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  1. Household Pharmaceutical Waste Disposal in Selangor, Malaysia-Policy, Public Perception, and Current Practices
    Ariffin M, Zakili TST
    Environ Manage, 2019 Oct;64(4):509-519.
    PMID: 31399770 DOI: 10.1007/s00267-019-01199-y
    Although pharmaceuticals treat illnesses and prevent diseases in humans and animals, ironically, they are now among the emerging pollutants in the environment. As individuals continue to consume medicines, households can become a primary source of pharmaceutical pollutants. This paper explains relevant Malaysian law and policy on the issue. Using a questionnaire survey, it also assesses public perception concerning the environmental impact of pharmaceutical waste and the current methods of disposal that are practiced in Selangor. The survey used a convenience sampling and the data collected were analysed using statistical descriptive analysis. Most of the participants were aware that pharmaceutical waste can have an adverse impact on the environment and public health. Half of the participants disposed of their pharmaceutical waste in trash bins. About 2.9% of the respondents poured their household pharmaceutical waste (HPW) directly down the drain, while 8.8% poured them down the sink in the kitchen or toilet. The study also discovered that while 73.8% of the respondents felt that HPW should be separated from other household solid waste, only 25.2% returned their medicinal waste through the medicine return-back programme. The majority of the respondents (82.5%) agreed that information concerning the proper disposal of HPW is insufficient. The study concludes that while the respondents were aware of the adverse impact of HPW, their practices to ensure proper disposal is discouraging. There is a need for effective unwanted medicines return-back programme as a more prudent disposal method of HPW to avoid any risk to the environment or human health.
  2. Effect of fluidising velocity on the combustion of rice husk in a bench-scale fluidised bed combustor for the production of amorphous rice husk ash
    Rozainee M, Ngo SP, Salema AA, Tan KG, Ariffin M, Zainura ZN
    Bioresour Technol, 2008 Mar;99(4):703-13.
    PMID: 17379511
    This study was focused on investigating the optimum fluidising velocity during the combustion of rice husk in a bench-scale fluidised bed combustor (ID 210mm) to obtain low carbon ash in the amorphous form. When all other parameters are held constant, the optimum fluidizing velocity aids in almost complete combustion, thereby releasing the entrapped carbon for further conversion. This results in ash with consistently low carbon content (less than 2wt%). The range of fluidising velocities investigated was from as low as 1.5U(mf) to as high as 8U(mf). It was found that the optimum fluidising velocity was approximately 3.3U(mf) as the mixing of rice husk with the bed was good with a high degree of penetration into the sand bed. The resulting ash retained its amorphous form with low residual carbon content (at 2.88wt%) and minimal sand contamination as shown by the X-ray diffraction analysis.
  3. The occurrence and potential ecological risk assessment of bauxite mine-impacted water and sediments in Kuantan, Pahang,Malaysia
    Kusin FM, Rahman MS, Madzin Z, Jusop S, Mohamat-Yusuff F, Ariffin M, et al.
    Environ Sci Pollut Res Int, 2017 Jan;24(2):1306-1321.
    PMID: 27771881 DOI: 10.1007/s11356-016-7814-7
    Recent bauxite mining activities in the vicinity of Kuantan, Pahang, have been associated with apparent environmental quality degradation and have raised environmental concerns among the public. This study was carried out to evaluate the overall ecological impacts on water and sediment quality from the bauxite mining activities. Water and sediment samples were collected at seven sampling locations within the bauxite mining areas between June and December 2015. The water samples were analyzed for water quality index (WQI) and distribution of major and trace element geochemistry. Sediment samples were evaluated based on geochemical indices, i.e., the enrichment factor (EF) and geoaccumulation index (I geo). Potential ecological risk index was estimated to assess the degree to which sediments of the mine-impacted areas have been contaminated with heavy metals. The results showed that WQIs of some locations were classified as slightly polluted and contained metal contents exceeding the recommended guideline values. The EFs indicated minimal to moderate enrichment of metals (Pb, Cu, Zn, Mn, As, Cd, Cr, Ni, Co, and Sr) in the sediments. I geo showed slightly to partially polluted sediments with respect to As at some locations. The potential ecological risk index (RI) showed that As posed the highest potential ecological risk with RI of 52.35-60.92 at two locations, while other locations indicated low risk. The findings from this study have demonstrated the impact of recent bauxite mining activities, which might be of importance to the local communities and relevant authorities to initiate immediate rehabilitation phase of the impacted area.
  4. Determination of trace metals in airborne particulate matter of Kuala Terengganu, Malaysia
    Mohd Tahir N, Poh SC, Suratman S, Ariffin MM, Shazali NA, Yunus K
    Bull Environ Contam Toxicol, 2009 Aug;83(2):199-203.
    PMID: 19436928 DOI: 10.1007/s00128-009-9751-3
    Results from the present study in Kuala Terengganu, Malaysia indicated a significant spatial variation but generally the total suspended particulate concentrations (mean = 17.2-148 microg/m(3)) recorded were below the recommended Malaysia guideline for total suspended particulate (mean of 24-h measurement = 260 microg/m(3)). Some of the elemental composition of particulate aerosol is clearly affected by non crustal sources, e.g. vehicular emission sources. Based on correlation and enrichment analyses, the elements could be grouped into two i.e. Pb, Cd and Zn group with sources from vehicular emission (r > 0.6; enrichment factor > 10) and Al, Fe, Mn and Cr group that appears to be of crustal origin (r > 0.6; enrichment factor < 10). It can also be concluded that the mean levels of Pb (1 ng/m(3)), Cd (0.02 ng/m(3)) and Zn (2 ng/m(3)) in the study area are generally lower than other urban areas in Malaysia (Pb < 181 ng/m(3); Cd < 6 ng/m(3); Zn < 192 ng/m(3)).
  5. Fulltext Systematical study of multi-walled carbon nanotube nanofluids based disposed transformer oil
    Suhaimi NS, Md Din MF, Ishak MT, Abdul Rahman AR, Mohd Ariffin M, Hashim N', et al.
    Sci Rep, 2020 Dec 02;10(1):20984.
    PMID: 33268816 DOI: 10.1038/s41598-020-77810-8
    In this paper, the electrical, dielectric, Raman and small angle X-ray scattering (SAXS) structure behavior of disposed transformer oil in the presence of multi-walled carbon nanotube (MWCNT) were systematically tested to verify their versatility for preparing better alternative transformer oil in future. MWCNT nanofluids are prepared using a two-step method with concentrations ranging from 0.00 to 0.02 g/L. The test results reveal that 0.005 g/L concentration possesses the most optimum performance based on the electrical (AC breakdown and lightning impulse) and dielectric (permittivity, dissipation factor and resistivity) behavior. According to the trend of AC breakdown strength and lightning impulse pattern, there were 212.58% and 40.01% enhancement indicated for 0.005 g/L concentration compared to the disposed transformer oil. The presence of MWCNT also yielding to the decrement of dissipation factor, increased on permittivity and resistivity behavior of disposed transformer oil which reflected to the performance of electrical properties. Furthermore, it is found that these features correlated to the structural properties as systematically verify by Raman and SAXS analysis study.
  6. Fulltext Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome
    Ariffin MH, Mohd-Mahdi SN, Baharudin A, M Tamil A, Abdul-Rhani S, Ibrahim K, et al.
    Malays Orthop J, 2023 Jul;17(2):35-42.
    PMID: 37583520 DOI: 10.5704/MOJ.2307.006
    INTRODUCTION: To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ.

    MATERIALS AND METHODS: Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression.

    RESULTS: All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy.

    CONCLUSIONS: A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.

  7. Flow injection potentiometric determination of paraquat in formulations and biological samples
    Saad B, Ariffin M, Saleh MI
    Talanta, 1998 Dec;47(5):1231-6.
    PMID: 18967428
    A flow injection potentiometric method for the rapid determination of paraquat in herbicide formulations and biological samples is described. It is based on the utilization of a flow-through potentiometric detector containing polyvinyl chloride-immobilised octamethylcyclotetrasiloxane, a lipophilic plasticizer (tetra-n-undecyl 3,3',4,4'-benzophenone tetracarboxylate) and membrane additive potassium tetrakis(4-chlorophenyl)borate. The detector was minimally interfered by the presence of constituents such as Na(+), K(+), Ca(2+), Mg(2+), glucose, urea, lactic and citric acids at physiological levels, respectively. Good correlation between results of the proposed method and HPLC for the formulation samples was found, while results for the determination of paraquat in biological samples such as urine, vomitus and stomach washout was less satisfactory.
  8. Can hyperchaotic maps with high complexity produce multistability?
    Natiq H, Banerjee S, Ariffin MRK, Said MRM
    Chaos, 2019 Jan;29(1):011103.
    PMID: 30709147 DOI: 10.1063/1.5079886
    In this paper, we investigate the dynamical behavior in an M-dimensional nonlinear hyperchaotic model (M-NHM), where the occurrence of multistability can be observed. Four types of coexisting attractors including single limit cycle, cluster of limit cycles, single hyperchaotic attractor, and cluster of hyperchaotic attractors can be found, which are unusual behaviors in discrete chaotic systems. Furthermore, the coexistence of asymmetric and symmetric properties can be distinguished for a given set of parameters. In the endeavor of chaotification, this work introduces a simple controller on the M-NHM, which can add one more loop in each iteration, to overcome the chaos degradation in the multistability regions.
  9. Complexity in congestive heart failure: A time-frequency approach
    Banerjee S, Palit SK, Mukherjee S, Ariffin M, Rondoni L
    Chaos, 2016 Mar;26(3):033105.
    PMID: 27036183 DOI: 10.1063/1.4941374
    Reconstruction of phase space is an effective method to quantify the dynamics of a signal or a time series. Various phase space reconstruction techniques have been investigated. However, there are some issues on the optimal reconstructions and the best possible choice of the reconstruction parameters. This research introduces the idea of gradient cross recurrence (GCR) and mean gradient cross recurrence density which shows that reconstructions in time frequency domain preserve more information about the dynamics than the optimal reconstructions in time domain. This analysis is further extended to ECG signals of normal and congestive heart failure patients. By using another newly introduced measure-gradient cross recurrence period density entropy, two classes of aforesaid ECG signals can be classified with a proper threshold. This analysis can be applied to quantifying and distinguishing biomedical and other nonlinear signals.
  10. A green solvent holder in electro-mediated microextraction for the extraction of phenols in water
    Chong YT, Mohd Ariffin M, Mohd Tahir N, Loh SH
    Talanta, 2018 Jan 01;176:558-564.
    PMID: 28917790 DOI: 10.1016/j.talanta.2017.08.068
    Electro-mediated microextraction (EMM) combined with micro-high performance liquid chromatography-ultraviolet detection was successfully developed for the determination of selected phenols, namely 4-chlorophenol (4CP), 2-nitrophenol (2NP) and 2,4-dichlorophenols (2,4 DCP) in water. A solvent-impregnated agarose gel disc was utilized as a solvent holder in this study. Under optimum extraction conditions, the method showed good linearity in the range of 0.1-250µgL-1, 0.3-250µgL-1and 0.2-500µgL-1for 4CP, 2NP and 2,4 DCP, respectively with correlation coefficients of ≥ 0.9975, ultra-trace LODs (0.03-0.1µgL-1) and satisfactory relative recovery average (85.0-114.1%) for the analysis of selected phenols. The proposed method was rapid and eco-friendly as the solvent holder was constructed using minute amounts of extraction solvent immobilized within the biodegradable agarose gel disc. A comparative microextraction technique termed solvent-impregnated agarose gel liquid phase microextraction (AG-LPME) was re-optimized and validated for the extraction of phenols in water. The method offered good linearity, ultra-trace LODs ranging 0.1-0.5µgL-1and satisfactory average of relative recovery (86.1-114.1%). The EMM was superior in terms of sensitivity and time-effectiveness compared to AG-LPME. Both techniques combine extraction and pre-concentration in mini-scaled approaches using an eco-friendly solvent holder that fulfil the green chemistry concept.
  11. Fulltext Indoor and outdoor residual spraying of a novel formulation of deltamethrin K-Othrine® (Polyzone) for the control of simian malaria in Sabah, Malaysia
    Rohani A, Fakhriy HA, Suzilah I, Zurainee MN, Najdah WMAW, Ariffin MM, et al.
    PLoS One, 2020;15(5):e0230860.
    PMID: 32413033 DOI: 10.1371/journal.pone.0230860
    Since 2000, human malaria cases in Malaysia were rapidly reduced with the use of insecticides in Indoor Residual Spray (IRS) and Long-Lasting Insecticide Net (LLIN). Unfortunately, monkey malaria in humans has shown an increase especially in Sabah and Sarawak. The insecticide currently used in IRS is deltamethrin K-Othrine® WG 250 wettable granule, targeting mosquitoes that rest and feed indoor. In Sabah, the primary vector for knowlesi malaria is An. balabacensis a species known to bite outdoor. This study evaluates an alternative method, the Outdoor Residual Spray (ORS) using a novel formulation of deltamethrin K-Othrine® (PolyZone) to examine it suitability to control knowlesi malaria vector in Sabah, compared to the current method. The study was performed at seven villages in Sabah having similar type of houses (wood, bamboo and concrete). Houses were sprayed with deltamethrin K-Othrine® (PolyZone) at two different dosages, 25 mg/m2 and 30 mg/m2 and deltamethrin K-Othrine® WG 250 wettable granule at 25 mg/m2, sprayed indoor and outdoor. Residual activity on different walls was assessed using standard cone bioassay techniques. For larval surveillances, potential breeding sites were surveyed. Larvae were collected and identified, pre and post spraying. Adult survey was done using Human Landing Catch (HLC) performed outdoor and indoor. Detection of malaria parasite in adults was conducted via microscopy and molecular methods. Deltamethrin K-Othrine® (PolyZone) showed higher efficacy when sprayed outdoor. The efficacy was found varied when sprayed on different types of wall surfaces. Deltamethrin K-Othrine® (PolyZone) at 25 mg/m2 was the most effective with regards to ability to high mortality and effective knock down (KD). The vector population was reduced significantly post-spraying and reduction in breeding sites as well. The number of simian malaria infected vector, human and simian malaria transmission were also greatly reduced.
  12. Fulltext Experimental and numerical evaluations of composite concrete-to-concrete interfacial shear strength under horizontal and normal stresses
    Al-Fasih MY, Mohamad ME, Ibrahim IS, Ahmad Y, Ariffin MAM, Sarbini NN, et al.
    PLoS One, 2021;16(5):e0252050.
    PMID: 34015027 DOI: 10.1371/journal.pone.0252050
    Effects of different surface textures on the interface shear strength, interface slip, and failure modes of the concrete-to-concrete bond are examined through finite element numerical model and experimental methods in the presence of the horizontal load with 'push-off' technique under different normal stresses. Three different surface textures are considered; smooth, indented, and transversely roughened to finish the top surfaces of the concrete bases. In the three-dimensional modeling via the ABAQUS solver, the Cohesive Zone Model (CZM) is used to simulate the interface shear failure. It is observed that the interface shear strength increases with the applied normal stress. The transversely roughened surface achieves the highest interface shear strength compared with those finished with the indented and smooth approaches. The smooth and indented surfaces are controlled by the adhesive failure mode while the transversely roughened surface is dominated by the cohesive failure mode. Also, it is observed that the CZM approach can accurately model the interface shear failure with 3-29% differences between the modeled and the experimental test findings.
  13. Fulltext Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report
    Ariffin MH, Ashfaq MM, Kang E
    Malays Orthop J, 2016 Mar;10(1):50-52.
    PMID: 28435547 MyJurnal DOI: 10.5704/MOJ.1603.009
    Transoral approach to the cervico-medullary junction is a well-established procedure. However oropharyngeal complications in the form of soft tissue morbidity postoperatively do occur. We report a case of a teenage boy with traumatic quadriparesis secondary to compression of the cervico-medullary junction by an os odontoideum. Decompression was done via transoral approach through a tubular retractor system, hence obviating the need for the splitting or separate retraction of the soft palate and minimised the damage and violation of surrounding soft tissues. His neurological status improved and he was able to ambulate with support on fourth post-operative day with no soft tissue morbidity in the oral cavity. To our knowledge this is the first case reported using this technique. We conclude that adoption of this method would improve the traditional transoral approach and reduce the oropharyngeal complications.
  14. Fulltext Osteoradionecrosis in Subaxial Cervical Spine - a Rare and Devastating Complication: A Case Report
    Rashid MZ, Ariffin MH, Rhani SA, Baharudin A, Ibrahim K
    Malays Orthop J, 2017 Nov;11(3):53-55.
    PMID: 29326769 MyJurnal DOI: 10.5704/MOJ.1711.005
    Osteoradionecrosis, a rare complication of radiation therapy, is a slow progression disease which affects the surrounding structures of spinal components. It essentially weakens the soft tissue and bony configuration and can cause nerve impingement or cord compression. We describe a patient who underwent radiotherapy for thyroid cancer and presented with cervical kyphosis with anterolisthesis of C3/C4 and C4/C5 some 32 years later. We explore the role of anterior and posterior fusion, as well as hyperbaric oxygen therapy in promoting healing.
  15. Fulltext Spinal cord injury - assessing tolerability and use of combined rehabilitation and NeuroAiD (SATURN) study - primary results of an exploratory study
    Kumar R, Htwe O, Baharudin A, Rhani SA, Ibrahim K, Nanra JS, et al.
    J Spinal Cord Med, 2023 Jul;46(4):682-686.
    PMID: 35604343 DOI: 10.1080/10790268.2022.2067972
    OBJECTIVE: MLC601/MLC901 has demonstrated neuroprotective and neuroregenerative properties that enhance neurological recovery in stroke and traumatic brain injury. We aimed to evaluate its safety and potential efficacy in patients with severe spinal cord injury.

    METHODS: Patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A and B were included in an open-label cohort study. Each received a course of MLC601/MLC901 for 6 months in addition to standard care and rehabilitation. Key endpoints were safety, AIS grade and motor scores at month 6 (M6).

    RESULTS: Among 30 patients included (mean age 42.2 ± 17.6 years, 24 men), 20 patients had AIS A while 10 patients had AIS B at baseline. Ten patients experienced 14 adverse events including one serious adverse event and six deaths, none were considered treatment-related. AIS improved in 25% of AIS A and 50% of AIS B. Improvement in ASIA motor score was seen most with cervical injury (median change from baseline 26.5, IQR: 6-55). These findings appear to be better than reported rates of spontaneous recovery for SCI AIS A and B.

    CONCLUSION: MLC601/MLC901 is safe and may have a role in the treatment of patients with SCI. A controlled trial is justified.

  16. Fulltext Compression Behaviour of Bio-Inspired Honeycomb Reinforced Starfish Shape Structures Using 3D Printing Technology
    Saufi SASA, Zuhri MYM, Dezaki ML, Sapuan SM, Ilyas RA, As'arry A, et al.
    Polymers (Basel), 2021 Dec 14;13(24).
    PMID: 34960939 DOI: 10.3390/polym13244388
    The bio-inspired structure (e.g., honeycomb) has been studied for its ability to absorb energy and its high strength. The cell size and wall thickness are the main elements that alter the structural ability to withstand load and pressure. Moreover, adding a secondary structure can increase the compressive strength and energy absorption (EA) capability. In this study, the bio-inspired structures are fabricated by fused deposition modelling (FDM) technology using polylactic acid (PLA) material. Samples are printed in the shape of a honeycomb structure, and a starfish shape is used as its reinforcement. Hence, this study focuses on the compression strength and EA of different cell sizes of 20 and 30 mm with different wall thicknesses ranging from 1.5 to 2.5 mm. Subsequently, the deformation and failure of the structures are determined under the compression loading. It is found that the smaller cell size with smaller wall thickness offered a crush efficiency of 69% as compared to their larger cell size with thicker wall thickness counterparts. It is observed that for a 20 mm cell size, the EA and maximum peak load increase, respectively, when the wall thickness increases. It can be concluded that the compression strength and EA capability increase gradually as the cell size and wall thickness increase.
  17. Fulltext Trapezius rotational flap for cervico-thoracic wound breakdown in post-radiotherapy necrosis: a case report
    Ariffin, M. H., Selvyn Lloyd, Rhani, S. A., Kamalnizat, Baharudin, A.
    Malays Orthop J, 2014;8(2):40-42.
    MyJurnal
    The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with post- radiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.
  18. Fulltext Trapezius Rotational Flap for Cervico-thoracic Wound Breakdown in Post-radiotherapy Necrosis : A Case Report
    Ariffin M, Lloyd S, Rhani S, Kamalnizat, Baharudin A
    Malays Orthop J, 2014 Jul;8(2):40-2.
    PMID: 25279091 DOI: 10.5704/MOJ.1407.001
    The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with postradiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.
  19. Severe Cervicothoracic Kyphoscoliosis in Neurofibromatosis - A Failure Of Posterior-Only Instrumentation: A Case Report
    Soh E, Muhamad-Ariffin MH, Baharudin A
    Malays Orthop J, 2020 Mar;14(1):88-91.
    PMID: 32296489 DOI: 10.5704/MOJ.2003.015
    Treatment of severe spinal deformities associated with neurofibromatosis has proven to be challenging. An 11-year-old girl, with neurofibromatosis and severe cervicothoracic kyphoscoliosis, was initially treated with posterior instrumentation and fusion. Implant failure developed within a year, requiring an anterior stabilisation and fusion with a non-vascularised fibular strut graft for better stability and increased likelihood of achieving union. The posterior instrumentation was removed due to its prominence and wound breakdown. Following the removal of the posterior implant, the fibular graft fractured. The patient was maintained on a cervical collar until union was achieved. Posterior spinal fusion alone in severe spinal deformities in neurofibromatosis has a high risk of failure. A combined anterior and posterior fusion may increase the chance of success, with better stability and union rate.
  20. Fulltext Retained intraspinal bullet: a rare case in a visitor to malaysia - a case report
    Ariffin M, Noreen F, Nor Hamdan Y, Shaharuddin AR, Azmi B
    Malays Orthop J, 2012 Nov;6(3):45-7.
    PMID: 25279057 MyJurnal DOI: 10.5704/MOJ.1207.005
    Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms.
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