; Aloe; Anti-Infective Agents; Anti-Bacterial Agents; Cicatrix; Cinnamomum zeylanicum; Cysts; Doxycycline; Humans; Inflammation; Microbial Sensitivity Tests; Oils, Volatile; Plant Extracts; Propionibacterium acnes; Skin Diseases; Staphylococcus epidermidis; Lycopersicon esculentum; Cucumis sativus; Piper betle
Fulltext Improvement of awareness and knowledge in breast cancer using online learning

Nurulhuda, M. H., Norwati, D., Sit Norazlina, J., Husbani, M. A. R.

Asian Journal of Medicine and Biomedicine, 2018;2(1):0-0.
MyJurnal

Background: Breast cancer is the most common cancer and the leading cause of cancer death among women in
Malaysia, accounting to 32.1% of all cancer among women. Preventive activities of breast health especially
mammogram screening was found to be effective in reducing the mortality and morbidities related to breast cancer. .
However, the number of people who come for screening is still unsatisfactory. Many patients come in advanced stage
of breast cancer attributed by lack of awareness and knowledge of the disease. The aim of this study was to introduce
a multimodality online course on breast cancer and its screening; and to measure its effectiveness in providing the
awareness and knowledge in breast cancer. Methodology: An online course was designed incorporating essential
knowledge regarding breast cancer and its screening. Group sampling was done to sample 30 undergraduate students.
Knowledge and awareness on breast cancer and its screening was measured using a validated questionnaire pre and
post exposure to the online course. Results: There was significant difference in Pre- &Post-exposure test knowledge
(p

MeSH terms: Breast; Breast Neoplasms; Female; Humans; Malaysia; Mammography; Surveys and Questionnaires; Students; Early Detection of Cancer
Fulltext Does body mass index of nursing students correlate with their attitude towards obesity?

Salziyan, B., Norwati, D.

Asian Journal of Medicine and Biomedicine, 2018;2(1):0-0.
MyJurnal

Health care personnel are important role models for promoting healthy lifestyle to general populations. Being
overweight and obese are commonly associated with stigmas and discriminations. Stigma against obese people is
common and it may relate to individual’s attitude on obesity. The study objective was to determine the correlation
between body mass index of nursing students and their attitude towards obesity. A cross-sectional study was
conducted between December 2011 and February 2012. Self-administered questionnaires were distributed to 297
nursing students in private colleges in Kelantan, Malaysia. Socio-demographic data, body mass index (BMI) and
attitude towards obesity by using the ATOP score were obtained. Data was analyzed using SPSS version 20.0.
Majority of the participants were Malays (99.7%), female (89.9%) and single (96.3%). About 64.3% had normal
BMI, 18.9% underweight, 13.8% overweight, 2.4% obese type I and 0.7% obese type II. The ATOP score were
ranging from 26.0 to 99.0 with mean (SD) of 62.8 (13.36). The attitude towards obese persons among the
participants was more toward positive attitude. Body mass index (BMI) was skewed to the left distribution with
the median (IQR) 20.8 (3.9). The correlation between attitude score and BMI was found to be not significant with
p-value of 0.47 and Pearson correlation coefficient 0.04. Thus, there was no correlation between attitude towards
obesity and individual’s BMI. Nursing students has positive attitude towards obesity. Their BMI does not seem to
affect their attitude towards obese persons and reflects that there was no stigma towards obese person.
Chronic respiratory diseases are neglected

Khoo EM

Malays Fam Physician, 2018;13(3):1-2.
PMID: 30800226
Fulltext Does the attire of a primary care physician affect patients' perceptions and their levels of trust in the doctor?

Zahrina AZ, Haymond P, Rosanna P, Ho R, Rajini AR, Low BT, et al.

Malays Fam Physician, 2018;13(3):3-11.
PMID: 30800227

INTRODUCTION: With increasing evidence of disease transmission through doctors' white coats, many countries have discouraged doctors from wearing their white coats during consultations. However, there have been limited studies about patients' preferences concerning doctors' attire in Malaysia. This study, therefore, aimed to investigate patients' perceptions of doctors' attire before and after the disclosure of information about the infection risk associated with white coats.
METHOD: This cross-sectional study was conducted from 1st June 2015 to 31st July 2015 at three different primary care settings (government, private, and university primary care clinics) using a self-administered questionnaire. A 1:5 systematic random sampling method was employed to select the participants. The respondents were shown photographs of male and female doctors in four different types of attire and asked to rate their level of confidence and trust in and ease with doctors in each type of attire. Subsequently, the respondents were informed of the risk of white coat-carried infections, and their responses were reevaluated. Data analysis was completed using SPSS Version 24.0. Associations of categorical data were assessed using the Chi-Square test, while the overall change in perceptions after the disclosure of additional information was examined using the McNemar test. Results with p-values < 0.05 were considered statistically significant.
RESULTS: A total of 299 respondents completed the questionnaire. Most of the respondents had more confidence and trust in the male (62.5%) and female (59.2%) doctors wearing white coats. A high proportion of the respondents from the government clinic (70.5%) felt more confidence in male doctors dressed in white coats (p-value = 0.018). In terms of ethnicity, male doctors in white coats were highly favored by Malays (61.0%), followed by the Chinese (41.2%) and Indians (38%) (p = 0.005). A similar preference was observed for the female doctors, whereby the highest number of Malays (60.3%), followed by the Chinese (41.2%) and Indians (40.0%) (p = 0.006), had a preference for female doctors wearing white coats. Only 21.9% of the initial 71.9% of patients who preferred white coats maintained their preference (p < 0.001) after learning of the risk of microbial contamination associated with white coats.
CONCLUSION: Most patients preferred that primary care doctors wear white coats. Nevertheless, that perception changed after they were informed about the infection risk associated with white coats.

MeSH terms: Ambulatory Care Facilities; Clothing; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Primary Health Care; Surveys and Questionnaires; Referral and Consultation; Universities; Disclosure; Trust; Patient Preference; Physicians, Primary Care
Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center

Farazdaq H, Andrades M, Nanji K

Malays Fam Physician, 2018;13(3):12-19.
PMID: 30800228

OBJECTIVE: The objective of this study is to determine the frequency and correlates of insomnia among elderly patients presenting to family medicine clinics at an academic center in Karachi, Pakistan.
STUDY DESIGN: This is a cross-sectional study.
PLACE AND DURATION OF STUDY: The study was conducted at the Outpatient Family Medicine Clinics at Aga Khan University Hospital between February 2013 and June 2013.
METHODOLOGY: Patients 60 years old and above were recruited (n=152) through non- probability consecutive sampling. Information was collected on a pretested structured questionnaire on demographics, insomnia symptoms, medical co-morbidities, lifestyle factors and sleep disorders. Data was analyzed on SPSS 19. Proportions and the Chi-Square test were used in the analyses, along with binary logistic regression.
RESULTS: The mean age of the participants was 65.68 years, and 38.80% of the participants were male and 61.20% were female. The prevalence of insomnia was 42.1%. It was more common in women than in men (64.10% vs. 35.9%). Increasing age [ORadj: 4.54; 95%CI: 1.85-11.17], being divorced/widowed [ORadj: 10.26; 95%CI: 2.79-37.73] and having an average household income of over Rs.50, 000, were significantly related to insomnia. The other factors associated with insomnia were Gastro Esophageal Reflux Disease [ORadj: 4.30; 95% CI: 1.67-11.04], depression [ORadj: 2.88, 95% CI: 1.13-7.33], caffeine consumption [ORadj: 6.50; 95% CI: 2.27-18.57], and cigarette smoking close to bed time [ORadj: 4.78; 95% CI: 0.88-25.90].
CONCLUSION: The study showed that older adults with multiple diseases were at high risk of insomnia. Certain life style practices enhanced the risk; hence, physicians should incorporate sleep history and tailor treatment to target both insomnia and related factors to optimize quality of life.
Fulltext Management of asthma in adults in primary care

Ban A, Omar A, Chong LY, Lockman H, Ida Zaliza ZA, Ali I, et al.

Malays Fam Physician, 2018;13(3):20-26.
PMID: 30800229 MyJurnal

Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and self-management and, an effective patient-healthcare provider partnership.

MeSH terms: Asthma; Chronic Disease; Health Education; Health Personnel; Humans; Patient Participation; Quality of Life; Early Diagnosis
Fulltext Gonococcal conjunctivitis: A case report

Anuar N, Idris NS

Malays Fam Physician, 2018;13(3):27-28.
PMID: 30800230

We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in the eye swab culture test. She and her sexual partner were treated successfully with intramuscular Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking, including sexual history, which translates into early recognition and treatment, thus preventing complications.

MeSH terms: Adult; Anti-Bacterial Agents; Ceftriaxone; Conjunctivitis; Conjunctivitis, Bacterial; Female; Gonorrhea; Humans; Infant, Newborn; Medical History Taking; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Sexual Partners; Azithromycin
Fulltext Sudden sensorineural hearing loss: A missed opportunity for treatment

Ali AH, Salahuddin Z, Salim R

Malays Fam Physician, 2018;13(3):29-30.
PMID: 30800231 MyJurnal

Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.

MeSH terms: Hearing Loss, Sudden; Hearing Loss, Sensorineural; Humans; Immune System; Malaysia; Morbidity; Otolaryngology; Primary Health Care
Case series of children with steroid-Induced glaucoma

Lam CS, Umi Kalthum MN, Norshamsiah MD, Bastion M

Malays Fam Physician, 2018;13(3):32-37.
PMID: 30800232

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids, particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent, and children are commonly being prescribed topical anti-inflammatories, including topical steroids, by general practitioners. Furthermore, topical steroids are also available over the counter, and this availability contributes to overuse without proper monitoring by an ophthalmologist. We present a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids among children for vernal keratoconjunctivitis. The medications were prescribed initially by general ophthalmologists and were continually bought over the counter by parents. At the presentation to our center, these patients were already compromised visually, exhibiting glaucomatous optic disc changes and high intraocular pressure. The series highlights the optic nerve damage resulting in irreversible visual compromises among children on long-term, topical steroids and the importance of regular monitoring with a low threshold for ophthalmologist referral.
Fulltext Intraosseous lipoma of the calcaneum: a rare cause of heel pain

Mawardi M, Hussin P

Malays Fam Physician, 2018;13(3):38-39.
PMID: 30800233
MeSH terms: Adult; Bone Neoplasms; Calcaneus; Humans; Lipoma*; Malaysia
Fulltext An Aubergine in My … Case of Rectal Foreign Body

Mohamad IS, Yaacob H

Malays Fam Physician, 2018;13(3):47-48.
PMID: 30800236 MyJurnal

A 24-year-old man presented to the casualty department with a history of left-sided, colicky abdominal pain for one day. It was associated with an inability to pass flatus or motion within the same duration. There was no history of vomiting. On examination, the vital signs were within normal limits, and he was afebrile. His abdomen was soft, but a hard mass was palpable on the left side of his abdomen. There was no peritonitis. The bowel sounds were sluggish.

MeSH terms: Abdomen; Adult; Humans; Male; Peritonitis; Vomiting; Abdominal Pain; Abdominal Cavity; Young Adult
Fulltext Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Loh UL, Tai PY, Hussein A, A Qamarruddin F

Cureus, 2018 Dec 17;10(12):e3743.
PMID: 30800553 DOI: 10.7759/cureus.3743

Orbital apex syndrome (OAS) is a localized orbital cellulitis at the orbital apex that can cause vision loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves. Herein, we report a rare and rapidly progressive case of OAS secondary to fungal pansinusitis caused by Scedosporiumapiospermum in an immunocompromised patient following the extraction of abscessed teeth. A 48-year-old man with diabetes mellitus who had failed to adhere to his treatment presented with complaints of a right-sided headache and toothache for two weeks, with nausea and vomiting for two days prior to presentation. The patient was treated for septic shock secondary to the dental abscesses. Non-contrast brain computed tomography (CT) showed no significant intracranial abnormalities other than pansinusitis. Four days later, dental extraction was performed. The patient reported progressive painless blurring of the vision in his right eye following the dental extractions and was referred to the ophthalmology department. Subsequent examinations revealed decreased optic nerve function and ophthalmoplegia in his right eye and dental caries in the upper molars, with a mucopurulent discharge from the right sphenoid region. The clinical diagnosis was OAS. Pus near the orbital apex was drained surgically. Methicillin-resistant Staphylococcus aureus was isolated from the pus and a nasal swab. Tissue culture from the septal wall yielded S.apiospermum. The patient's condition deteriorated, despite intensive antibiotic and antifungal treatment and repeated surgical debridement. The disease progressed rapidly to his left eye. Sixty-seven days after the inital presentation, his visual acuity (VA) of both eyes was classified as no perception of light (NPL). The patient discharged himself from the hospital (at own risk discharge) and subsequently failed to attend a scheduled appointment in the ophthalmology clinic. If immunocompromised patients present with OAS, fungal infections should be ruled out. Prompt and aggressive treatment using a multidisciplinary approach is mandatory in cases of potentially life-threatening and vision-threatening fungal infections.

MeSH terms: Abscess; Anti-Bacterial Agents; Antifungal Agents; Cranial Nerves; Debridement; Dental Caries; Diabetes Mellitus; Headache; Humans; Male; Methicillin; Middle Aged; Molar; Mycoses; Nausea; Ophthalmology; Ophthalmoplegia; Optic Nerve; Optic Nerve Diseases; Shock, Septic; Tomography, X-Ray Computed; Toothache; Visual Acuity; Vomiting; Immunocompromised Host; Orbital Cellulitis; Methicillin-Resistant Staphylococcus aureus
Fulltext Indications, Clinical Outcomes, and Survival Rate of Pediatric Penetrating Keratoplasty in Suburban Malaysia: A 10-year Experience

Mun-Wei L, Md Said H, Punitan R, Ibrahim M, Shatriah I

Cureus, 2018 Dec 17;10(12):e3744.
PMID: 30800554 DOI: 10.7759/cureus.3744

Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period. Results Sixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 ± 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05). Conclusions Infective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.

External Links