MyMedR

Safeguarding against potential injury from an eye drops bottle

Krishnan R, Shamsher S, Adzura S

Med J Malaysia, 2023 Nov;78(6):849-851.

We describe a potential cause of eye injury, its concerns and ways to prevent it. The first author underwent a left cataract operation and was prescribed eye drops postoperatively. While applying one of the eye drops, he felt an object hitting the lower eyelid. A serrated plastic piece had fallen off the bottle. Had it fallen on the operated site, it might have caused serious untoward complications. Nurses, carers and patients need to be educated to remove the serrated piece from the bottle before applying eye drops. Manufacturers of eye drops should design safer bottles without such serrated pieces to prevent such eye injuries.

Comparison of the expression of beta-catenin in hepatocellular carcinoma in areas with high and low levels of exposure to aflatoxin B1

Chen Ban K, Singh H, Krishnan R, Fong Seow H

J Surg Oncol, 2004 Jun 1;86(3):157-63.

PMID: 15170655

Previous studies showed that the frequency of beta-catenin mutation was different in mice when induced by different chemicals. The aim of this study is to compare the expression of beta-catenin and p53 in hepatocellular carcinoma (HCC) from areas with exposure to high and low levels of aflatoxin B1 (AFB1).

Fulltext Gastric strongyloidiasis in a Malaysian patient

Shekhar KC, Krishnan R, Pathmanathan R, Fook CS

Southeast Asian J. Trop. Med. Public Health, 1997 Mar;28(1):158-60.

PMID: 9322300

Strongyloides stercoralis infection is of low prevalence in Malaysia. We report an unusual case presenting primarily with gastric symptoms. The patient was a 72 years old Chinese male admitted for progressive weight loss and abdominal bloating. Gastroscopic examination revealed mucosal prepyloric elevations in the gastric mucosa. Gastric strongyloidiasis was confirmed by the presence of adult forms, as well as ova and larval rhabditiform stages of the worm in the gastric mucosal crypts. We believe that this is the first histologically documented case of gastric strongyloidiasis in Malaysia.

Fulltext Cervical necrotising fasciitis consequent to mastoid infection

Chua HK, Chandra Segar CB, Krishnan R, Ho CK

Med J Malaysia, 2002 Mar;57(1):104-7.

PMID: 14569726

We present a case of cervical necrotising fasciitis in a 56 year old man, secondary to a rare mastoid infection. The patient had coexisting diabetes mellitus and hypertension. He was treated with early surgical debridement followed by neck and chest reconstruction and radical mastoidectomy. Aggressive antibiotic therapy and supportive care was given. He recovered well with minimal residual functional deficit.

Fulltext Chromosome 7 aneuploidy in clear cell and papillary renal cell carcinoma: detection using silver in situ hybridization technique

Pailoor J, Rajandram R, Yap NY, Ng KL, Wang Z, Iyengar KR

Indian J Pathol Microbiol, 2013 Apr-Jun;56(2):98-102.

PMID: 24056643 DOI: 10.4103/0377-4929.118688

Chromosome 7 aberrations in renal cell carcinoma (RCC) have been reported in papillary renal cell carcinoma (pRCC) and clear cell renal cell carcinoma (ccRCC). However, the implication of these anomalies on prognosis and survival is still unclear. RCC Chromosome 7 aberrations have commonly been detected by fluorescent in situ hybridization and chromogenic in situ hybridization but not silver in situ hybridization (SISH).

Fulltext Fulminant hepatitis due to infectious mononucleosis

Krishnan R, Jayalakshmi P

Med J Malaysia, 1989 Dec;44(4):362.

PMID: 2520052

Research to prevent injuries

Krishnan R, Karim H

World Health Forum, 1998;19(2):159-60.

PMID: 9652215

Fulltext A rare case of fulminant hemobilia resulting from gallstone erosion of the right hepatic artery

Jee SL, Lim KF, Krishnan R

Med J Malaysia, 2014 Aug;69(4):191-2.

PMID: 25500850 MyJurnal

Hemobilia is a rare but potentially lethal condition. The commonest cause of hemobilia is trauma, accounting up to 85% of all cases. Hemobilia caused by gallstones is very rare. Most of the cases of hemobilia are either managed conservatively or treated by embolization. Surgery is indicated only when there is an associated surgical condition or when embolization fails. We report a case of a 72-year-old patient with massive hemobilia caused by gallstone erosion to the adjacent artery, diagnosed intraoperatively. The complication was successfully managed by cholecystectomy and repair of the bleeding vessel. This case highlights the importance that hemobilia should be suspected in patients presenting with upper gastrointestinal bleeding. Although rare, massive hemobilia can be life threatening, leading to significant morbidity and mortality. Therefore, a high index of suspicion and timely intervention are important.

Gall bladder cancer

Krishnan R

Med J Malaysia, 2005 Jul;60 Suppl B:139.

PMID: 16108196

Fulltext Erosive potential of commonly used beverages, medicated syrup, and their effects on dental enamel with and without restoration: An in vitro study

Trivedi K, Bhaskar V, Ganesh M, Venkataraghavan K, Choudhary P, Shah S, et al.

J Pharm Bioallied Sci, 2015 Aug;7(Suppl 2):S474-80.

PMID: 26538901 DOI: 10.4103/0975-7406.163508

AIM: This study evaluates erosive potential of commonly used beverages, medicated syrup, and their effects on dental enamel with and without restoration in vitro.

MATERIALS AND METHODS: Test medias used in this study included carbonated beverage, noncarbonated beverage, high-energy sports drink medicated cough syrup, distilled water as the control. A total of 110 previously extracted human premolar teeth were selected for the study. Teeth were randomly divided into two groups. Test specimens were randomly distributed to five beverages groups and comprised 12 specimens per group. Surface roughness (profilometer) readings were performed at baseline and again, following immersion for 14 days (24 h/day). Microleakage was evaluated. The results obtained were analyzed for statistical significance using SPSS-PC package using the multiple factor ANOVA at a significance level of P < 0.05. Paired t-test, Friedman test ranks, and Wilcoxon signed ranks test.

RESULTS: For surface roughness high-energy sports drink and noncarbonated beverage showed the highly significant difference with P values of 0.000 and 0.000, respectively compared to other test media. For microleakage high-energy sports drink had significant difference in comparison to noncarbonated beverage (P = 0.002), medicated syrup (P = 0.000), and distilled water (P = 0.000).

CONCLUSION: High-energy sports drink showed highest surface roughness value and microleakage score among all test media and thus greater erosive potential to enamel while medicated syrup showed least surface roughness value and microleakage among all test media.

Some epidemiological aspects and economic costs of injuries in Malaysia

Arokiasamy JT, Krishnan R

Asia Pac J Public Health, 1994;7(1):16-20.

PMID: 8074939

Injuries are one of the leading causes of death in the world. In Malaysia, injuries form one of the three main causes of mortality. They are also an important cause of permanent and temporary disability and work absenteeism in the productive age group. Increasing affluence and industrialization coupled with growing population and transportation needs in rapidly developing countries like Malaysia have resulted in a surge of road and occupational injuries. Three quarters of fatalities due to road, occupational, drowning and home injuries occur in those below 45 years of age. A majority of injuries in these categories are attributed to "human" factors and therefore can be prevented by public education and enforced training of workers. The total annual economic loss due to all types of injuries is estimated to be 2 billion Malaysian Ringgit (US$1 = MR2.76 approximately). The government is currently in the process of setting up full-time departments for road safety and occupational health and safety.

Fulltext Fatal Steven Johnson syndrome in a child

Krishnan R

Med J Malaysia, 1990 Sep;45(3):267.

PMID: 2152093

Fulltext Safe travel--a worthwhile destination

Krishnan R

World Health Forum, 1992;13(2-3):163-4.

PMID: 1418328

Fulltext Ban on firecrackers should not be lifted during festivals

Krishnan R

Med J Malaysia, 1990 Dec;45(4):353.

PMID: 2152061

Fulltext A review of occupational Injury research In Malaysia

Ganesh CS, Krishnan R

Med J Malaysia, 2016 06;71(Suppl 1):100-104.

PMID: 27801392 MyJurnal

A literature review of 16 papers on occupational injury research in Malaysia published during a 13-year period from 2000-2013 was carried out. The objective of this review and article selection was based on relevance to the research theme and mention of areas for future research. Most of the publications have focused on descriptive epidemiology, management practices, worker's knowledge, attitude, training, and rehabilitation services. The transportation, agriculture and construction sectors were found to be the most hazardous sectors and would benefit the most from Occupational Safety & Health (OSH) research and interventions. There is a strong need to develop a national injury surveillance system and also a mechanism to ensure adherence to the Occupational Safety & Health Act(OSHA) 1994. Detailed description and identification of risk factors for occupational injury in the environment, including machinery and equipment used was generally lacking. Future research on occupational injury should focus on surveillance to determine the magnitude of occupational injuries, determination of risk factors, identifying costeffective interventions (such as enforcement of OSHA regulations), and assessment of rehabilitation services. Relevant government agencies, universities, corporate sector and occupational safety organizations need to play a proactive role in identifying priority areas and research capacity building. Funding for occupational injury should be commensurate with the magnitude of the problem.

Human infection with Dirofilaria repens in Malaysia

Shekhar KC, Pathmanathan R, Krishnan R

J Helminthol, 1996 Sep;70(3):249-52.

PMID: 8960220

Human dirofilariasis is a rare infection in Malaysia. Thus far, only two human cases have been reported viz. Dirofilaria immitis and D. (Nochtiella) repens and in both instances, adult worms were recovered from infected patients. The two cases reported in the present study, one from Melaka and the other from Penang, were diagnosed histologically. Based on the diagnostic criteria for identifying Dirofilaria in tissue sections, the parasites were identified as D. (Nochtiella) repens.

A study of children with poisoning admitted to University Hospital, Kuala Lumpur

Krishnan, R.

Malaysian Journal of Child Health, 1991;3(1):34-36.

MyJurnal

A prospective study of 92 children with poisoning admitted to University Hospital, Kuala Lumpur is reported. Majority of the affected children were below 3 years of age and belonged to low income families. Household items, especially kerosene, and medications were most often implicated. All children recovered completely. Preventive strategies are discussed.

Fulltext The prevalence of dental fluorosis and its associated factors in Salem district

Ramesh M, Narasimhan M, Krishnan R, Chalakkal P, Aruna RM, Kuruvilah S

Contemp Clin Dent, 2016 6 17;7(2):203-8.

PMID: 27307668 DOI: 10.4103/0976-237X.183061

CONTEXT: There are various regions in India that have high levels of fluoride in drinking water sources. Many people residing in such places suffer from dental fluorosis (DF).

AIMS: To evaluate the prevalence of DF in children residing in Salem and also to find any correlation between DF and other related factors.

MATERIALS AND METHODS: One school from each block of Salem (total 21 blocks) was selected for the study. A single examiner had evaluated untreated caries, lesions, and DF (for permanent anterior teeth and molars) using the Dean's fluorosis index, in all children. Water fluoride level determination at each school was done using the Tamil Nadu Water Fluoridation and Drainage Board field kit. Other factors that may have contributed to DF were assessed using a questionnaire, which was provided to each student. The data obtained were statistically analyzed using the SPSS software version 11.5.

STATISTICAL ANALYSIS: Chi-square test was used for statistical analysis.

RESULTS: DF was present in 56.9% of the children examined. It was mostly seen in 9 years old (72%) and male (59%) children. A positive correlation was found between the occurrence of DF and the duration of residence in a place with high water fluoride content, consumption of borewell water (64%), the parts per million of fluoride in drinking water, consumption of black tea (59%). However, no correlation was found between DF, dental caries, consumption of milk, or consumption of foods cooked in aluminum vessels.

CONCLUSION: There was a correlation between DF and factors such as male gender, bore well water consumption, black tea consumption and the duration of residence in a place with high water fluoride content.

Fulltext The effect of fluorosis on human teeth under light microscopy: A cross-sectional study

Ramesh M, Narasimhan M, Krishnan R, Aruna RM, Kuruvilla S

J Oral Maxillofac Pathol, 2017 Sep-Dec;21(3):345-350.

PMID: 29391706 DOI: 10.4103/jomfp.JOMFP_247_16

Background: Fluoride is needed for the normal development of bone and teeth; in high levels, it affects developing teeth and bone. Dental fluorosis (DF) is caused by ingestion of excess fluoride mainly through drinking water.

Aim: The present study aims to observe and understand the histological changes of fluorosed teeth under light microscope (LM).

Materials and Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. Thirty extracted teeth were selected with varying degrees of DF based on modified Dean's fluorosis index. Ground sections of these teeth were prepared and the sections were studied under binocular LM. Photomicrographs were taken under high power objective using 15 megapixels Nikon camera.

Results and Conclusion: Qualitative histologic changes in different grades of fluorosed teeth were evaluated in enamel, dentin, cementum and between their junctions. Fluoride interacts with enamel in both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin, increased interglobular dentin, increased secondary curvatures and changes in cementum such as diffuse cementodentinal junction and increased thickness of Tomes' granular layer. Changes in the structure of the teeth with Dean's index below 2 and teeth with Dean's index of 2 and above were compared using Chi-square test. P value was found to be highly significant being 0.00047. Many of the features of dental fluorosis seen in the present study under light microscope are comparable to those results studied under specialized microscopes.

Knowledge, attitudes, and practices of dentists after the COVID-19 pandemic: A cross-sectional study

Varghese E, Krishnan R, Muddebihal F, Dawood T, Gowrish S, Lavanya T, et al.

Dent Res J (Isfahan), 2023;20:66.

PMID: 37483904

BACKGROUND: Dentists are at an increased risk of encountering cross-infections because of working in close proximity with oral mucosa and saliva making use of high-speed rotary instruments during treatment generating large amount of aerosols and splatter which in turn increases the probability of nosocomial spread of infections. The present study aimed to evaluate the knowledge, attitudes, and practices of dentists after the COVID-19 pandemic.

MATERIALS AND METHODS: The present cross-sectional study was conducted using Google Forms wherein a well-structured questionnaire composed of a total of 25 closed-ended questions was distributed among practicing dentists through online mode. Step-wise linear regression analysis was done to determine the influence of independent variables on the knowledge, attitude, and practice scores of the participants. P < 0.05 was considered statistically significant.

RESULTS: On analyzing the results, multiple linear regression analysis revealed no significant difference in the knowledge scores among the participants, while good attitude and practice scores were significantly associated with higher qualification of the participants. Another noteworthy finding in the study was the significant correlation observed between the various components of the knowledge, attitude, and practice scores among the participants (P < 0.05).

CONCLUSION: It could be concluded from the findings of the present survey that dentists were found to have good knowledge scores about the COVID-19 pandemic. They should, however, pay more emphasis on practicing tele-triaging and proper screening and should follow various guidelines and advisories issued from time to time by the competent authorities.

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