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The influences of age, gender and geometric pattern of visual image on the verticality perception: A subjective visual vertical (SVV) study among Malaysian adults

Zakaria MN, Salim R, Tahir A, Zainun Z, Mohd Sakeri NS

Clin Otolaryngol, 2019 03;44(2):166-171.
PMID: 30411501 DOI: 10.1111/coa.13255

OBJECTIVES: Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults.
STUDY DESIGN: This study employed a repeated measures design.
SETTINGS: Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia.
PARTICIPANTS: Eligible Malaysian adults (N = 187, aged 21-75 years) were recruited and categorised into young (N = 60), middle-aged (N = 66) and older (N = 61) groups. Most of them were Malay, and 51.3% were men.
MAIN OUTCOME MEASURES: Subjective visual vertical angles (in degrees) were determined from each participant in a static upright condition using a computerised SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern).
RESULTS: Three-way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P > 0.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P = 0.004).
CONCLUSION: While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (ie, arrow pattern). Further SVV research on vestibular-disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.
Fulltext The Test-Retest Reliability of Subjective Visual Horizontal Testing: Comparisons between Solid and Dotted Line Images

Zakaria MN, Wahat NHA, Zainun Z, Sakeri NSM, Salim R

J Audiol Otol, 2020 Apr;24(2):107-111.
PMID: 31995977 DOI: 10.7874/jao.2019.00297

The present study aimed to determine the test-retest reliability of subjective visual horizontal (SVH) testing when tested with solid and dotted line images. In this repeated measures study, 36 healthy young Malaysian adults (mean age=23.3±2.3 years, 17 males and 19 females) were enrolled. All of them were healthy and had no hearing, vestibular, balance, or vision problems. The SVH angles were recorded from each participant in an upright body position using a computerized device. They were asked to report their horizontality perception for solid and dotted line images (in the presence of a static black background). After 1 week, the SVH procedure was repeated. The test-retest reliability of SVH was found to be good for both solid line [intraclass correlation (ICC)=0.80] and dotted line (ICC=0.78). As revealed by Bland-Altman plots, for each visual image, the agreements of SVH between the two sessions were within the clinically accepted criteria (±2°). The SVH testing was found to be temporally reliable, which can be clinically beneficial. Both solid and dotted lines in the SVH testing are reliable to be used among young adults.
The influence of type of visual image and gender on the perception of horizontality: a subjective visual horizontal (SVH) study

Zakaria MN, Tahir A, Zainun Z, Salim R, Mohd Sakeri NS, Abdul Wahat NH

Acta Otolaryngol, 2021 Jan;141(1):62-65.
PMID: 32957810 DOI: 10.1080/00016489.2020.1817552

BACKGROUND: The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH.
OBJECTIVE: The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults.
MATERIALS AND METHODS: In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device.
RESULTS: The arrow pattern produced significantly bigger SVH angles than the solid line (p < .001). In contrast, no significant influence of gender was found on SVH results (p = .743), Based on the statistical outcomes, the preliminary normative data for SVH were established.
CONCLUSIONS AND SIGNIFICANCE: The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.
Earlier Peak Latencies May Not Fully Reflect the Robustness of Cervical Vestibular Evoked Myogenic Potential to CE-Chirp Stimulus

Zakaria MN, Abdallatif AMR, Mohamad WNW, Salim R, Dzulkarnain AAA

J Audiol Otol, 2021 Dec 20.
PMID: 34922418 DOI: 10.7874/jao.2021.00458
Fulltext Cervical vestibular evoked myogenic potential (cVEMP) findings in adults with sensorineural hearing loss (SNHL): comparisons between 500 Hz tone burst and narrowband CE-Chirp stimuli

Zakaria MN, Salim R, Abdul Wahat NH, Md Daud MK, Wan Mohamad WN

Sci Rep, 2023 Dec 21;13(1):22842.
PMID: 38129442 DOI: 10.1038/s41598-023-48810-1

There has been a growing interest in studying the usefulness of chirp stimuli in recording cervical vestibular evoked myogenic potential (cVEMP) waveforms. Nevertheless, the study outcomes are debatable and require verification. In view of this, the aim of the present study was to compare cVEMP results when elicited by 500 Hz tone burst and narrowband (NB) CE-Chirp stimuli in adults with sensorineural hearing loss (SNHL). Fifty adults with bilateral SNHL (aged 20-65 years) underwent the cVEMP testing based on the established protocol. The 500 Hz tone burst and NB CE-Chirp (centred at 500 Hz) stimuli were presented to each ear at an intensity level of 120.5 dB peSPL. P1 latency, N1 latency, and P1-N1 amplitude values were analysed accordingly. The NB CE-Chirp stimulus produced significantly shorter P1 and N1 latencies (p 0.80). In contrast, both stimuli elicited cVEMP responses with P1-N1 amplitude values that were not statistically different from one another (p = 0.157, d = 0.15). Additionally, age and hearing level were found to be significantly correlated (r = 0.56, p
Establishing transducers-dependent sensorineural acuity level normative data among young Malaysian adults

Zakaria MN, Ensin EG, Awang MA, Salim R, Nik Othman NA, Rashid MFN

Med J Malaysia, 2023 Dec;78(7):901-906.
PMID: 38159926

INTRODUCTION: The sensorineural acuity level (SAL) test was developed as an alternative assessment to estimate bone conduction (BC) thresholds in cases where masking problems occur in pure tone audiometry (PTA). Nevertheless, prior to its clinical application, the respective SAL normative data must be made available. As such, the present study was carried out to establish SAL normative data using an insert earphone and two different commercially available bone transducers. Additionally, to determine the effect of earphone type on SAL test results, it was also of interest to compare the present study's findings with those of a previous study (that used a headphone to derive SAL normative data).
MATERIALS AND METHODS: In this repeated-measures study, 40 Malaysian adults (aged 19-26 years) with normal hearing bilaterally (based on PTA results) were enrolled. They then underwent the SAL test based on the recommended protocol by Jerger and Tillman (1960). The SAL normative data for each ear were obtained by calculating the differences between air conduction (AC) thresholds in quiet and AC thresholds in noise by means of insert earphone, B71 and B81 bone vibrators.
RESULTS: The SAL normative values were comparable between the ears (p > 0.05), and the data were pooled for subsequent analyses (n = 80 ears). Relative to B81 bone transducer, B71 bone vibrator produced statistically higher SAL normative data at all frequencies (p < 0.05). The SAL normative values established by the present study were statistically lower than those of the previous study (that utilised headphones) at most of frequencies tested (p < 0.05).
CONCLUSIONS: The SAL normative data produced by the two bone vibrators were significantly different. The SAL normative values were also affected by the type of earphone used. While conducting the SAL test on Malaysian patients, the information provided by this study can be useful to guide the respective clinicians in choosing the appropriate normative data.
The Narrowband CE-Chirp Stimulus Does Not Necessarily Produce More Robust Cervical Vestibular Evoked Myogenic Potential

Zakaria MN, Salim R, Anual MSI, Patuzzi R

Ear Hear, 2024 Feb 22.
PMID: 38383959 DOI: 10.1097/AUD.0000000000001497

OBJECTIVE: Various studies have been conducted to search for the most optimal stimulus for eliciting cervical vestibular evoked myogenic potential (cVEMP). More recently, there is a growing interest to study the usefulness of chirp stimuli in cVEMP recording. Nevertheless, contradictory outcomes have been reported across the studies, and further research with larger samples would be beneficial to provide better insight into this matter. As such, the present study was carried out to compare cVEMP results between narrowband (NB) CE-Chirp (centered at 500 Hz) and 500 Hz tone burst stimuli.
DESIGN: In this study that employed a comparative study design, 98 normally hearing adults aged between 19 and 24 years were enrolled. All of them underwent the cVEMP testing based on the recommended test protocol. The stimuli were a 500 Hz tone burst and a NB CE-Chirp (360-720 Hz) presented through insert earphones at an intensity level of 120.5 dB peSPL.
RESULTS: For each stimulus, cVEMP results did not differ significantly between the ears (p > 0.05). Relative to the 500 Hz tone burst, the NB CE-Chirp stimulus produced statistically shorter P1 and N1 latencies (p < 0.001). On the other hand, P1-N1 amplitude was found to be comparable between the two stimuli (p > 0.05).
CONCLUSIONS: The present study did not find any supporting evidence that the NB CE-Chirp stimulus (centered at 500 Hz) outperformed the conventional 500 Hz tone burst in the cVEMP testing. Both stimuli are considered equally appropriate to record cVEMP responses in clinical settings.
Fulltext A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Vong, K.S., Mohamad, I., Salim, R.

Malaysian Family Physician, 2018;13(1):34-36.
MyJurnal

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.
Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.
Usually, the patient will point at the level of FB on the neck to indicate the location.
Methods: Clinical report.
Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.
Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.
Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may
cause total dysphagia as the passage of food is completely blocked.
Fulltext A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Vong KS, Mohamad I, Salim R

Malays Fam Physician, 2018;13(1):34-36.
PMID: 29796208

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter. Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia. Usually, the patient will point at the level of FB on the neck to indicate the location.

Methods: Clinical report.

Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy. Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.

Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may cause total dysphagia as the passage of food is completely blocked.
Fulltext Diagnosis of Obstructive Sleep Apnea Using Feature Selection, Classification Methods, and Data Grouping Based Age, Sex, and Race

Sheta A, Thaher T, Surani SR, Turabieh H, Braik M, Too J, et al.

Diagnostics (Basel), 2023 Jul 20;13(14).
PMID: 37510161 DOI: 10.3390/diagnostics13142417

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that affects approximately 3-7% of males and 2-5% of females. In the United States alone, 50-70 million adults suffer from various sleep disorders. OSA is characterized by recurrent episodes of breathing cessation during sleep, thereby leading to adverse effects such as daytime sleepiness, cognitive impairment, and reduced concentration. It also contributes to an increased risk of cardiovascular conditions and adversely impacts patient overall quality of life. As a result, numerous researchers have focused on developing automated detection models to identify OSA and address these limitations effectively and accurately. This study explored the potential benefits of utilizing machine learning methods based on demographic information for diagnosing the OSA syndrome. We gathered a comprehensive dataset from the Torr Sleep Center in Corpus Christi, Texas, USA. The dataset comprises 31 features, including demographic characteristics such as race, age, sex, BMI, Epworth score, M. Friedman tongue position, snoring, and more. We devised a novel process encompassing pre-processing, data grouping, feature selection, and machine learning classification methods to achieve the research objectives. The classification methods employed in this study encompass decision tree (DT), naive Bayes (NB), k-nearest neighbor (kNN), support vector machine (SVM), linear discriminant analysis (LDA), logistic regression (LR), and subspace discriminant (Ensemble) classifiers. Through rigorous experimentation, the results indicated the superior performance of the optimized kNN and SVM classifiers for accurately classifying sleep apnea. Moreover, significant enhancements in model accuracy were observed when utilizing the selected demographic variables and employing data grouping techniques. For instance, the accuracy percentage demonstrated an approximate improvement of 4.5%, 5%, and 10% with the feature selection approach when applied to the grouped data of Caucasians, females, and individuals aged 50 or below, respectively. Furthermore, a comparison with prior studies confirmed that effective data grouping and proper feature selection yielded superior performance in OSA detection when combined with an appropriate classification method. Overall, the findings of this research highlight the importance of leveraging demographic information, employing proper feature selection techniques, and utilizing optimized classification models for accurate and efficient OSA diagnosis.
The global prevalence of vestibular dysfunction in children and adolescents: a systematic review and meta-analysis

Saniasiaya J, Islam MA, Salim R

Eur Arch Otorhinolaryngol, 2023 Jan 30.
PMID: 36715738 DOI: 10.1007/s00405-023-07842-z

BACKGROUND: Vestibular dysfunction has been extensively studied amongst the older population. Recently, conditions and management of vestibular dysfunction among children and adolescent has gained attention. Yet, a lack of awareness and expertise in managing children and adolescents with vestibular dysfunction has led to a delay in diagnosis as well as a trifling prevalence rate.
AIM: To conduct a systematic review and meta-analyses to estimate the overall pooled prevalence of vestibular dysfunction in children and adolescents.
METHODS: PubMed, Scopus, and Web of Science databases were searched to identify studies published until 29 April 2022. We used a random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test. The robustness of the pooled estimates was checked by different subgroups and sensitivity analyses.
RESULTS: We identified 1811 studies, of which 39 studies (n = 323,663) were included in the meta-analysis. Overall, the pooled prevalence of children and adolescents with VD was 30.4% [95% CI 28.5-32.3%]. The age of the participants ranged from 1 to 19 years. Participants of the included 39 studies were from 15 countries. Among the studies, 34 were cross-sectional, and five were case-control designed. There were discrepancies found in the studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations.
CONCLUSION: The prevalence of VD among children and adolescents was found to be 30.4% based on high-quality evidence. Due to the subjective assessment of most studies pooled in the analysis, the results should be interpreted cautiously until future comparative studies with objective assessments are carried out.
Characteristics and diagnostic approach of vestibular migraine in children and adolescents: A systematic review

Saniasiaya J, Salim R

Auris Nasus Larynx, 2023 Apr;50(2):218-227.
PMID: 35843849 DOI: 10.1016/j.anl.2022.06.007

OBJECTIVE: Vestibular migraine (VM) is the most common cause of episodic vertigo afflicts 1% of the general population. The complexity of VM is owing to the migrainous, and vestibular components and much knowledge have been gained in recent years on VM in the adult population. Akin to that, numerous studies focusing on VM in children and adolescent has emerged. We reviewed the literature to understand the characteristics and diagnostic approach of VM in children and adolescents.
METHODS: A literature search was conducted over a period of one month (April 2022).
RESULTS: 16 articles were selected based on our objective and selection criteria. A total of patients was included, with a median age of 10.9 years. 11 studies diagnosed VM based on diagnostic criteria. Caloric test and electro/videonystagmography are the most favoured investigation used (50%). Imaging was performed in 56.2% of included studies.
CONCLUSION: Deciphering the ideal diagnostic approach for VM is prudent to ensure children and adolescents suffering from VM are treated earlier. VM can be diagnosed using the established diagnostic criteria, which requires thorough and meticulous history taking. The available oto-neurological examination aims to exclude other disorders as its significance in diagnosing VM is still debatable.
Bilateral Vestibular Atelectasis with Tullio's Phenomenon

Roy S, Kumarasamy G, Salim R

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1599-1602.
PMID: 31750223 DOI: 10.1007/s12070-019-01685-z

Vestibular dehiscence or atelectasis is a rarity known to cause vertigo. This pathology poses many challenges especially in diagnosis and treatment simply due to the scarcity of reported cases. The etiologic factors, disease pathophysiology and complications remain unclear. We report a young adult female who presented with unsteadiness for 2 years associated with headache. Tullio's phenomenon was observed which led to a finding of bilateral vestibular dehiscence involving the medial walls on high resolution computed tomography.
Well-being and needs of Malay carers of people with mental illness in Singapore

Poon AWC, Abdul Wahab N, Salim R, Ow R

Health Soc Care Community, 2021 01;29(1):164-174.
PMID: 32619086 DOI: 10.1111/hsc.13079

Despite the importance of carers supporting the lives of people with mental illness, there are limited studies investigating the well-being and needs of Malay carers in multicultural Singapore. The Malays consist of 13.4% of Singapore's population. A mixed methods qualitative dominant research approach was used to explore the well-being and needs of Malay carers in a voluntary welfare organisation. The Kessler-10, Friendship Scale and Carers' and Users' Expectations of Services-Carer version were used to assess the needs and well-being of 17 Malay carers. Findings show that Malay carers experienced poor well-being and had numerous unmet needs. Four main themes were found: (a) Concerns related to relatives with mental illness, (b) Mental health practices related to carers, (c) Holistic support for carers and (d) Preference for greater spiritual support in mental health. Recovery-oriented mental health practice implications are discussed. Spirituality of Malay carers needs to be given greater consideration in recovery-oriented mental health services.
Unlocking sustainable supply chain performance through dynamic data analytics: a multiple mediation model of sustainable innovation and supply chain resilience

Piprani AZ, Khan SAR, Salim R, Khalilur Rahman M

Environ Sci Pollut Res Int, 2023 Aug;30(39):90615-90638.
PMID: 37460891 DOI: 10.1007/s11356-023-28507-8

This article provides a theoretical framework for comprehending the connections between dynamic data analytics capability (DDAC), innovation capabilities (IC), supply chain resilience (RES), and sustainable supply chain performance (SSCP). Since this is the first empirical investigation of the sequential mediation effect between DDAC and SSCP through IC and RES, it fills a critical need in the supply chain literature. A quantitative methodology was used, involving a survey questionnaire distributed to 259 large Pakistani manufacturing firms. We used PLS-SEM to test for the expected associations. Findings show that using DDAC has a beneficial effect on both innovative and resilient capabilities, which in turn leads to better SSCP. The research illuminates the sequential mediating roles of product, process, and resilience, underlining the need of combining data-driven innovation with resilience in order to achieve sustainable supply chain performance. These results provide useful guidance for businesses that want to boost their sustainability results by taking a more all-encompassing approach to data-driven innovation and resilience.
Fulltext Metallic hair pin aspiration into the left tertiary bronchus

Noh, K.B., Salim, R., Abdullah, M.S., Mohamad, I.

Malaysian Family Physician, 2018;13(2):36-38.
MyJurnal

Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.
Fulltext Metallic hair pin aspiration into the left tertiary bronchus

Noh KB, Salim R, Abdullah MS, Mohamad I

Malays Fam Physician, 2018;13(2):36-38.
PMID: 30302183

Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.
Fulltext Statistical Analysis of Metal Chelating Activity of Centella asiatica and Erythroxylum cuneatum Using Response Surface Methodology

Mohd Salim RJ, Adenan MI, Amid A, Jauri MH, Sued AS

Biotechnol Res Int, 2013;2013:137851.
PMID: 23533781 DOI: 10.1155/2013/137851

The purpose of the study is to evaluate the relationship between the extraction parameters and the metal chelating activity of Centella asiatica (CA) and Erythroxylum cuneatum (EC). The response surface methodology was used to optimize the extraction parameters of methanolic extract of CA and EC with respect to the metal chelating activity. For CA, Run 17 gave optimum chelating activity with IC50 = 0.93 mg/mL at an extraction temperature of 25°C, speed of agitation at 200 rpm, ratio of plant material to solvent at 1 g : 45 mL and extraction time at 1.5 hour. As for EC, Run 13 with 60°C, 200 rpm, 1 g : 35 mL and 1 hour had metal chelating activity at IC50 = 0.3817 mg/mL. Both optimized extracts were further partitioned using a solvent system to evaluate the fraction responsible for the chelating activity of the plants. The hexane fraction of CA showed potential activity with chelating activity at IC50 = 0.090 and the ethyl acetate fraction of EC had IC50 = 0.120 mg/mL. The study showed that the response surface methodology helped to reduce the extraction time, temperature and agitation and subsequently improve the chelating activity of the plants in comparison to the conventional method.
Cryptococcocis: a rare fungal infection of the tongue

Mohamad I, Abdullah B, Salim R, Rajet KA, Naik VR

Southeast Asian J. Trop. Med. Public Health, 2010 Sep;41(5):1188-91.
PMID: 21073040

Fungal infection in the oral cavity is not uncommon. The site involved is usually species related. Cryptococcus rarely infects the oral cavity. We report an elderly patient who presented with a central lesion on the dorsum of the tongue. Biopsy revealed a fungal infection. Special stains confirmed cryptococcus. Being a rare location for cryptococcal infection, clinical suspicion should be correlated with histopathological examination. Once confirmed, the patient should be treated with an antifungal medication.
Fulltext The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia - retrospective study and its implication

Mohamad I, Hassan S, Salim R

Malays J Med Sci, 2007 Jul;14(2):19-21.
PMID: 22993487 MyJurnal

Tonsillectomy is performed for several indications, the two commonest in practice are infective ( chronic tonsillitis ) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of specimens post-tonsillectomy. In this paper, a retrospective evaluation of 480 specimens from 241 patient who has undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 ( 96.25 % ) were reactive lymphoid hyperplasia and 18 ( 3.75 % ) were follicular hyperplasia. None of them were found malignant. The result of this study indicate that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.

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