Displaying publications 1 - 20 of 59 in total

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  1. Abdul Razak SE, Mustapha M, Mohammed Shah S, Abu Kasim NA
    Heliyon, 2024 Feb 15;10(3):e24681.
    PMID: 38317937 DOI: 10.1016/j.heliyon.2024.e24681
    The sustainability issues resulting from Malaysian palm oil production have garnered much interest in the palm oil industry. Consequently, Malaysian palm oil industry is indirectly exposed to sustainability risks, including boycott and reputational and regulatory risks. Hence, the industry encounters intense pressure from numerous stakeholders to address sustainability issues. Prior studies propounded that sustainability risk management (SRM) could minimise the adverse impact of sustainability risks by addressing sustainability issues. Nevertheless, the implementation of sustainability risk management in Malaysia remains low as numerous companies are not ready for it. Drawing on contingency theory, the objective of this study is to investigate the influence of contextual factors that can influence companies' readiness in implementing sustainability risk management. Data was collected through the distribution of questionnaires between July and December 2020. A total of 407 questionnaires were distributed, with a response rate of 29 %. Resultantly, sustainability strategy, business size, top management support, and regulatory pressure positively and significantly influenced sustainability risk management implementation. The findings also expanded the current theoretical knowledge with valuable insights for policymakers regarding the factors influencing to companies' readiness in implementing SRM.
  2. Abdullah MN, Mustapha M, Sallih N, Ahmad A, Mustapha F, Dahliyanti A
    Materials (Basel), 2021 Jun 22;14(13).
    PMID: 34206150 DOI: 10.3390/ma14133440
    The utilisation of rice husk ash (RHA) as an aluminosilicate source in fire-resistant coating could reduce environmental pollution and can turn agricultural waste into industrial wealth. The overall objective of this research is to develop a rice-husk-ash-based geopolymer binder (GB) fire-retardant additive (FR) for alkyd paint. Response surface methodology (RSM) was used to design the experiments work, on the ratio of RHA-based GB to alkyd paint. The microstructure behaviour and material characterisation of the coating samples were studied through SEM analysis. The optimal RHA-based GB FR additive was formulated at 50% wt. FR and 82.628% wt. paint. This formulation showed the result of 270 s to reach 200 °C and 276 °C temperature at equilibrium for thermal properties. Furthermore, it was observed that the increased contents of RHA showed an increment in terms of the total and open porosities and rough surfaces, in which the number of pores on the coating surface plays an important role in the formation of the intumescent char layer. By developing the optimum RHA-based GB to paint formulation, the coating may potentially improve building fire safety through passive fire protection.
  3. Abubakar AA, Ibrahim SM, Ali AK, Handool KO, Khan MS, Noordin Mustapha M, et al.
    Animal Model Exp Med, 2019 Mar;2(1):34-43.
    PMID: 31016285 DOI: 10.1002/ame2.12051
    BACKGROUND: Chondrocytes in the growth plate (GP) undergo increases in volume during different cascades of cell differentiation during longitudinal bone growth. The volume increase is reported to be the most significant variable in understanding the mechanism of long bone growth.

    METHODS: Forty-five postnatal Sprague-Dawley rat pups, 7-15 days old were divided into nine age groups (P7-P15). Five pups were allocated to each group. The rats were sacrificed and tibia and metatarsal bones were harvested. Bone lengths were measured after 0, 24, 48, and 72 hours of ex vivo incubation. Histology of bones was carried out, and GP lengths and chondrocyte densities were determined.

    RESULTS: There were significant differences in bone length among the age groups after 0 and 72 hours of incubation. Histological sectioning was possible in metatarsal bone from all age groups, and in tibia from 7- to 13-day-old rats. No significant differences in tibia and metatarsal GP lengths were seen among different age groups at 0 and 72 hours of incubation. Significant differences in chondrocyte densities along the epiphyseal GP of the bones between 0 and 72 hours of incubation were observed in most of the age groups.

    CONCLUSION: Ex vivo growth of tibia and metatarsal bones of rats aged 7-15 days old is possible, with percentage growth rates of 23.87 ± 0.80% and 40.38 ± 0.95% measured in tibia and metatarsal bone, respectively. Histological sectioning of bones was carried out without the need for decalcification in P7-P13 tibia and P7-P15 metatarsal bone. Increases in chondrocyte density along the GP influence overall bone elongation.

  4. Ayipo YO, Mordi MN, Mustapha M, Damodaran T
    Eur J Pharmacol, 2021 Feb 15;893:173837.
    PMID: 33359647 DOI: 10.1016/j.ejphar.2020.173837
    Neuropsychiatric disorders are diseases of the central nervous system (CNS) which are characterised by complex pathomechanisms that including homeostatic failure, malfunction, atrophy, pathology remodelling and reactivity anomaly of the neuronal system where treatment options remain challenging. β-Carboline (βC) alkaloids are scaffolds of structurally diverse tricyclic pyrido[3,4-b]indole alkaloid with vast occurrence in nature. Their unique structural features which favour interactions with enzymes and protein receptor targets account for their potent neuropharmacological properties. However, our current understanding of their biological mechanisms for these beneficial effects, especially for neuropsychiatric disorders is sparse. Therefore, we present a comprehensive review of the scientific progress in the last two decades on the prospective pharmacology and physiology of the βC alkaloids in the treatment of some neuropsychiatric conditions such as depression, anxiety, Alzheimer's disease, Parkinson's disease, brain tumour, essential tremor, epilepsy and seizure, licking behaviour, dystonia, agnosia, spasm, positive ingestive response as demonstrated in non-clinical models. The current evidence supports that βC alkaloids offer potential therapeutic agents against most of these disorders and amenable for further drug design.
  5. Azmi NA, Ahem A, Mustapha M, Bastion MC
    BMJ Case Rep, 2016 Sep 28;2016.
    PMID: 27681348 DOI: 10.1136/bcr-2016-215987
    We report a case of enucleation for painful blind eye secondary to recurrent bleeding from choroidal neovascularisation in an eye that was irradiated following presumed metastatic breast carcinoma to the choroid. A 58-year-old woman with a history of treated breast malignancy presented with haemophthalmus and intractable glaucoma in the right eye. One year previously she had presented with right vitreous haemorrhage with subretinal mass that had been irradiated given her history of breast carcinoma. Following irradiation, vitrectomy was performed to clear the blood. Intraoperative and postoperative angiography findings suggested a diagnosis of breakthrough bleeding secondary to polypoidal choroidal vasculopathy. At this presentation, however, the intraocular bleeding was recurrent resulting in elevated intraocular pressure and pain. Despite repeat surgery and medical therapy, the eye had to be enucleated. Histopathology showed choroidal neovascularisation.
  6. Baig Z, Mamat O, Mustapha M, Mumtaz A, Munir KS, Sarfraz M
    Ultrason Sonochem, 2018 Jul;45:133-149.
    PMID: 29705306 DOI: 10.1016/j.ultsonch.2018.03.007
    The exceptional properties of graphene and its structural uniqueness can improve the performance of nanocomposites if it can attain the uniform dispersion. Tip sonication assisted graphene solvent dispersion has been emerged as an efficient approach but it can cause significant degradation of graphene structure. This study aimed to evaluate the parametric influence of tip sonication on the characteristics of sp2 carbon structure in graphene nanoplatelets by varying the sonication time and respective energy at three different amplitudes (60%, 80% and 100%). The study is essential to identify appropriate parameters so as to achieve high-quality and defect-free graphene with a highly desirable aspect ratio after solvent dispersion for composite reinforcement. Quantitative approach via Raman spectroscopy is used to find the defect ratio and lateral size of graphene evolved under the effect of tip sonication parameters. Results imply that the defect ratio is steady and increases continually with GNPs, along with the transformation to the nano-crystalline stage I up to 60 min sonication at all amplitudes. Exfoliation was clearly observed at all amplitudes together with sheet re-stacking due to considerable size reduction of sheets with large quantity. Finally, considerable GNPs fragmentation occurred during sonication with increased amplitude and time as confirmed by the reduction of sp2 domain (La) and flake size. This also validates the formation of edge-type defect in graphene. Convincingly, lower amplitude and time (up to 60 min) produce better results for a low defect content and larger particle size as quantified by Raman analysis.
  7. Bala JA, Balakrishnan KN, Abdullah AA, Mohamed R, Haron AW, Jesse FFA, et al.
    Microb Pathog, 2018 Jul;120:55-63.
    PMID: 29709684 DOI: 10.1016/j.micpath.2018.04.057
    Orf disease is known to be enzootic among small ruminants in Asia, Africa, and some other parts of the world. The disease caused by orf virus is highly contagious among small ruminant species. Unfortunately, it has been neglected for decades because of the general belief that it only causes a self-limiting disease. On the other hand, in the past it has been reported to cause huge cumulative financial losses in livestock farming. Orf disease is characterized by localized proliferative and persistent skin nodule lesions that can be classified into three forms: generalized, labial and mammary or genitals. It can manifest as benign or malignant types. The later type of orf can remain persistent, often fatal and usually causes a serious outbreak among small ruminant population. Morbidity and mortality rates of orf are higher especially in newly infected kids and lambs. Application of antibiotics together with antipyretic and/or analgesic is highly recommended as a supportive disease management strategy for prevention of subsequent secondary microbial invasion. The presence of various exotic orf virus strains of different origin has been reported in many countries mostly due to poorly controlled cross-border virus transmission. There have been several efforts to develop orf virus vaccines and it was with variable success. The use of conventional vaccines to control orf is a debatable topic due to the concern of short term immunity development. Following re-infection in previously vaccinated animals, it is uncommon to observe the farms involved to experience rapid virus spread and disease outbreak. Meanwhile, cases of zoonosis from infected animals to animal handler are not uncommon. Despite failures to contain the spread of orf virus by the use of conventional vaccines, vaccination of animals with live orf virus is still considered as one of the best choice. The review herein described pertinent issues with regard to the development and use of potential effective vaccines as a control measure against orf virus infection.
  8. Basripuzi NH, Sharma RSK, Norhadila Z, Shahar ZS, Nor-Dilaila MS, Mustapha MS, et al.
    Vet Parasitol, 2020 Oct 15;287:109274.
    PMID: 33086185 DOI: 10.1016/j.vetpar.2020.109274
    This study was conducted to investigate potential interactions between the abomasal blood feeder Haemonchus contortus and the intestinal mucosal browser Trichostrongylus colubriformis among deliberately infected Boer goats. Faecal and blood samples were collected twice a week for eight weeks from 25 parasite-naïve goats. Correlation analysis and multiple linear regression models were conducted to explore the association between phenotypic variables and variables taken at necropsy. Positive associations were identified between total FEC and log T. colubriformis number (r = 0.62, p 
  9. Bastion ML, Mustapha M, Ho I
    BMJ Case Rep, 2012;2012.
    PMID: 23093508 DOI: 10.1136/bcr-2012-007260
    To report a unique case of crystallisation in the anterior chamber and subretinal space in a Malay lady following inadvertent subretinal injection of ranibizumab prior to vitrectomy for proliferative diabetic retinopathy.
  10. Chan PY, Mohd Ripin Z, Abdul Halim S, Kamarudin MI, Ng KS, Eow GB, et al.
    Sci Rep, 2019 05 31;9(1):8117.
    PMID: 31148550 DOI: 10.1038/s41598-019-44142-1
    There is a lack of evidence that either conventional observational rating scale or biomechanical system is a better tremor assessment tool. This work focuses on comparing a biomechanical system and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale in terms of test-retest reliability. The Parkinson's disease tremors were quantified by biomechanical system in joint angular displacement and predicted rating, as well as assessed by three raters using observational ratings. Qualitative comparisons of the validity and function are made also. The observational rating captures the overall severity of body parts, whereas the biomechanical system provides motion- and joint-specific tremor severity. The tremor readings of the biomechanical system were previously validated against encoders' readings and doctors' ratings; the observational ratings were validated with previous ratings on assessing the disease and combined motor symptoms rather than on tremor specifically. Analyses show that the predicted rating is significantly more reliable than the average clinical ratings by three raters. The comparison work removes some of the inconsistent impressions of the tools and serves as guideline for selecting a tool that can improve tremor assessment. Nevertheless, further work is required to consider more variabilities that influence the overall judgement.
  11. Chatziralli I, Ventura CV, Touhami S, Reynolds R, Nassisi M, Weinberg T, et al.
    Eye (Lond), 2021 May;35(5):1459-1466.
    PMID: 32651545 DOI: 10.1038/s41433-020-1080-0
    OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has imposed measures of social distancing and barriers in delivery of "in person" education. Institutions, involved in training the next generation of ophthalmologists, are using alternative teaching methods to maintain the standard of education.

    METHODS: We conducted a worldwide survey among physicians, who are actively involved in Ophthalmology-related education, between 3 and 14 April 2020. The expert survey, developed on the basis of literature search and focus group discussions, comprised 23 questions addressing the use of e-learning in Ophthalmology during the COVID-19 pandemic.

    RESULTS: A total of 321 participants from both academic and non-academic institutions worldwide, with variable practice experience and expertise, completed the survey. Before the pandemic, the majority of participants used traditional training modalities, including lectures, grand rounds and journal clubs, and 48% did not use any e-learning. There was a statistically significant increase in the use of all e-learning alternatives during the pandemic (p 

  12. Che Mohd Nassir CMN, Damodaran T, Yusof SR, Norazit A, Chilla G, Huen I, et al.
    Pharmaceutics, 2021 Aug 05;13(8).
    PMID: 34452169 DOI: 10.3390/pharmaceutics13081207
    The distinctive anatomical assemble and functionally discrete multicellular cerebrovasculature dynamics confer varying rheological and blood-brain barrier permeabilities to preserve the integrity of cerebral white matter and its neural microenvironment. This homeostasis intricately involves the glymphatic system that manages the flow of interstitial solutes, metabolic waste, and clearance through the venous circulation. As a physiologically integrated neurogliovascular unit (NGVU) serving a particularly vulnerable cerebral white matter (from hypoxia, metabolic insults, infection, and inflammation), a likely insidious process over a lifetime could inflict microenvironment damages that may lead to pathological conditions. Two such conditions, cerebral small vessel disease (CSVD) and vascular parkinsonism (VaP), with poorly understood pathomechanisms, are frequently linked to this brain-wide NGVU. VaP is widely regarded as an atypical parkinsonism, described by cardinal motor manifestations and the presence of cerebrovascular disease, particularly white matter hyperintensities (WMHs) in the basal ganglia and subcortical region. WMHs, in turn, are a recognised imaging spectrum of CSVD manifestations, and in relation to disrupted NGVU, also include enlarged perivascular spaces. Here, in this narrative review, we present and discuss on recent findings that argue for plausible clues between CSVD and VaP by focusing on aberrant multicellular dynamics of a unique integrated NGVU-a crossroad of the immune-vascular-nervous system-which may also extend fresher insights into the elusive interplay between cerebral microvasculature and neurodegeneration, and the potential therapeutic targets.
  13. Che Mohd Nassir CMN, Damodaran T, Ismail NI, Hashim S, Jaffer U, Hamid HA, et al.
    Life (Basel), 2023 Jan 12;13(1).
    PMID: 36676165 DOI: 10.3390/life13010216
    In this narrative review, we present the evidence on nucleotide-binding and oligomerization (NOD) domain-like receptor (NLR) family pyrin domain (PYD)-containing 3 (NLRP3) inflammasome activation for its putative roles in the elusive pathomechanism of aging-related cerebral small vessel disease (CSVD). Although NLRP3 inflammasome-interleukin (IL)-1β has been implicated in the pathophysiology of coronary artery disease, its roles in cerebral arteriothrombotic micro-circulation disease such as CSVD remains unexplored. Here, we elaborate on the current manifestations of CSVD and its' complex pathogenesis and relate the array of activators and aberrant activation involving NLRP3 inflammasome with this condition. These neuroinflammatory insights would expand on our current understanding of CSVD clinical (and subclinical) heterogenous manifestations whilst highlighting plausible NLRP3-linked therapeutic targets.
  14. Che Mohd Nassir CMN, Hashim S, Wong KK, Abdul Halim S, Idris NS, Jayabalan N, et al.
    Mol Neurobiol, 2021 Aug;58(8):4188-4215.
    PMID: 34176095 DOI: 10.1007/s12035-021-02457-z
    Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has affected the global society in numerous unprecedented ways, with considerable morbidity and mortality. Both direct and indirect consequences from COVID-19 infection are recognized to give rise to cardio- and cerebrovascular complications. Despite current limited knowledge on COVID-19 pathogenesis, inflammation, endothelial dysfunction, and coagulopathy appear to play critical roles in COVID-19-associated cerebrovascular disease (CVD). One of the major subtypes of CVD is cerebral small vessel disease (CSVD) which represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger subsequent neuroinflammation and neurodegeneration. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, and Alzheimer's disease. In the background of COVID-19 infection, the heightened cellular activations from inflammations and oxidative stress may result in elevated levels of microthrombogenic extracellular-derived circulating microparticles (MPs). Consequently, MPs could act as pro-coagulant risk factor that may serve as microthrombi for the vulnerable microcirculation in the brain leading to CSVD manifestations. This review aims to appraise the accumulating body of evidence on the plausible impact of COVID-19 infection on the formation of microthrombogenic MPs that could lead to microthrombosis in CSVD manifestations, including occult CSVD which may last well beyond the pandemic era.
  15. Cheng TC, Yahya MFN, Mohd Naffi AA, Othman O, Seng Fai T, Yong MH, et al.
    J Craniofac Surg, 2021 Oct 01;32(7):2285-2291.
    PMID: 33770023 DOI: 10.1097/SCS.0000000000007645
    BACKGROUND: To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery.

    METHODS: This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction.

    RESULTS: All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009).

    CONCLUSIONS: During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.

  16. Chong SH, Ch'ng TW, Mustapha M
    Cureus, 2022 Jan;14(1):e21146.
    PMID: 35165597 DOI: 10.7759/cureus.21146
    We report a case of transient crystalline keratopathy induced by contact with Dieffenbachia plant sap and review previous reports on plant-induced crystalline keratopathy. A 27-year-old man with underlying diabetes mellitus presented with ocular pain, redness, and tearing after Dieffenbachia plant sap accidentally entered his right eye while he had been cutting the grass one day prior to presentation. The visual acuity of his right eye was 6/9. His conjunctiva was injected with an epithelial defect over the inferior conjunctiva. There were fine needle-like oxalate crystals in the epithelial and stromal layer of the cornea inferiorly. He was treated with topical dexamethasone and levofloxacin. The crystals disappeared from the cornea when he was reviewed one month later. He maintained good visual acuity, and no corneal opacity was noted. In conclusion, patients with crystalline keratopathy after exposure to Dieffenbachia plant sap can have a full recovery without sequelae after supportive treatment. Eliciting the history from patients regarding the type of plant involved is imperative. Ophthalmologists should be aware of the possibility of crystalline keratopathy developing, even though most patients retain good vision.
  17. Chua SW, Mustapha M, Wong KK, Ami M, Mohd Zahidin AZ, Nasaruddin RA
    Clin Ophthalmol, 2021;15:3147-3152.
    PMID: 34326630 DOI: 10.2147/OPTH.S320987
    Purpose: The objectives of this study were to determine the prevalence of microbial contamination of multi-user preserved ophthalmic drops (POD) in Ophthalmology Outpatient Clinic (OOC), to compare the rate of contamination between the dropper tip and the residual contents in the bottle, and to identify the contaminating organisms.

    Methods: This was an observational cross-sectional study using a convenience sampling method conducted in the OOC of Universiti Kebangsaan Malaysia Medical Center, Malaysia. The samples of POD bottles were divided into groups obtained after 14 days (T14) and after 30 days (T30) of use. The contamination rate at the dropper tip and in the residual contents was determined and the contaminating organisms were identified.

    Results: A total of 140 of 149 extended-use POD bottles were included. The prevalence of contamination was 30%. There was a statistically significant difference in the rate of contamination between samples T14 and T30 (19% and 11%, respectively; p=0.046). Proparacaine and tropicamide showed higher contamination rates in the T14 samples (p=0.027 and p=0.497, respectively) than in the T30 samples. The site of contamination was higher at the dropper tip than in the residual contents (p>0.05). Coagulase-negative Staphylococcus species were the most frequently identified contaminants (89%).

    Conclusion: The dropper tip was more contaminated than the residual contents, and coagulase-negative Staphylococcus species, which are common commensal flora of the ocular conjunctiva and skin, were the most frequently identified organisms.

  18. Chuang HG, Aziz NHA, Wong JH, Mustapha M, Abdullah JM, Idris Z, et al.
    Eur Neuropsychopharmacol, 2021 04;45:59-72.
    PMID: 32014377 DOI: 10.1016/j.euroneuro.2019.12.121
    The present study focused on investigating the effect of toll-like receptor 4 (TLR4) antagonist Lipopolysaccharide-Rhodobacter sphaeroides(LPS-RS) on acute, stress-induced voluntary ethanol preference and drinking behaviour, neuronal components activation, and gene expression associated with stress and addictive behaviour. This study involved the exposure of restraint stress and social isolation using Swiss Albino mice. Two-bottle choice ethanol preference analysis was used in the evaluation of voluntary ethanol seeking and drinking behaviour. Several behavioural assessments were carried out to assess fear and anxiety-like behaviour, neuromuscular ability, motor coordination and locomotion. Morphological and immunoreactivity analysis and gene expression analysis were done after the completion of behavioural assessments. TLR4 antagonist LPS-RS treated stressed-mice showed a significant decrease in ethanol drinking compared with stressed mice. Behavioural results showed that stress exposure induced fear and anxiety-like behaviour; however; no significant deficit was found on motor coordination, neuromuscular ability, locomotion and exploratory behaviour among groups. Morphological analysis showed no significant change in the prefrontal cortex and hippocampus among all groups, while immunoreactivity analysis showed higher expression of c-Fos in prefrontal cortex and hippocampus, higher TLR4 expression in the prefrontal cortex and glial fibrillary acidic protein (GFAP) in hippocampus among stressed-animals. Stressed-mice also showed significant increase in TLR4, Nuclear Factor-Kappa B (NF-kB), inducible nitric oxide synthase (iNOS), dopamine receptor D2 (DRD2), cyclic adenosine monophosphate (cAMP) response element binding protein-1 (CREB-1) and opioid receptor MU-1 (OPRM-1) genes expression compared with control and LPS-RS treated stressed-mice. As a conclusion, the antagonism of TLR4 could provide therapeutic value in the treatment of stress-induced addiction.
  19. Danapal P, Mustapha M, Abdul Malek NS, Yeak J, A Qamarruddin F
    Cureus, 2021 Jun;13(6):e15929.
    PMID: 34336431 DOI: 10.7759/cureus.15929
    Endogenous endophthalmitis (EE) is a rare but potentially sight-threatening disease with an appreciable mortality rate. Diabetes mellitus remains the most frequently associated condition especially in the Asian population, which potentiates Klebsiella pneumoniae involvement. Endogenous Klebsiella pneumoniae endophthalmitis (EKE) usually has a poor final visual outcome despite treatment with intravitreal and systemic antibiotics. We report three cases of EKE with systemic involvement Klebsiella pneumoniae invasive syndrome (KPIS). KPIS was diagnosed in three patients with multiple comorbidities who presented with a blurring of vision and eye redness. Patient 1 was a 63-year-old Malay man diagnosed with left eye panophthalmitis with multifocal liver and prostate abscesses. He underwent drainage of the liver abscess and eventually evisceration of the left eye due to scleral perforation. Patient 2 was a 66-year-old Malay woman diagnosed with left eye endophthalmitis. Due to hemodynamic instability, vitrectomy was delayed and eventually sustained corneal perforation and eviscerated. The patient eventually succumbed to infection. Patient 3 was a 42-year-old Malay woman diagnosed with KPIS, renal abscess, lung abscess, and left endogenous endophthalmitis. She underwent a vitrectomy but her postoperative vision remained poor. All patients received multiple intravitreal antibiotics and systemic antibiotics. KPIS is frequently associated with catastrophic disabilities. Our cases highlight the importance of an early suspicion of systemic involvement in patients presenting with EKE. Prompt diagnosis, emergent radiographic evaluation, early adequate drainage, and appropriate treatment with antibiotics potentially improve survival and visual prognosis.
  20. Dasrilsyah AM, Wan Abdul Halim WH, Mustapha M, Tang SF, Kaur B, Ong EY, et al.
    Cornea, 2023 Nov 01;42(11):1395-1403.
    PMID: 37267451 DOI: 10.1097/ICO.0000000000003308
    PURPOSE: The aim of this study was to measure and compare the effect of topical insulin (0.5 units, 4 times per day) versus artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients.

    METHODS: This is a double-blind randomized controlled hospital-based study involving diabetic patients with postoperative corneal epithelial defects after vitreoretinal surgery. Diabetic patients were randomized into 2 different groups and received either 0.5 units of topical insulin (DTI) or artificial tears (Vismed, sodium hyaluronate 0.18%; DAT). The primary outcome measured was the rate of corneal epithelial wound healing (mm 2 /h) over a preset interval and time from baseline to minimum size of epithelial defect on fluorescein-stained anterior segment digital camera photography. The secondary outcome measured was the safety of topical insulin 0.5 units and artificial tears (Vismed, sodium hyaluronate 0.18%). Patients were followed up until 3 months postoperation.

    RESULTS: A total of 38 eyes from 38 patients undergoing intraoperative corneal debridement during vitreoretinal surgery with resultant epithelial defects (19 eyes per group) were analyzed. DTI was observed to have a significantly higher healing rate compared with the DAT group at rates over 36 hours ( P = 0.010), 48 hours ( P = 0.009), and 144 hours ( P = 0.009). The rate from baseline to closure was observed to be significantly higher in the DTI group (1.20 ± 0.29) (mm 2 /h) compared with the DAT group (0.78 ± 0.20) (mm 2 /h) as well ( P < 0.001). No adverse effect of topical insulin and artificial tears was reported.

    CONCLUSIONS: Topical insulin (0.5 units, 4 times per day) is more effective compared with artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients, without any adverse events.

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