Displaying publications 1 - 20 of 151 in total

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  1. Ramza Ramli R, Mohamad I, Mohamad Zaki Z
    Acta Inform Med, 2012 Dec;20(4):264-5.
    PMID: 23378697 DOI: 10.5455/aim.2012.20.264-265
    Common foreign bodies in adults include fish bones and improperly chewed meat A 72-year-old Malay gentleman was brought in by his son to the emergency department after he was seen gasping at home. The patient has an underlying history of stroke with neurological deficit include his gag reflex. According to family members, the patient had the symptom a day after he had allegedly consumed a piece of durian without removing its seed. Patient was then admitted to Intensive care Unit (ICU) for monitoring. His blood gas normalized and was extubated after 2 days in ICU before discharged home the next day.
  2. Izwan-Anas N, Ya'cob Z, Low VL, Lourdes EY, Ramli R, Bolongan G, et al.
    Acta Trop, 2021 Jun;218:105904.
    PMID: 33775626 DOI: 10.1016/j.actatropica.2021.105904
    Most female black flies in the genus Simulium are blood-sucking flies and they can cause various parasitic diseases in human and animal. A total of 94 species of black flies have been reported in Malaysia, however, their biting behavior and role as vector of infectious agents remain understudied. To fill in this knowledge gap, we attempted to survey adult black flies from field populations in Peninsular Malaysia. In a survey carried out in 2017 at Tasik Kenyir, Terengganu, three females were caught while attracted and landed on human skin. Further morphological and molecular analyses showed that the specimens were identical to Simulium (Gomphostilbia) aziruni Takaoka, Hashim & Chen of the Simulium gombakense species-group. This is the first report on a black fly species attracted to human in Malaysia which serves as a steppingstone towards in-depth studies for black flies in this region.
  3. Makmor-Bakry M, Ahmat A, Shamsuddin A, Lau CL, Ramli R
    Anaesthesiol Intensive Ther, 2019;51(3):218-223.
    PMID: 31434472 DOI: 10.5114/ait.2019.87362
    BACKGROUND: Failure of antibiotic treatment increases mortality of critically ill patients. This study investigated the association between the treatment resolution of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vancomycin pharmacokinetic variables.

    METHODS: A total of 28 critically ill patients were included in this study. All data were collected from medical, microbiology and pharmacokinetic records. The clinical response was evaluated on the basis of clinical and microbiological parameters. The 24-h area under the curve (AUC0-24) was estimated from a single trough level using established equations.

    RESULTS: Out of the 28 patients, 46% were classified as responders to vancomycin treatment. The trough vancomycin concentration did not differ between the responders and non-responders (15.02 ± 6.16 and 14.83 ± 4.80 μg mL-1; P = 0.929). High vancomycin minimum inhibitory concentration (MIC) was observed among the non-responders (P = 0.007). The ratio between vancomycin trough concentration and vancomycin MIC was significantly lower in the non-responder group (8.76 ± 3.43 vs. 12.29 ± 4.85 μg mL-1; P = 0.034). The mean ratio of estimated AUC0-24 and vancomycin MIC was 313.78 ± 117.17 μg h mL-1 in the non-responder group and 464.44 ± 139.06 μg h mL-1 in the responder group (P = 0.004). AUC0-24/MIC of ≥ 400 μg h mL-1 was documented for 77% of the responders and 27% of the non-responders (c2 = 7.03; P = 0.008).

    CONCLUSIONS: Ratio of trough concentration/MIC and AUC0-24/MIC of vancomycin are better predictors for MRSA treatment outcomes than trough vancomycin concentration or AUC0-24 alone. The single trough-based estimated AUC may be sufficient for the monitoring of treatment response with vancomycin.

  4. Muhamad S, Sengupta P, Ramli R, Nasir A
    Andrologia, 2019 Nov;51(10):e13383.
    PMID: 31373711 DOI: 10.1111/and.13383
    The worldwide declining trend in male fertility has been a steady concern since the past few decades. Male infertility reportedly accounts for half of the overall infertility cases in the world. Despite the evidences of reduced fertility rates in Malaysia in the recent years, there is lack of interventions regarding the reproductive parameters in Malaysian men. Complexity in determining the underlying causatives in most of the male subfertility and infertility cases limits the scope of management. The sociodemographic impacts upon overall health as well as on reproductive health of men are undeniable. The present study has analysed the data collected from patients' records in the Fertility Clinic, International Islamic University Malaysia (IIUM), from the January 2009 until December 2018. A total of 300 male patients were included in the study and were categorised according to their seminal fluid analysis (SFA) records. The sociodemographic characteristics for each subject were analysed. The results presented significant correlations among essential sociodemographic factors, such as educational attainment, marital duration as well as the age of wife, with the levels of semen abnormalities in the subjects. The study thereby unleashes scope for further investigations focusing upon the demographic factors for better insights to ameliorate male reproductive health in the Malaysian population.
  5. bin Sabir Husin Athar PP, bte Ahmad Norhan N, bin Saim L, bin Md Rose I, bte Ramli R
    Ann Acad Med Singap, 2008 Sep;37(9):788-3.
    PMID: 18989497
    INTRODUCTION: Metastatic adenocarcinoma from the gastrointestinal tract to the sinonasal tract is rare. The histological morphology of this lesion is indistinguishable from the colonic variant of primary sinus adenocarcinoma or intestinal-type adenocarcinoma (ITAC).

    CLINICAL PICTURE: This is a report of a case of metastatic adenocarcinoma of colorectal origin to the paranasal sinuses in a 52-year-old female who was previously treated for adenocarcinoma of the sigmoid colon. A histologic study of the surgical specimen from the sinonasal cavity demonstrated a tumour identical to the patient's prior primary tumour of the colon. The sinonasal neoplastic tissue showed marked positivity for carcinoembryonic antigen and expressed cytokeratin 20, which differentiates metastatic colonic adenocarcinoma from ITAC.

    TREATMENT/OUTCOME: The patient received palliative radiation but died 3 months after the diagnosis.

    CONCLUSION: Distinguishing metastatic adenocarcinoma from gastrointestinal tract from ITAC can be difficult. In view of the resemblance, immunohistochemical staining can help in differentiating them. It is important to recognise these as metastatic lesions as the treatment is mainly palliative.

  6. Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Ramli R, et al.
    Antibiotics (Basel), 2021 May 04;10(5).
    PMID: 34064457 DOI: 10.3390/antibiotics10050531
    Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients' notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.
  7. Mohd Yunus SS, Nabil S, Rashdi MF, Nazimi AJ, Nordin R, Tan HL, et al.
    Antibiotics (Basel), 2023 Apr 02;12(4).
    PMID: 37107058 DOI: 10.3390/antibiotics12040696
    This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This cross-sectional study was performed from September 2017 to March 2019. The self-administered questionnaire comprised two sections: background information of the specialists and their opinions on the NICE guideline. The questionnaire was distributed to 794 potential participants, and 277 responded (response rate of 34.9%). In general, 49.8% of the respondents believed that clinicians should adhere to the guideline, although the majority of oral and maxillofacial surgeons (54.5%) actually disagreed with this view. The dental procedures that were perceived as presented moderate-to-high risk for IE were minor surgery for an impacted tooth with a recent episode of infection, dental implant surgery, periodontal surgery and dental extraction in patients with poor oral hygiene. The cardiac conditions that were strongly recommended for antibiotic prophylaxis were severe mitral valve stenosis or regurgitation and previous IE. Less than half of Malaysian clinical specialists agreed with the changes in the 2008 NICE guideline, contributing to their insistence that antibiotic prophylaxis is still needed for high-risk cardiac conditions and selected invasive dental procedures.
  8. Ramli R, Hanafi NS, Hussein N, Lee PY, Shariff Ghazali S, Cheong AT, et al.
    PMID: 36852891 DOI: 10.1177/10105395231158684
    Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians' level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim's health literacy and facilitated by educational resources, family engagement, and regular health briefing.
  9. Abu A, Leow LK, Ramli R, Omar H
    BMC Bioinformatics, 2016 Dec 22;17(Suppl 19):505.
    PMID: 28155645 DOI: 10.1186/s12859-016-1362-5
    BACKGROUND: Taxonomists frequently identify specimen from various populations based on the morphological characteristics and molecular data. This study looks into another invasive process in identification of house shrew (Suncus murinus) using image analysis and machine learning approaches. Thus, an automated identification system is developed to assist and simplify this task. In this study, seven descriptors namely area, convex area, major axis length, minor axis length, perimeter, equivalent diameter and extent which are based on the shape are used as features to represent digital image of skull that consists of dorsal, lateral and jaw views for each specimen. An Artificial Neural Network (ANN) is used as classifier to classify the skulls of S. murinus based on region (northern and southern populations of Peninsular Malaysia) and sex (adult male and female). Thus, specimen classification using Training data set and identification using Testing data set were performed through two stages of ANNs.

    RESULTS: At present, the classifier used has achieved an accuracy of 100% based on skulls' views. Classification and identification to regions and sexes have also attained 72.5%, 87.5% and 80.0% of accuracy for dorsal, lateral, and jaw views, respectively. This results show that the shape characteristic features used are substantial because they can differentiate the specimens based on regions and sexes up to the accuracy of 80% and above. Finally, an application was developed and can be used for the scientific community.

    CONCLUSIONS: This automated system demonstrates the practicability of using computer-assisted systems in providing interesting alternative approach for quick and easy identification of unknown species.

  10. Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R
    BMC Emerg Med, 2014;14:17.
    PMID: 25086638 DOI: 10.1186/1471-227X-14-17
    The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.
  11. Aziz NA, Mohd Ali MH, Ramli R
    BMJ Case Rep, 2022 Feb 08;15(2).
    PMID: 35135794 DOI: 10.1136/bcr-2021-246603
    A young adult patient with 46XX congenital adrenal hyperplasia (CAH) presented with recurrent painful haematuria. CAH was diagnosed at birth following ambiguous genitalia. Hormonal treatment was started, female gender was assigned and feminising genitoplasty was planned, however the patient was lost to follow-up. Gender dysphoria started to occur during childhood which prompted the family to raise the patient as a boy. He eventually identified himself as a male. Examination revealed a male phenotype with severely virilised genitalia. Imaging studies confirmed the presence of uterus with low confluent urogenital sinus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and the troublesome symptoms were cured.
  12. Nawawi SH, Wan Ibrahim WZ, Yahya MM, Ramli R
    BMJ Case Rep, 2023 Aug 17;16(8).
    PMID: 37591622 DOI: 10.1136/bcr-2022-253129
    A woman in her early 50s with uncontrolled diabetes mellitus and a huge uterine fibroid presented to the emergency department with diabetic ketoacidosis and bilateral acute lower limb ischaemia. Vascular and advanced imaging studies confirmed distal aortic compression by a huge uterine fibroid, resulting in extensive lower limb arterial thrombosis. After resuscitation, the patient underwent emergency hysterectomy, thromboembolectomy and amputation of the right leg. She remained critically ill and died of fulminant sepsis and multiorgan failure 10 days later. This case reports the effects of external vascular compression by a large pelvic mass.
  13. Abdul Mulalek N, Wan Abas WR, Muhammad Tamyez F, Ramli R
    BMJ Case Rep, 2023 Dec 18;16(12).
    PMID: 38110342 DOI: 10.1136/bcr-2023-258548
  14. Sooryanarayana R, Choo WY, Hairi NN, Chinna K, Hairi F, Ali ZM, et al.
    BMJ Open, 2017 Sep 01;7(8):e017025.
    PMID: 28864485 DOI: 10.1136/bmjopen-2017-017025
    BACKGROUND: As Malaysia is fast becoming an ageing nation, the health, safety and welfare of elders are major societal concerns. Elder abuse is a phenomenon recognised abroad but less so locally. This paper presents the baseline findings from the Malaysian Elder Mistreatment Project (MAESTRO) study, the first community-based study on elder abuse in Malaysia.

    DESIGN: Cross-sectional study, analysing baseline findings of a cohort of older adults.

    SETTING: Kuala Pilah district, Negeri Sembilan state, Malaysia.

    OBJECTIVES: To determine the prevalence of elder abuse among community dwelling older adults and its associated factors.

    PARTICIPANTS: A total of 2112 community dwelling older adults aged 60 years and above were recruited employing a multistage sampling using the national census.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Elder abuse, measured using a validated instrument derived from previous literature and the modified Conflict Tactic Scales, similar to the Irish national prevalence survey on elder abuse with modification to local context. Factors associated with abuse and profiles of respondents were also examined.

    RESULTS: The prevalence of overall abuse was reported to be 4.5% in the past 12 months. Psychological abuse was most common, followed by financial, physical, neglect and sexual abuse. Two or more occurrences of abusive acts were common, while clustering of various types of abuse was experienced by one-third of abused elders. Being male (adjusted OR (aOR) 2.15, 95% CI 1.23 to 3.78), being at risk of social isolation (aOR 1.96, 95% CI 1.07 to 3.58), a prior history of abuse (aOR 3.28, 95% CI 1.40 to 7.68) and depressive symptomatology (aOR 7.83, 95% CI 2.88 to 21.27) were independently associated with overall abuse.

    CONCLUSION: Elder abuse occurred among one in every 20 elders. The findings on elder abuse indicate the need to enhance elder protection in Malaysia, with both screening of and interventions for elder abuse.

  15. Mansor MS, Nor SM, Ramli R
    Behav Processes, 2020 Nov;180:104229.
    PMID: 32866554 DOI: 10.1016/j.beproc.2020.104229
    Mixed-species flocks (MSFs) serve important roles in bird communities, especially in tropical forests. Although structure of mixed-species bird flocks and its benefits has been intensively studied globally, the foraging plasticity of a species when joining MSFs has rarely been evaluated. The present study examines foraging strategies of the Rufous-crowned Babbler (Malacopteron magnum), Chestnut-winged Babbler (Cyanoderma erythropterum) and Black-naped Monarch (Hypothymis azurea) when participating in MSFs in the Krau Wildlife Reserve, central Peninsular Malaysia. These species exhibit active foraging shifts in utilisation of vertical strata, foraging substrate, attack manoeuvres and foliage density, when foraging in MSFs, compared to when foraging outside MSFs. While the Rufous-crowned Babbler and Chestnut-winged Babbler commonly used gleaning and stretching (to completely extend the legs or neck to reach the food items) manoeuvres when foraging outside MSFs, respectively, they adopted probing manoeuvre and frequently used higher strata upon joining MSFs. The Chestnut-winged Babbler tended to forage on the underside of leaves and the Black-naped Monarch frequently utilised branches when joining MSFs, while they exclusively used aerial leaf litter and live green leaves, respectively, when foraging with conspecifics. The monarch also adopted the hovering manoeuvre and frequently foraged within denser foliage cover when joining MSFs. This study demonstrated that flock members exhibits foraging plasticity either through an expansion or active shift in foraging niches when participating in MSFs, thus suggesting the occurrence of possible foraging improvement and/or reductions in predation risk.
  16. Mansor MS, Ramli R
    Behav Processes, 2017 Jul;140:121-126.
    PMID: 28438691 DOI: 10.1016/j.beproc.2017.04.010
    Niche theory suggests that sympatric species reduce interspecific competition through segregation of shared resources by adopting different attack manoeuvres. However, the fact that flycatcher-like bird species exclusively use the sally manoeuvre may thus challenge this view. We studied the foraging ecology of three flycatcher-like species (i.e. Paradise-flycatcher Terpsiphone sp., Black-naped Monarch Hypothymis azurea, and Rufous-winged Philentoma Philentoma pyrhoptera) in the Krau Wildlife Reserve in central Peninsular Malaysia. We investigated foraging preferences of each bird species and the potential niche partitioning via spatial or behavioural segregation. Foraging substrate was important parameter that effectively divided paradise-flycatcher from Black-naped Monarch and Rufous-winged Philentoma, where monarch and philentoma foraged mainly on live green leaves, while paradise-flycatcher foraged on the air. They also exhibited different foraging height preferences. Paradise-flycatcher, for instance, preferred the highest studied strata, while Black-naped Monarch foraged mostly in lower strata, and Rufous-winged Philentoma made use of the lowest strata. This study indicates that niche segregation occurs among sympatric species through foraging substrate and attack manoeuvres selection.
  17. Mansor MS, Nor SM, Ramli R, Sah SAM
    Behav Processes, 2018 Dec;157:73-79.
    PMID: 30193765 DOI: 10.1016/j.beproc.2018.09.001
    With the rapid growth of agricultural areas globally, forest birds increasingly encounter fragmented landscapes in which forest patches are surrounded by an agricultural plantation matrix, yet how birds respond behaviourally to this fragmentation is poorly understood. Information on microhabitat requirements of birds is scarce, but nevertheless essential to predicting adaptation of bird species to the patchy landscapes. We investigated foraging patterns of three tropical insectivorous birds, Green Iora Aegithina viridissima, Pin-striped Tit-Babbler Macronus gularis and Chestnut-winged Babbler Cyanoderma erythropterum, to determine whether they vary in foraging methods in different forest patches. Our study area encompassed old-logged lowland forest; one continuous forest and three forest patches. Observations were performed for 15 days every month for a period of 13 months. Information on foraging height, substrate, attack manoeuvres, and foliage density was collected independently for each foraging bird individual. All three species used different foraging substrates and attack manoeuvres in different habitat types. The Green Iora frequently used lower strata when foraging in forest patches as opposed to continuous forest, while the Pin-striped Tit-Babbler tended to forage in more dense vegetation in patches. Only Chestnut-winged Babbler displayed complete foraging plasticity across all study parameters. Different habitat features (e.g., edges, microclimates) between continuous forest and forest patches significantly influenced the foraging strategies of the study species. These changes in foraging strategies suggest that some Malaysian forest birds (e.g. generalist species) can respond behaviourally to fragmentation and habitat loss. Although continuous forest has critically important characteristics that need to be conserved, remnant forest patches are also important as ecological movement corridors and foraging grounds for birds.
  18. Weng PL, Ramli R, Shamsudin MN, Cheah YK, Hamat RA
    Biomed Res Int, 2013;2013:938937.
    PMID: 23819125 DOI: 10.1155/2013/938937
    Little is known on the genetic relatedness and potential dissemination of particular enterococcal clones in Malaysia. We studied the antibiotic susceptibility profiles of Enterococcus faecium and Enterococcus faecalis and subjected them to pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). E. faecium and E. faecalis displayed 27 and 30 pulsotypes, respectively, and 10 representative E. faecium and E. faecalis isolates (five each) yielded few different sequence types (STs): ST17 (2 isolates), ST78, ST203, and ST601 for E. faecium, and ST6, ST16, ST28, ST179, and ST399 for E. faecalis. Resistance to tazobactam-piperacillin and ampicillin amongst E. faecium isolates was highly observed as compared to E. faecalis isolates. All of the isolates were sensitive to vancomycin and teicoplanin. The presence of epidemic and nosocomial strains of selected E. faecium STs: 17, 78, and 203 and E. faecalis ST6 as well as high rates of resistance to multiple antibiotics amongst E. faecium isolates is of a particular concern.
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