Browse publications by year: 2020

  1. Jeyamogan S, Khan NA, Sagathevan K, Siddiqui R
    BMJ Open Sci, 2020;4(1):e100040.
    PMID: 35047686 DOI: 10.1136/bmjos-2019-100040
    Background: Cancer remains a global threat resulting in significant morbidity and mortality despite advances in therapeutic interventions, suggesting urgency for identification of anticancer agents. Crocodiles thrive in polluted habitat, feed on germ-infested meat, are exposed to carcinogenic heavy metals, are the very few species to survive the catastrophic Cretaceous-Paleogene extinction event, yet have a prolonged lifespan and rarely been reported to develop cancer. Therefore, we hypothesised that animals living in polluted environments such as crocodiles possess anticancer molecules/mechanisms.

    Methods: Crocodylus porosus was procured, blood collected, dissected and lysates prepared from internal organs. Organ lysates and sera were tested for growth inhibition, cytotoxic effects and cell survival against HeLa, PC3 and MCF7 cells and subjected to liquid chromatography mass spectrometry. RNA transcriptome analysis and differential gene analysis were performed using Galaxy Bioinformatics.

    Results: Sera exhibited potent growth inhibition and cytotoxic effects against cancer cells. 80 molecules were detected from C. porosus and 19 molecules were putatively identified. Additionally, more than 100 potential anticancer peptides were identified from sera using bioinformatics based on peptide amino acid composition, binary profile, dipeptide composition and pseudo-amino acid composition. Following transcriptome analysis, 14 genes in treated HeLa cells, 51 genes in treated MCF7 cells and 2 genes in treated PC3 cells, were found to be expressed, compared with untreated controls.

    Conclusion: Animals residing in polluted milieus are an unexploited source for prospective pharmaceutical drugs, and could lead to identification of novel antitumour compound(s) and/or further understanding of the mechanisms of cancer resistance.

  2. Balkhoyor AM, Awais M, Biyani S, Schaefer A, Craddock M, Jones O, et al.
    BMJ Surg Interv Health Technol, 2020;2(1):e000040.
    PMID: 35047792 DOI: 10.1136/bmjsit-2020-000040
    OBJECTIVE: Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta-a putative biomarker for cognitive control processes.

    DESIGN SETTING AND PARTICIPANTS: Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4-7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate.

    RESULTS: Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain-behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=-0.594, p=0.0058), but no such relationship emerged for novices.

    CONCLUSION: We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.

  3. Lam SE, Noor NM, Bradley DA, Mahmud R, Pawanchek M, Abdul Rashid HA
    Biomed Phys Eng Express, 2020 Nov 05;6(6).
    PMID: 35042836 DOI: 10.1088/2057-1976/abc2a4
    This work investigates the suitability of locally fabricated 6 mol% Ge-doped optical fibres as dosimeters for small-field output ratio measurements. Two fabrications of fibre, cylindrical (CF) and flat (FF) fibres, were used to measure doses in small photon fields, from 4 to 15 mm. The findings were compared to those of commercial Ge-doped fibre (COMM), EBT3 film and an IBA CC01 ionization chamber. Irradiations were carried out using a 6 MV SRS photon beam operating at a dose rate of 1000 cGy min-1, delivering a dose of 16 Gy. To minimise the possibility of the fibres failing to be exposed to the intended dose in small fields, the fibres were accommodated in a custom-made Perspex phantom. For the 4 mm cone the CF and FF measured output ratios were found to be smaller than obtained with EBT3 film by 32% and 13% respectively. Conversely, while for the 6 to 15 mm cone fields the FF output ratios were consistently greater than those obtained using EBT3 film, the CF output ratios differed from those of EBT3 film by at most 3.2%, at 6 mm, otherwise essentially agreeing with EBT3 values at the other field sizes. For the 4 to 7.5 mm cones, all output ratios obtained from Ge-doped optical fibre measurements were greater than those of IBA CC01 ionization chamber. The measured FF and CF output ratios for the 7.5 to 15 mm cones agreed with published MC estimates to within 15% and 13%, respectively. Down to 6 mm cone field, present measurements point to the potential of CF as a small-field dosimeter, its use recommended to be complemented by the use of EBT3 film for small-field dosimetry.
  4. Mardhiyah A, Philip K, Mediani HS, Yosep I
    Child Health Nurs Res, 2020 Jul;26(3):323-328.
    PMID: 35004475 DOI: 10.4094/chnr.2020.26.3.323
    Purpose: Hope has been identified as a protective factor that contributes to achieving a better quality to life, especially in patients with chronic disease. The purpose of this review was to synthesize current knowledge about the relationship between hope and quality of life among adolescents living with chronic illnesses.

    Methods: We searched major English-language databases (PsycINFO, PubMed, and CINAHL) for studies from January 1, 2002 to July 12, 2019. Studies were included if they provided data on hope and its relationship with quality of life among adolescents with chronic diseases.

    Results: In total, five articles were selected from the 336 studies that were retrieved. All five studies reported a positive correlation between hope and quality of life, such that people with a higher level of hope had a better quality of life. Hope was found to have direct and indirect effects on quality of life in adolescents with chronic diseases.

    Conclusion: Healthcare professionals should make more efforts to enhance hope in adolescents with chronic diseases in order to improve their quality of life. Future studies exploring how hope develops in adolescents with chronic diseases and the long-term impact of hope on quality of life are necessary.

  5. Daud AZC, Aman NA, Chien CW, Judd J
    F1000Res, 2020;9:1306.
    PMID: 34950457 DOI: 10.12688/f1000research.25753.1
    Background: Little is known on how time spent on touch-screen technology affects the hand skills development of preschool children. This study aimed to investigate the effects of touch-screen technology usage on hand skills among preschool children. Methods: Case-control design was employed to compare the hand skills of children who were engaged in touch-screen technology. A total of 128 participants aged between five and six years old who attended preschool were recruited and divided into two groups: high usage touch-screen technology (HUTSTG) and, low usage touch-screen technology (LUTSTG). Children's Hand Skills ability Questionnaire (CHSQ) and Assessment of Children's Hand Skills (ACHS) were used to evaluate the children's hand skills. Results: There were significant differences in the hand skills of preschool children between HUTSTG and LUTSTG. Results showed that preschool children in LUTSTG had better hand skills in all domains of CHSQ (p≤0.001) and ACHS (p<0.001) as compared to HUTSTG. Conclusion: Frequent use of touch-screen technology might cause disadvantages to the development of hand skills among preschool children.
    MeSH terms: Child; Child, Preschool; Hand*; Humans; Motor Skills*; Surveys and Questionnaires; Technology; Case-Control Studies
  6. Idumah CI, Obele CM, Emmanuel EO, Hassan A
    Surf Interfaces, 2020 Dec;21:100734.
    PMID: 34957345 DOI: 10.1016/j.surfin.2020.100734
    Recent nanotechnological advancements have enabled novel innovations in protective polymer nanocomposites (PNC) coatings for anti-corrosion, anti-fouling and self-healing services on material surfaces. Nanotechnology encompases research, manufacturing, and application of nanoparticulate architectures, tubular structures, sheets or plates exhibiting sizes below 100 nanometers (nm) in at least a single dimension. Inclusions of nanoparticles into organic entities have demonstrated enhanced properties essential for attainiment of aesthetics, anti-corrosion, thermal stability for high-temperature performances, mechanical strength essential for resisting coating deterioration in harsh environments, nano-architectural cross-linking capable of hindering penetration of corrosive, and biofouling entities. Unlike previously published literature, this paper elucidates very recently emerging important advancements in novel techniques utilized in developing PNC coatings for applications in aerospace, packaging, automotive, biomedicine, maritime, and oil and gas industries for attaining superior anti-fouling, anti-corrosion, and self-healing behaviors on critical material surfaces. Emerging market structures and novel applications are also presented.
  7. Wong YS, Zulkefly NS, Tan KA
    Int J Adolesc Med Health, 2020 Jun 08;33(6):493-500.
    PMID: 32549164 DOI: 10.1515/ijamh-2019-0228
    OBJECTIVES: The present study aimed to examine the mediational role of maladaptive cognitive schema in the association between stressful life events, which are operationalised as major (i. e. negative life events) and minor (i. e. daily hassles) life stressors, and depressive symptoms among adolescents.

    METHODS: A cross-sectional correlational study was conducted to recruit participants across four selected states of Kedah, Kelantan, Melaka and Selangor in Peninsular Malaysia. This study involved a total of 1,032 adolescents from 25 government secondary schools, identified using probability proportional to size cluster sampling technique. Data were collected through a self-report questionnaire.

    RESULTS: Using structural equation modelling analyses, findings revealed a full mediation effect of maladaptive cognitive schema between negative life events and depressive symptoms, and a partial mediation effect between daily hassles and depressive symptoms.

    CONCLUSIONS: This study provided valuable insights about the significance of maladaptive cognitive schema as a mediator in the stress-depression association and advanced the understanding of mechanism underlying development of depressive symptoms among adolescents in Malaysia. Findings also benefit the clinical practice in the development of targeted depression prevention and intervention programs.

  8. ISBN: 978-967-19598-0-0
    Citation: National Coordinating Committee on Food and Nutrition. Nutrition Research Priorities in Malaysia - For 12th Malaysia Plan (2021-2025). Putrajaya: Ministry of Health Malaysia, 2020

    Older versions:
    National Coordinating Committee on Food and Nutrition. Nutrition Research Priorities in Malaysia - For 10th Malaysia Plan (2011-2015). Putrajaya: Ministry of Health Malaysia, 2009
    National Coordinating Committee on Food and Nutrition. Nutrition Research Priorities in Malaysia - For 11th Malaysia Plan (2016-2020). Putrajaya: Ministry of Health Malaysia, 2020
    MeSH terms: Malaysia; Nutrition Disorders; Research; Nutrition Assessment
  9. Amelia-Yap ZH, Tan TK, Prakash BK, Chen CD, Sofian-Azirun M, Low VL
    J Vector Borne Dis, 2020 10 1;57(4):359-361.
    PMID: 34856717 DOI: 10.4103/0972-9062.313959
    MeSH terms: Alleles; Animals; Insecticide Resistance; Malaysia; Culicidae*
  10. Cameron NA, Molsberry R, Pierce JB, Perak AM, Grobman WA, Allen NB, et al.
    J Am Coll Cardiol, 2020 Dec 01;76(22):2611-2619.
    PMID: 33183896 DOI: 10.1016/j.jacc.2020.09.601
    BACKGROUND: Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes.

    OBJECTIVES: The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies.

    METHODS: We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas.

    RESULTS: Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018.

    CONCLUSIONS: Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted.

    MeSH terms: Adolescent; Adult; Cross-Sectional Studies; Ethnic Groups; Female; Health Services Needs and Demand; Humans; Maternal Mortality/trends*; Pregnancy; Risk Factors; Rural Health/statistics & numerical data*; United States/epidemiology; Urban Health/statistics & numerical data*; Risk Assessment/methods; Risk Assessment/statistics & numerical data; Healthcare Disparities/statistics & numerical data
  11. Roy DC, Biswas SK, Sheam MM, Hasan MR, Saha AK, Roy AK, et al.
    Curr Res Microb Sci, 2020 Sep;1:37-43.
    PMID: 34841300 DOI: 10.1016/j.crmicr.2020.06.001
    Globally, water pollution from the textile industries is an alarming issue. Malachite Green dye of the triphenylmethane group is an extensively used dye in the fabric industries that is emitted through textile wastewater. This study aimed to isolate and characterize potential Malachite Green (MG) dye degrading bacteria from textile effluents. Different growth and culture parameters such as temperature, pH and dye concentration were optimized to perform the dye-degradation assay using different concentrations of MG dye in the mineral salt medium. A photo-electric-colorimeter was used to measure the decolorizing activity of bacteria at different time intervals after aerobic incubation. Two potential bacterial strains of Enterobacter spp. CV-S1 (accession no: MH450229) and Enterobacter spp. CM-S1 (accession no: MH447289) were isolated from textile effluents exhibiting potential MG dye decoloring efficiency. Further, the RAPD analysis and 16S rRNA sequencing confirmed the genetic differences of the isolated strains. Enterobacter sp CV-S1 and Enterobacter sp CM-S1 can completely decolor MG dye up to 15 mg/L under shaking condition without any requirement of sole carbon source. Thus, these two bacteria have the potency to be utilized in the textile wastewater treatment plant.
  12. Jackson K, Devaraj E, Lakshmi T, Rajeshkumar S, Dua K, Chellappan DK, et al.
    Bioinformation, 2020;16(11):817-827.
    PMID: 34803254 DOI: 10.6026/97320630016817
    It is of interest to study the cytotoxicity of silibinin assisted silver nanoparticles in human colorectal (HT-29) cancer cells. Silver nanoparticles were synthesized using silibinin as a reducing agent. The synthesized silibinin assisted silver nanoparticles ( SSNPs) were characterized and analyzed using a transmission electron microscope and spectrophotometer. The SSNPs synthesized in this study are spherical and their size ranges from 10 to 80 nm. HT-29 cells were treated with different concentrations (2, 4, 6, 8 and 10 ng/mL) of SSNPs and cytotoxicity was evaluated. The apoptosis was using flow cytometry. p53 protein expression using western blot. SSNPs are induced a decrease in viability and increased concentration-dependent cytotoxicity in HT-29 cells. SSNPs treatment also caused apoptosis-related morphological changes. SSNPs treatments at 8 and 16 ng/ml showed a prominent apoptotic change i.e., 70.3% and 83.6% respectively, and decreased viability of HT-29 cells 20% and 11.2% respectively as compared to control cells. SSNPs treatments induced p53 expression in HT-29 cells. Data shows that SSNPs have the potential to induce apoptosis in colorectal cancer cells. This provides insights for the further evaluation of SSNPs in fighting colon cancer.
  13. Akshayaa L, Lakshmi T, Devaraj E, Roy A, Raghunandhakumar S, Sivaperumal P, et al.
    Bioinformation, 2020;16(11):878-881.
    PMID: 34803262 DOI: 10.6026/97320630016878
    Design and development of effective anti-virals in combating CoVid-19 is a great challenge worldwide. Known drugs such as chloroquine, lopinavir, favipiravir and remdesivir are used in the management of CoVid - 19. It is known that Ivermectin and remdesivir both are effective against filoviruses, paramyxo viruses. Available data also shows that ivermectin and remedesivir repress the replication of SARS-CoV-2. Thus, we document the potential use of ivermectin and remdesivir in the management of CoVid -19.
  14. Ramamoorthy K, Raghunandhakumar S, Anand RS, Paramasivam A, Kamaraj S, Nagaraj S, et al.
    Bioinformation, 2020;16(11):965-973.
    PMID: 34803274 DOI: 10.6026/97320630016965
    Astaxanthin (AXN) is known to have health benefits by epidemiological studies. Therefore, it is of interest to assess the effect of AXN (derived from indigenous unicellular green alga Haematococcus lacustris) to modulate cell cycle arrest, lysosomal acidification and eventually apoptosis using in vitro in A549 lung cancer cells. Natural extracts of astaxanthin were obtained by standardized methods as reported earlier and characterized by standard HPLC and MS. Treatment of A549 cells with AXN (purified fraction) showed significant reduction in cell viability (about 50%) as compared to crude extract at 50µM concentration. Thus, we show the anticancer effects and lysosomal acidification in A549 cells by Astaxanthin from Haematococcus lacustris for further consideration. Together, our results demonstrated the anticancer potential of AXN from Haematococcus lacustris, which is found to be mediated via its ability to induce cell cycle arrest, lysosomal acidification and apoptotic induction.
  15. Mishra NP, Das SS, Yadav S, Khan W, Afzal M, Alarifi A, et al.
    Sens Int, 2020;1:100042.
    PMID: 34766044 DOI: 10.1016/j.sintl.2020.100042
    On March 11, 2020, the novel Corona virus disease (COVID-19), was described as a pandemic by World Health Organization (WHO). Globally, the COVID-19 has not only affected the public health socially but also has rigorously affected economically. Substantial declines in income, increase in unemployment, and distractions in the transportation, amenities, and industrial sectors are amongst the major concerns of the pandemic disease extenuation. Furthermore, the governments of most of the countries underestimated the menaces of COVID-19 spread and were typically responsive for the calamities in their respective countries. As outbreak of this pandemic is not likely to wane in the nearby future, preventive actions are prerequisite to prevent infection spread, save people lives and also to save the economic affluence. In this review, based on the present knowledge and available literature, we have demonstrated the various aspects of pre-and post-COVID-19 effects over the social and economic phases worldwide. Moreover, the evidence based data have been summarized regarding threats, social influences, scientific upgrades, moral dynamics, stress and adapting in the pre- and post- COVID-19 situations.
  16. Chaturvedi A, Rao G, Praharaj SK, Guruprasad KP, Pais V
    Alcohol Alcohol, 2020 Jun 25;55(4):391-394.
    PMID: 32363396 DOI: 10.1093/alcalc/agaa033
    AIM: Chronic alcohol consumption can activate and dysregulate the neuroimmune system which leads to neuroinflammation. Neuroimmune regulatory proteins (NIReg) (e.g. Cluster of Differentiation 200 (CD200)) are the regulators of innate immune response and are responsible for silencing the innate immunity and suppression of inflammation. In this study, we explored the changes of serum levels of CD200 in patients with alcohol dependence at baseline, after one-week alcohol withdrawal and after one-month of alcohol abstinence.

    METHODS: Seventeen patients with alcohol dependence admitted for de-addiction treatment and 12 healthy controls were enrolled in the study. Blood samples were collected at baseline, after one-week, and after one-month, and CD200 levels were measured using enzyme-linked immunosorbent assay kit and compared with the healthy controls.

    RESULTS: The serum level of the neuroimmune regulatory protein CD200 in alcohol dependent group (at baseline) was significantly lower compared to healthy controls (p=0.003), and increased after one-week, and one-month period.

    CONCLUSION: The present study indicates that decrease of CD200 serum levels in alcohol dependent patients and its rise during alcohol withdrawal and abstinence may provide a preliminary evidence of the role of neuroimmune regulatory proteins in neuroadaptation during alcohol withdrawal.

    MeSH terms: Adult; Alcoholism/blood*; Female; Humans; Male; Antigens, CD/blood*; Case-Control Studies
  17. Gupta A, Pradhan B, Maulud KNA
    Earth Syst Environ, 2020;4(3):523-534.
    PMID: 34723072 DOI: 10.1007/s41748-020-00179-1
    The COVID-19 pandemic has spread obstreperously in India. The increase in daily confirmed cases accelerated significantly from ~ 5 additional new cases (ANC)/day during early March up to ~ 249 ANC/day during early June. An abrupt change in this temporal pattern was noticed during mid-April, from which can be inferred a much reduced impact of the nationwide lockdown in India. Daily maximum (T Max), minimum (T Min), mean (T Mean) and dew point temperature (T Dew), wind speed (WS), relative humidity, and diurnal range in temperature and relative humidity during March 01 to June 04, 2020 over 9 major affected cities are analyzed to look into the impact of daily weather on COVID-19 infections on that day and 7, 10, 12, 14, 16 days before those cases were detected (i.e., on the likely transmission days). Spearman's correlation exhibits significantly lower association with WS, T Max, T Min, T Mean, T Dew, but is comparatively better with a lag of 14 days. Support Vector regression successfully estimated the count of confirmed cases (R 2 > 0.8) at a lag of 12-16 days, thus reflecting a probable incubation period of 14 ± 02 days in India. Approximately 75% of total cases were registered when T Max, T Mean, T Min, T Dew, and WS at 12-16 days previously were varying within the range of 33.6-41.3 °C, 29.8-36.5 °C, 24.8-30.4 °C, 18.7-23.6 °C, and 4.2-5.75 m/s, respectively. Thus, we conclude that coronavirus transmission is not well correlated (linearly) with any individual weather parameter; rather, transmission is susceptible to a certain weather pattern. Hence multivariate non-linear approach must be employed instead.
  18. Huang MC, Liou MH, Iwaki Y
    J Soc Econ Dev, 2020 Sep 19.
    PMID: 34720470 DOI: 10.1007/s40847-020-00113-1
    Policymaking for science, technology, and innovation (R&D) is stepping into a new era in the twenty-first century within a highly integrated production network, making it more challenging to capture the impact of R&D investment from an evidence-based approach. To unfold the paradox of the R&D spillover effect spared in the global supply chain, we use computable general equilibrium model with the GTAP database v10 to analyze the impact of Japan's public R&D investment to the world focus on key sectors of global supply chain, namely chemical and pharmaceutical, electronic equipment, machinery, and transportation equipment to examine its output, external trades, and welfare. The productivity parameters triggered by public R&D investment are calibrated from the SciREX Policymaking Intelligent Assistance System-Economic Simulator (SPIAS-e). The simulation results show significant increase in Japan's output and export for chemical and pharmaceutical, electronic equipment, and transportation equipment. The GDP growth was stimulated by 0.6% and substantial welfare improvement by USD 78,000 million, while other countries such as Malaysia and Taiwan by 0.4-0.6%. In contrast, the economic indicators of China reveal a negative impact, implying a structural change in the composition of the production network. It is notable to see a higher economic integration of Oceania within the region through its vibrant production and trades. The study provides comprehensive global analysis on production networks and insights for evaluating the R&D investment spillover effects.
  19. Shariffudin NS, Min TW, Adnan A, Hashim H, Teo KSS
    Taiwan J Ophthalmol, 2020 08 14;11(3):292-295.
    PMID: 34703746 DOI: 10.4103/tjo.tjo_29_20
    A 6-year-old boy was referred from the optometrist for bilateral painless blurred vision of 2 weeks duration during routine screening. Upon examination, best-corrected visual acuity was 20/200 (right eye) and 20/120 (left eye). Anterior segment examination was normal for both eyes. Funduscopy showed bilateral optic disc swelling with peripapillary exudates and diffuse retinochoroiditis involving the posterior pole. Optical coherence tomography revealed diffuse retinal thickening with intraretinal fluids and cystoid changes of central fovea. Fluorescein angiography showed bilateral hot discs with vasculitis in all quadrants and large areas of nonperfusion at peripheral retina. The patient was initially treated as presumed ocular tuberculosis (TB) based on clinical presentation and history of contact with family member having pulmonary TB. Antituberculous therapy was started and both eyes received panretinal laser photocoagulation. After 3 weeks of anti-TB treatment, serology for Bartonella turned out to be positive. Treatment was changed to intravenous ceftriaxone for 10 days followed by oral cotrimoxazole for 6 weeks and combined treatment with oral prednisolone. Gradual clinical improvement was seen with corresponding visual gain due to the reduction of macular edema, but residual thickening remained due to its chronicity.
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