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Photoluminescence and thermoluminescence dosimetry properties of Ag/Y co-doped ZnO nanophosphor for radiation measurements

Abdurabu Thabit H, Ismail AK, Kabir NA, Abu Mhareb MH, Al Mutairi AM, Bafaqeer A, et al.

Luminescence, 2024 Feb;39(2):e4683.
PMID: 38332469 DOI: 10.1002/bio.4683

This work explores the thermoluminescence (TL) and photoluminescence (PL) properties of Ag/Y co-doped zinc oxide (ZnO) nanophosphor. The proposed dosimeter was prepared by the coprecipitation method and sintered at temperatures from 400°C to 1000°C in an air atmosphere. Raman spectroscopy was studied to investigate the structural features of this composition. The new proposed dosimeter revealed two peaks at 150°C and 175°C with a small shoulder at high temperature (225°C). The PL spectrum showed strong green emissions between 500 to 550 nm. The Raman spectrum showed many bands related to the interaction between ZnO, silver (Ag), and yttrium oxide (Y2 O3 ). The rising sintering temperature enhanced the TL glow curve intensity. The Ag/Y co-doped ZnO nanophosphor showed an excellent linearity index within a dose from 1 to 4 Gy. The minimum detectable dose (MDD) of the Ag/Y co-doped ZnO nanopowder (pellets) equaled 0.518 mGy. The main TL properties were achieved in this work as follows: thermal fading (37% after 45 days at 1 and 4 Gy), optical fading (53% after 1 h and 68% after 6 h by exposure to sunlight), effective atomic number (27.6), and energy response (flat behavior from 0.1 to 1.3 MeV). Finally, the proposed material shows promising results nominated to be used for radiation measurements.
Fulltext Isolated Pancreatic Tail Injury in Paediatrics; A Case Report and Literature Review

Al Kuddoos NM, Ismail AK, Shen KWC, Shibraumalisi NA, Yunus AY

Bull Emerg Trauma, 2020 Oct;8(4):249-252.
PMID: 33426141 DOI: 10.30476/beat.2020.85719

Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.
Fulltext Puzzle task ERP response: time-frequency and source localization analysis

Almurshedi A, Ismail AK

Transl Neurosci, 2015;6(1):187-197.
PMID: 28123804 DOI: 10.1515/tnsci-2015-0020

Perceptual decision making depends on the choices available for the presented task. Most event-related potential (ERP) experiments are designed with two options, such as YES or NO. In some cases, however, subjects may become confused about the presented task in such a way that they cannot provide a behavioral response. This study aims to put subjects into such a puzzled state in order to address the following questions: How does the brain respond during puzzling moments? And what is the brain's response to a non-answerable task? To address these questions, ERP were acquired from the brain during a scintillation grid illusion task. The subjects were required to count the number of illusory dots, a task that was impossible to perform. The results showed the presence of N130 over the parietal area during the puzzling task. Coherency among the brain hemispheres was enhanced with the complexity of the task. The neural generators' source localizations were projected to a multimodal complex covering the left postcentral gyrus, supramarginal gyrus, and angular gyrus. This study concludes that the brain component N130 is strongly related to perception in a puzzling task network but not the visual processing network.
Experience of using expired lyophilized snake antivenom during a medical emergency situation in Lao People's Democratic Republic--A possible untapped resource to tackle antivenom shortage in Southeast Asia

Blessmann J, Hanlodsomphou S, Santisouk B, Krumkamp R, Kreuels B, Ismail AK, et al.

Trop Med Int Health, 2023 Jan;28(1):64-70.
PMID: 36416013 DOI: 10.1111/tmi.13833

OBJECTIVES: To evaluate the safety and efficacy of expired lyophilized snake antivenom of Thai origin during a medical emergency in 2020/2021 in Lao People's Democratic Republic.
METHODS: Observational case series of patients with potentially life-threatening envenoming who consented to the administration of expired antivenom between August 2020 and May 2022.
RESULTS: A total of 31 patients received the expired antivenom. Malayan pit vipers (Calloselasma rhodostoma) were responsible for 26 (84%) cases and green pit vipers (Trimeresurus species) for two cases (6%). In three patients (10%) the responsible snake could not be identified. Of these, two presented with signs of neurotoxicity and one with coagulopathy. A total of 124 vials of expired antivenom were administered. Fifty-nine vials had expired 2-18 months earlier, 56 vials 19-36 months and nine vials 37-60 months before. Adverse effects of variable severity were observed in seven (23%) patients. All 31 patients fully recovered from systemic envenoming.
CONCLUSIONS: Under closely controlled conditions and monitoring the use of expired snake antivenom proved to be effective and safe. Discarding this precious medication is an unnecessary waste, and it could be a valuable resource in ameliorating the current shortage of antivenom. Emergency use authorization granted by health authorities and preclinical testing of expired antivenoms could provide the support and legal basis for such an approach.
Fulltext Audit of pain management in the emergency department

Fathil SM, Soong NS, Mustafa NM, Arith A, Ng WN, Bahrum NA, et al.

Med J Malaysia, 2011 Jun;66(2):89-91.
PMID: 22106683 MyJurnal

Pain management in Malaysian Emergency Departments has not been studied well. Convenience sampling was used to recruit 402 patients who presented with acute pain over a 2-week period. The 11-point Numerical Rating Scale was used to quantify pain. Pain relieving medications were prescribed to 178 patients (44.3%) in the Emergency Department. These patients had a median pain score of 7 on arrival. Nonsteroidal anti inflammatory drugs were the most commonly prescribed class of analgesic. Pain was found to be inadequately treated.
Fulltext A prospective study of tracheal intubation in an academic emergency department in Malaysia

Fathil SM, Mohd Mahdi SN, Che'man Z, Hassan A, Ahmad Z, Ismail AK

Int J Emerg Med, 2010;3(4):233-7.
PMID: 21373289 DOI: 10.1007/s12245-010-0201-0

BACKGROUND: Airway management is an important part of the management of the critically ill and injured patients in the Emergency Department (ED). Numerous studies from developed countries have demonstrated the competency of emergency doctors in intubation. To date there have been no published data on intubations performed in EDs in Malaysia.
METHODS: Data on intubations from 7 August 2007 till 28 August 2008 were prospectively collected.
RESULTS: There were 228 intubations included in the study period. Cardiopulmonary arrest was the main indication for intubation (35.5%). The other indications were head injury (18.4%), respiratory failure (15.4%), polytrauma (9.6%) and cerebrovascular accident (7.0%). All of the 228 patients were successfully intubated. Rapid sequence intubation (RSI) was the most frequent method (49.6%) of intubation. A total of 223 (97.8%) intubations were done by ED personnel. In 79.8% of the cases, intubations were successfully performed on the first attempt. Midazolam was the most common induction agent used (97 patients), while suxamethonium was the muscle relaxant of choice (109 patients). There were 34 patients (14.9%) with 38 reported immediate complications. The most common complication was oesophageal intubation.
CONCLUSION: Emergency Department UKMMC personnel have a high competency level in intubation with an acceptable complication rate. RSI was the most common method for intubation.
KEYWORDS: Airway; Intubation; Orotracheal intubation; Rapid sequence intubation
Isolation and characterization of a mo -reducing bacterium

Ghani B, Takai M, Hisham NZ, Kishimoto N, Ismail AK, Tano T, et al.

Appl Environ Microbiol, 1993 Apr;59(4):1176-80.
PMID: 16348915

A Mo -reducing bacterium (strain 48), which grew on medium supplemented with 200 mM Mo, was isolated from stream water obtained from Chengkau, Malaysia. The chemical properties of strain 48 conform to the characteristics of Enterobacter cloacae. Under anaerobic conditions in the glucose-yeast extract medium containing phosphate ion (2.9 mM) and Mo (10 mM), the bacterium reduced Mo to form molybdenum blue. Approximately 27% of Mo added to the medium was reduced after 28 h of cultivation. The reduction of Mo with glucose as an electron donor was strongly inhibited by iodoacetic acid, sodium fluoride, and sodium cyanide, suggesting an involvement of the glycolytic pathway and electron transport in Mo reduction. NADH and N,N,N',N' -tetramethyl-p-phenylenediamine served as electron donors for Mo reduction. When NADH was used as an electron donor, at first cytochrome b in the cell extract was reduced, and then molybdenum blue was formed. Sodium cyanide strongly inhibited Mo reduction by NADH (5 mM) but not the reduction of cytochrome b in the cell extract, suggesting that the reduced component of the electron transport system after cytochrome b serves as an electron donor for Mo reduction. Both ferric and stannous ions strongly enhanced the activity of Mo reduction by NADH.
The role of a point-of-care ultrasound protocol in facilitating clinical decisions for snakebite envenomation in Taiwan: a pilot study

Ho CH, Ismail AK, Liu SH, Tzeng YS, Li LY, Pai FC, et al.

Clin Toxicol (Phila), 2021 Sep;59(9):794-800.
PMID: 33605805 DOI: 10.1080/15563650.2021.1881535

BACKGROUND: The incidence of acute compartment syndrome (ACS) following snakebite envenomation may be seriously overestimated in Taiwan. Snakebite-induced ACS is difficult to determine solely by clinical examination. Snakebite patients previously underwent surgical intervention based on speculation and general clinical examinations suggesting ACS presentations instead of direct intracompartmental pressure (IP) measurement prior to fasciotomy. Point-of-care ultrasound (POCUS) is a relatively widely available noninvasive tool. This study aimed to evaluate snakebite-envenomated patients for the presence of subcutaneous edema and diastolic retrograde arterial flow (DRAF).
MATERIALS AND METHODS: Snakebite patients were prospectively recruited between 2017 and 2019. All patients were examined with POCUS to locate edema and directly visualize and measure the arterial flow in the compressed artery. The presence of DRAF in the compressed artery is suggestive of ACS development because when compartment space restriction occurs, increased retrograde arterial flow is observed in the artery.
RESULTS: Twenty-seven snakebite patients were analyzed. Seventeen patients (63%) were bitten by Crotalinae snakes, seven (26%) by Colubridae, one (4%) by Elapidae, and two (7%) had unidentified snakebites. All Crotalinae bit patients received antivenom, had subcutaneous edema and lacked DRAF in a POCUS examination series.
DISCUSSION: POCUS facilitates clinical decisions for snakebite envenomation. We also highlighted that the anatomic site of the snakebite is an important factor affecting the prognosis of the wounds. There were limitations of this study, including a small number of patients and no comparison with the generally accepted invasive evaluation for ACS.
CONCLUSIONS: We are unable to state that POCUS is a valid surrogate measurement of ACS from this study but see this as a starting point to develop further research in this area. Further study will be needed to better define the utility of POCUS in patients envenomated by snakes throughout the world.
A case of fatal envenomation by a captive puff adder (Bitis arietans) in Malaysia

Husain Z, Wicaksono AC, Renault A, Md Zhahir SS, Ismail AK

Toxicon, 2023 Mar 01;224:107023.
PMID: 36640813 DOI: 10.1016/j.toxicon.2023.107023

The Puff Adder (Bitis arietans) is a viper native to Africa and the Middle East. Envenomation by this species often requires the administration of appropriate antivenom in order to achieve a favorable outcome. A patient was bitten in both hands by a captive B. arietans presented to a teaching hospital in Malaysia. The patient developed painful progressive swelling on both limbs that extended to the chest, hypotension, hypokalemia with worsening anemia, thrombocytopenia, coagulopathy, and severe metabolic acidosis. The patient was managed supportively while waiting for the appropriate antivenom, Antivipmyn-Africa, from the Singapore Zoo. The patient developed cardiorespiratory arrest twice and did not recover from the second. The patient was pronounced dead 23 hours post-incident. The local unavailability of the appropriate antivenom may be the most important factor that contributed to the patient's death. There is also a need to amend the Malaysian Wildlife Act in order to prevent such cases from recurring.
The use of warning lights and siren by the ambulance crew in the Universiti Kebangsaan Malaysia Medical Centre

Ismail AK, Mohd Salleh NI, Hamdan NA, Mohd Jawi MI, Abdul Razak SN, Md Jamal S, et al.

Eur J Emerg Med, 2012 Dec;19(6):408-9.
PMID: 22343753 DOI: 10.1097/MEJ.0b013e328351e62e
Ventricular bigeminy following a cobra envenomation

Ismail AK, Weinstein SA, Auliya M, Appareo P

Clin Toxicol (Phila), 2012 Jul;50(6):518-21.
PMID: 22702902 DOI: 10.3109/15563650.2012.696119

Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation.
A bite by the Twin-Barred Tree Snake, Chrysopelea pelias (Linnaeus, 1758)

Ismail AK, Weinstein SA, Auliya M, Sabardin DM, Herbosa TJ, Saiboon IM, et al.

Clin Toxicol (Phila), 2010 Mar;48(3):222-6.
PMID: 20345298 DOI: 10.3109/15563650903550964

The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species.
The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales

Ismail AK, Abdul Ghafar MA, Shamsuddin NS, Roslan NA, Kaharuddin H, Nik Muhamad NA

J Emerg Med, 2015 Sep;49(3):287-93.
PMID: 26022936 DOI: 10.1016/j.jemermed.2015.02.043

Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS).
Fulltext Frequency, clinical characteristics and outcomes of Tropidolaemus species bite envenomations in Malaysia

Ismail AK, Abd Hamid MNH, Ariff NA, Frederic Ng VER, Goh WC, Abdul Samat NS, et al.

PLoS Negl Trop Dis, 2023 Jan;17(1):e0010983.
PMID: 36598885 DOI: 10.1371/journal.pntd.0010983

Pit vipers from the genus Tropidolaemus are identified as one of the common causes of snake bite from venomous species in Malaysia. All Tropidolaemus species bite cases referred to the Remote Envenomation Consultation Services (RECS) between 2015-2021 were included. A total of 4,718 snake-related injuries cases consulted to RECS with 310 (6.6%) involved Tropidolaemus species; of these 190 (61.3%) were T. subannulatus and 120 (38.7%) T. wagleri. All the T. subannulatus cases occurred in Sabah and Sarawak while all cases of T. wagleri occurred in Peninsular Malaysia. The majority of patients were male (74.8%) and adults between 18-59 years old (61.2%). The upper limb (56.6%) was the most frequent anatomical region involved. Most cases were non-occupationally related (75.4%). Bites from both species caused local pain (77.1%) and swelling (27.2%). Most patients complained of mild pain (48.0%). Paracetamol (40.0%) was the most common analgesic prescribed. Antivenom was not indicated in all cases. Two patients were given antivenom inappropriately before RECS consultation. Most patients (54.7%) needed hospital observation for less than 24 hours. No deaths occurred in the group studied.
Fulltext Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department

Jamal SM, Fathil SM, Nidzwani MM, Ismail AK, Yatim FM

Med J Malaysia, 2011 Aug;66(3):231-3.
PMID: 22111446

The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.
Fulltext The Brain-Gut Clinic in Hospital Universiti Sains Malaysia: Pioneering New Service to Advance Neuro-Gastroenterology and Motility in Malaysia

Lee YY, Izham N, Mohd Zulkifly MF, Mohamed Mustafar MF, Ismail AK, Mohamed Shah NFFN, et al.

Malays J Med Sci, 2023 Jun;30(3):1-7.
PMID: 37425382 DOI: 10.21315/mjms2023.30.3.1

Neurogastroenterology and motility is a new but advanced subspecialty within gasteroenterology that cater to difficult, persistent and refractory gut-brain symptoms. Hospital USM has the country's first and new state-of-the art motility lab that was recently launched on the 25 May 2023, and is covered in nationwide media. Another first is the Brain-Gut Clinic, established on the 16 November 2022. The clinic is a new concept that builds on unique multiple disciplines in relation to the gut-brain axis. It is hoped that there will be more awareness on the existence of neurogastroenterology and motility among doctors and community, and that more research can be forthcoming to reduce the disease burden.
Fulltext Rhabdomyolysis due to unidentified jellyfish envenomation in west Malaysian waters

Loy JS, Khoo CC, Arumugam T, Ngian GH, Ismail AK

Toxicon X, 2024 Mar;21:100170.
PMID: 38021315 DOI: 10.1016/j.toxcx.2023.100170

Jellyfish envenomation is a common marine injury. We report a case of a 9-year-old boy who developed muscle weakness and rhabdomyolysis after a jellyfish sting. He was stung on the face, hands, and feet. He sustained immediate pain and numbness; however no immediate action was taken. He was taken to a primary health clinic and discharged with syrup Paracetamol 15mg/kg/dose and syrup Chlorpheniramine maleate 0.1mg/kg/dose for symptomatic relief. Over the next several days, the pain became generalized involving upper and lower limbs, aggravated by movement, and not alleviated by analgesia nor antihistamine. His condition worsened with the development of weakness of upper and lower limbs and 'tea-colored' urine from day 3 of illness. He received treatment for rhabdomyolysis at a district hospital. Maintaining hydration and urine output and symptomatic relief are central to treatment. His muscle pain and weakness improved. He was discharged well and remained asymptomatic at follow up.
Rapid Determination of Non-steroidal Anti-inflammatory Drugs in Aquatic Matrices by Two-phase Micro-electrodriven Membrane Extraction Combined with Liquid Chromatography

Mohamad Hanapi NS, Sanagi MM, Ismail AK, Saim N, Wan Ibrahim WN, Wan Ibrahim WA, et al.

J Chromatogr Sci, 2018 Feb 01;56(2):166-176.
PMID: 29069322 DOI: 10.1093/chromsci/bmx092

Two-phase micro-electrodriven membrane extraction (EME) procedure for the pre-concentration of selected non-steroidal anti-inflammatory drugs (NSAIDs) in aquatic matrices was investigated. Agarose film was used as interface between donor and acceptor phase in EME which allowed for selective extraction of the analytes prior to high performance liquid chromatography-ultraviolet detection. Charged analytes were transported from basic aqueous sample solution through agarose film into 1-octanol as an acceptor phase at 9 V potential. Response surface methodology in conjunction with the central composite design showed good correlations between extraction time and applied voltage (R2 > 0.9358). Under optimized extraction conditions, the method showed good linearity in the concentration range of 0.5-500 μg L-1 with coefficients of determination, r2≥ 0.9942 and good limits of detection (0.14-0.42 μg L-1) and limits of quantification (0.52-1.21 μg L-1). The results also showed high enrichment factors (62-86) and good relative recoveries (72-114%) with acceptable reproducibilities (RSDs ≤ 7.5% n = 3). The method was successfully applied to the determination of NSAIDs from tap water and river water samples. The proposed method proved to be rapid, simple and requires low voltage and minute amounts of organic solvent, thus environmentally friendly.
Ionic liquid-impregnated agarose film two-phase micro-electrodriven membrane extraction (IL-AF-μ-EME) for the analysis of antidepressants in water samples

Mohamad Hanapi NS, Sanagi MM, Ismail AK, Wan Ibrahim WA, Saim N, Wan Ibrahim WN

J Chromatogr B Analyt Technol Biomed Life Sci, 2017 Mar 01;1046:73-80.
PMID: 28142101 DOI: 10.1016/j.jchromb.2017.01.028

The aim of this study was to investigate and apply supported ionic liquid membrane (SILM) in two-phase micro-electrodriven membrane extraction combined with high performance liquid chromatography-ultraviolet detection (HPLC-UV) for pre-concentration and determination of three selected antidepressant drugs in water samples. A thin agarose film impregnated with 1-hexyl-3-methylimidazolium hexafluorophosphate, [C6MIM] [PF6], was prepared and used as supported ionic liquid membrane between aqueous sample solution and acceptor phase for extraction of imipramine, amitriptyline and chlorpromazine. Under the optimized extraction conditions, the method provided good linearity in the range of 1.0-1000μgL(-1), good coefficients of determination (r(2)=0.9974-0.9992) and low limits of detection (0.1-0.4μgL(-1)). The method showed high enrichment factors in the range of 110-150 and high relative recoveries in the range of 88.2-111.4% and 90.9-107.0%, for river water and tap water samples, respectively with RSDs of ≤7.6 (n=3). This method was successfully applied to the determination of the drugs in river and tap water samples. It is envisaged that the SILM improved the perm-selectivity by providing a pathway for targeted analytes which resulted in rapid extraction with high degree of selectivity and high enrichment factor.
Fulltext Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic

Mohd Salleh Sahimi H, Azman N, Nik Jaafar NR, Mohd Daud TI, Baharudin A, Ismail AK, et al.

Int J Environ Res Public Health, 2021 May 03;18(9).
PMID: 34063714 DOI: 10.3390/ijerph18094879

Healthcare workers (HCW) are exposed to health-related anxiety in times of pandemic as they are considered to have a high risk of being infected whilst being the vital workforce to manage the outbreak. This study determined the factors that influence health anxiety and its extent in correlations with perceived risk, knowledge, attitude, and practice of HCW. A cross-sectional online survey was conducted on a total of 709 HCW from both public and private healthcare facilities who completed a set of questionnaires on sociodemographic data, knowledge, attitude, and practice of HCW on COVID-19, and health anxiety traits assessed using the short version Health Anxiety Inventory (HAI). Multiple linear regression (adjusted R2 = 0.06) revealed respondents with higher perceived risk for COVID-19 significantly predicted higher HAI scores (beta 1.281, p < 0.001, 95%, CI: 0.64, 1.92), and those with a higher cautious attitude towards COVID-19 significantly predicted higher HAI scores (beta 0.686, p < 0.001, 95%CI: 0.35, 1.02). Healthcare workers' perceived risk and cautious attitude towards COVID-19 might be potentially influenced by management of the sources and approaches to the dissemination of information of the pandemic. The implementation of certain measures that minimize the infection risk and its related anxiety is important to preserve both their physical and psychological wellbeing.

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