Displaying all 9 publications

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  1. Raman P, Suliman NB, Zahari M, Kook M, Ramli N
    Eye (Lond), 2018 07;32(7):1183-1189.
    PMID: 29491486 DOI: 10.1038/s41433-018-0057-8
    OBJECTIVE: To assess the relationship between baseline intraocular pressure (IOP), blood pressure (BP) and ocular perfusion pressure (OPP), and the 5-year visual field progression in normal-tension glaucoma (NTG) patients.

    DESIGN: Prospective, longitudinal study.

    METHODS: Sixty-five NTG patients who were followed up for 5 years are included in this study. All the enrolled patients underwent baseline 24-h IOP and BP monitoring via 2-hourly measurements in their habitual position and were followed up for over 5 years with reliable VF tests. Modified Anderson criteria were used to assess VF progression. Univariable and multivariable analyses using Cox's proportional hazards model were used to identify the systemic and clinical risk factors that predict progression. Kaplan-Meier survival analyses were used to compare the time elapsed to confirmed VF progression in the presence or absence of each potential risk factor.

    RESULTS: At 5-year follow-up, 35.4% of the enrolled patients demonstrated visual field progression. There were statistically significant differences in the mean diastolic blood pressure (p p  43.7 mmHg (log rank = 0.018).

    CONCLUSION: Diastolic parameters of BP and OPP were significantly lower in the NTG patients who progressed after 5 years. Low nocturnal DOPP is an independent predictor of glaucomatous visual field progression in NTG patients.

  2. Raman P, Khy Ching Y, Sivagurunathan PD, Ramli N, Mohd Khalid KH
    J Glaucoma, 2019 08;28(8):685-690.
    PMID: 31033782 DOI: 10.1097/IJG.0000000000001269
    PRECIS: This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD).

    AIM: Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients.

    METHODS: This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model.

    RESULTS: Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=-0.20, P=0.03; rs=-0.20, P=0.04; rs=-0.28, P=0.003; rs=0.21, P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation.

    CONCLUSION: Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.

  3. Nur Hanis Y, Raman P, Premala Devi S, Mohd Khalid KH
    Med J Malaysia, 2019 08;74(4):296-299.
    PMID: 31424036
    OBJECTIVE: The Ministry of Health introduced the cluster hospital project in Kuala Pilah district in 2016 to allow sharing of resources between the hospitals in the same vicinity. The aim of this study is to compare the demographic profile, prevalence of cataract blindness and low vision among patients who presented for cataract surgery before and after the programme.

    METHODOLOGY: This is a retrospective cohort study of patients who underwent cataract surgery in Kuala Pilah Cluster Hospitals between 2010 and 2017. A total of 2539 records of patients were reviewed. Patients were assigned into two groups: Group 1 (2010-2012)- before the programme (2010-2012) and Group 2 (2015-2017) after the introduction of the programme.

    RESULTS: There was a significant increase in number of cataract cases in the district hospital after the cluster initiative. The mean age of patients undergoing cataract surgery was similar in both groups. The common comorbidities were hypertension (Group 1=57.3%; Group 2=70.8%) and diabetes mellitus (Group 1=40.6%; Group 2=51.1%). In 2010-2012, most of the patients were one eye blind (34.4%), whereas in 2015-2017 majority of patients presented with vision better than 6/18 (43.5%). The proportion of patients with cataract blindness reduced from 6% in 2010-2012 to 4.3% in 2015-2017 (p<0.01).

    CONCLUSION: There is a significant decrease in percentage of patients with cataract blindness and low vision after the introduction of Kuala Pilah Cluster Hospital Program. We believe that that cluster hospital system is effective in improving accessibility to eye care and therefore increases the cataract detection rate.
  4. Raman P, Suliman NB, Zahari M, Mohamad NF, Kook MS, Ramli N
    J Glaucoma, 2019 11;28(11):952-957.
    PMID: 31688446 DOI: 10.1097/IJG.0000000000001359
    PRECIS: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

    PURPOSE: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

    DESIGN: This was a prospective, longitudinal study.

    METHODS: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

    RESULTS: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

    CONCLUSION: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

  5. Yeap KC, Sivagurunathan PD, Raman P, Khalid KHM
    GMS Ophthalmol Cases, 2019;9:Doc25.
    PMID: 31355123 DOI: 10.3205/oc000114
    Purpose: To report a rare case of non-tuberculous mycobacterial (NTM) choroiditis masquerading as choroidal tumour, where the initial diagnosis was masked by keratitis. Casedescription: A 57-year-old heroin chaser with a pre-existing left eye blindness due to past blunt trauma presented with diffuse bacterial keratitis on the same side. Systemic examination revealed multiple non-tender cervical lymphadenopathies. B-scan ultrasonography showed a hyperechoic choroidal mass with surrounding exudative retinal detachment, resembling a choroidal tumour. However, computed tomography (CT) and magnetic resonance imaging (MRI) scan findings were suggestive of inflammatory choroidal changes. Inflammatory markers were significantly raised and infective screening was positive for HIV and Hepatitis C. Tuberculosis workup was normal. In view of intractable pain, evisceration was done and his vitreous humour was sent for polymerase chain reaction (PCR). It was reported to be positive for Mycobacterium Fortuitum. Conclusion: NTM ocular infections are rare, challenging to diagnose, and potentially sight threatening. Early recognition and prompt treatment is life and vision saving.
  6. Zainol N, Raman P, Devi-S P, Mohd Khalid KH
    Retin Cases Brief Rep, 2023 Jul 01;17(4):362-364.
    PMID: 34381008 DOI: 10.1097/ICB.0000000000001186
    OBJECTIVE: To report a rare case of suprachoroidal hemorrhage during phacoemulsification in a patient with bilateral carotid-cavernous fistula.

    METHOD: Case report.

    RESULT: A 76-year-old woman with underlying hypertension presented left eye poor vision due to an underlying dense cataract. Her initial preoperative assessment was uneventful, and she underwent phacoemulsification. During epinucleus removal, there was sudden, unexpected anterior chamber shallowing, resulting in posterior capsule rupture. While the surgeon extended the wound to facilitate epinucleus removal, there was a further decrease of red reflex, followed by hardening of the globe, indicating a suprachoroidal hemorrhage. The corneal wound was opposed swiftly without an intraocular lens. Further evaluation after that revealed the patient had a chronic headache for several years, and ocular examination showed bilateral esophoria. A computed tomography demonstrated features suggestive of bilateral carotid-cavernous fistula, which was confirmed with computed tomography angiography later.

    CONCLUSION: Patients with carotid-cavernous fistula have elevated episcleral venous pressure and vortex venous pressure. Sudden decompression of the globe in these patients predisposes them to higher suprachoroidal hemorrhage risk, although this condition is generally rare in phacoemulsification.

  7. Vasudevan V, Prabaharan J, Krishnan N, K A, Gopinath SCB, Raman P
    Anal Methods, 2023 Aug 03;15(30):3735-3751.
    PMID: 37493014 DOI: 10.1039/d3ay00704a
    Borassus flabellifer L., commonly known as Asian palmyra, is native to South and Southeast Asia. The endosperms of B. flabellifer (known as nungu in Dravidian culture) are widely consumed during the summer season. It is rich in various nutrients and helps in reducing weight, treating skin and digestive issues, lowering body temperature, and managing migraines and diabetes. This study focuses on identifying the small molecules and proteins from the two varieties of B. flabellifer tender fruit endosperms collected from districts around Chennai, Tamil Nadu, India. The collected free nuclear endosperm was subjected to direct extraction and the mesocarp and cellular endosperms were lyophilized and homogenized. Metabolites were extracted by hexane, methanol, and chloroform and investigated using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS). The compounds identified were from the classes of carboxylic acids, flavonoids, amino acids, alkaloids, fatty acids, oligopeptides, vitamins, and glycosides. High-performance liquid chromatography (HPLC) technique was employed to estimate the quantity of amino acids, wherein the total amino acid in the green variety was found to be higher than in the black variety. Proteins were identified after simulating with a gastrointestinal enzyme using liquid chromatography tandem mass spectrometry (LC-MS/MS)-based peptide mass fingerprinting. The different mineral oxides present in the tender fruit endosperm were identified using X-ray diffraction studies, which confirmed the presence of mineral oxides, such as Br1.25ClO2.75Pb3.88, calcium zirconium tantalum oxide, and barium fluoroniobate. This study validates the presence of bioactive metabolites in green and black varieties of B. flabellifer tender fruit endosperm with a range of activities, such as anti-inflammatory, antibacterial, anticancer, and anti-diabetic properties.
  8. Soundararajan P, Parthasarathy S, Sakthivelu M, Karuppiah KM, Velusamy P, Gopinath SCB, et al.
    Curr Med Chem, 2023 Oct 18.
    PMID: 37877148 DOI: 10.2174/0109298673250752230921090452
    Edible oils are inevitable requisites in the human diet as they are enriched with essential fatty acids, vitamins, carotenoids, sterols, and other antioxidants. Due to their nutritive value and commercial significance, edible oils have been used for food preparation for many centuries. The use of global consumption of edible oils has dramatically increased throughout the world in the 21st century owing to their incredible application in all kinds of food preparation. However, a variety of pollutants, such as pesticides, toxic chemicals, heavy metals, and environmental pollution, have contributed to the contamination of edible oils. Furthermore, the benzophenanthridine alkaloids, sanguinarine, dihydrosanguinarine, butter yellow, and other several agents are added intentionally, which are known to cause a number of human diseases. Apart from this, repeated heating and reusing of oils results in trans fats, and lipid peroxidation alters the fatty acid composition, which adversely affects the health of consumers and increases the risk of cardiovascular diseases. Moreover, the prevention of edible oil contamination in human health at various levels is inevitable to ensure consumer safety. Hence, the present review provides an overview of vegetable cooking oils and the health ailments that detection techniques are focused on.
  9. P DS, K A, S M, Gopinath SCB, Raman P
    Curr Med Chem, 2024 Feb 06.
    PMID: 38367263 DOI: 10.2174/0109298673272435231204072922
    Neurodegenerative diseases (NDDs) comprise a large number of disorders that affect the structure and functions of the nervous system. The major cause of various neurodegenerative diseases includes protein aggregation, oxidative stress and inflammation. Over the last decade, there has been a gradual inclination of neurological research in order to find drugs that can prevent, slow down, or treat these diseases. The most common NDDs are Alzheimer's, Parkinson's, and Huntington's illnesses which claims the lives of 6.8 million people worldwide each year and it is expected to rise by 7.1%. The focus on alternative medicine, particularly plant-based products, has grown significantly in recent years. Plants are considered a good source of biologically active molecules and hence phytochemical screening of plants will pave the way for discovering new drugs. Neurodegeneration has long been linked to oxidative stress, either as a direct cause or as a side effect of other variables. Therefore, it has been proposed that the use of antioxidants to combat cellular oxidative stress within the nervous system may be a viable therapeutic strategy for neurological illnesses. In order to prevent and treat NDDs, this review article covers the therapeutic compounds/ metabolites from plants with the neuroprotective role. However, these exhibit other beneficial molecular functions in addition to antioxidant activity is the potential application in the management or prevention of neurodegenerative disorders. Further, it gives future researchers the significance of considering peptide-based therapeutics through various mechanisms in delaying or curing neurodegenerative diseases.
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