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Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury

Zamli AH, Mustafah NM, Sa'at N, Shaharom S

Med J Malaysia, 2020 11;75(6):642-648.
PMID: 33219171

INTRODUCTION: Neurogenic bladder (NB) is a recognized secondary medical impairment following spinal cord injury (SCI). Ultrasound (US) of the kidneys, ureters and bladder (KUB) has been recommended as a useful, non-invasive surveillance method with good diagnostic sensitivity. This study aims to understand US diagnosed NB complications and identify its associated factors.
METHODS: We enrolled all patients referred for SCI rehabilitation from 2012 to 2015 that fulfilled our study criteria. Data that were retrospectively reviewed included demographic and clinical characteristic data; and US KUB surveillance studies.
RESULTS: Out of 136 electronic medical records reviewed, 110 fulfilled the study criteria. The prevalence of NB in our study population was 80.9%. We found 22(20%) of the patients showed evidence of US diagnosed NB complications with the mean detection of 9.61±7.91 months following initial SCI. The reported NB complications were specific morphological changes in the bladder wall 8(36.4%); followed by unilateral/bilateral hydronephrosis 7(31.8%); bladder and/or renal calculi 5(22.7%); and mixed complication 2(9.1%) respectively. Half of the patients with NB complications had urodynamic diagnosis of neurogenic detrusor overactivity with/without evidence of detrusor sphincter dyssynergia. We found co-existing neurogenic bowel, presence of spasticity and mode of bladder management were significantly associated factors with US diagnosed NB complications (p<0.05), while spasticity was its predictor with adjusted Odds Ratio value of 3.93 (1.14, 13.56).
CONCLUSION: NB is a common secondary medical impairment in our SCI population. A proportion of them had US diagnosed NB complications. Co-existing neurogenic bowel, presence of spasticity and mode of bladder management were its associated factors; while spasticity was its predictor.
Fulltext Retrospective review on effectiveness of high-amplitude penile vibratory stimulation for conservative sperm retrieval in anejaculatory men with spinal cord injury: an Asian case series

Zamli AH, Ismail NA, Ong KG

Spinal Cord Ser Cases, 2016;2:15038.
PMID: 28053740 DOI: 10.1038/scsandc.2015.38

High-amplitude penile vibratory stimulation (PVS) is recommended as the first line method for conservative sperm retrieval in anejaculatory Caucasian men with spinal cord injury (SCI). Evidence of its effectiveness in Asian population is lacking. We described the effectiveness of high amplitude PVS for conservative sperm retrieval in the anejaculatory local men with SCI. Records of all SCI patients referred for conservative sperm retrieval trial from August 2014 to August 2015 were screened. Those who failed in artificial stimulation methods for sperm retrieval including masturbation, prostatic massage and low amplitude PVS were subjected to high amplitude PVS using Viberect X3. Data pertaining to detailed neurological findings, time to ejaculate, seminal fluid volume and its gross appearance, somatic responses at ejaculation and any adverse events were retrieved. Successful outcome is defined as occurrence of antegrade ejaculation. Thirteen out of 16 patients fulfilled all study criteria. 46% of the patients had neurological level above T6 followed by 34% with neurological level between T7-T12. Preserved reflexogenic and spontaneous erection were reported by 84.6% and successful coitus was reported by 45.4% of the patients. The overall ejaculatory success using high amplitude, high-frequency vibratory stimulation in our study was 46.15%. Among the patients with lesion at T6 and above, the ejaculatory success rate was 66.7% while for the study subjects with lesions below T6 was 33.3%. In conclusion, PVS outcome for sperm retrieval in asian population is comparable to that of Caucasian population. Its use is highly applicable in local population.
Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study

Zamli AH, Ratnalingam K, Yusmido YA, Ong KG

Spinal Cord Ser Cases, 2017;3:16044.
PMID: 28503317 DOI: 10.1038/scsandc.2016.44

INTRODUCTION: This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury.
MATERIALS AND METHODS: The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded.
RESULTS: SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings.
DISCUSSION: The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.

Study site: Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia
Fulltext Staphylococcus aureus Orbital Abscess With Impending Compressive Optic Neuropathy in an Immunocompetent Individual With Subclinical Bacteriuria: A Case Report

Hasbi A, Shatriah I, A Rahim H, Zamli AH, Tai E

Cureus, 2023 Dec;15(12):e50693.
PMID: 38229775 DOI: 10.7759/cureus.50693

This is a case of an orbital abscess evidenced radiologically in a 41-year-old female with no comorbidities. She was healthy and had no history of trauma or infection of the adjacent structures. She denied having symptoms of upper or lower respiratory and urinary tract infections. The decision for surgical drainage was made following a slow response to antimicrobial agents after 24 hours, a progressive painful erythematous eyelid swelling, and further deterioration of vision. Her clinical condition and visual acuity improved following cutaneous incision and drainage. Culture and sensitivity results for urine and orbital abscess were positive for Staphylococcus (S.) aureus. The patient regained full visual recovery without any sequelae. In conclusion, an orbital abscess is a blinding and life-threatening condition that rarely occurs in immunocompetent individuals and uncommonly arises from distant sources. A high index of suspicion, early institution of appropriate diagnostic imaging, and aggressive medical and surgical treatment are necessary for a favorable visual outcome in orbital abscess cases.
Fulltext Evaluation of Dry Eye Parameters Among Electronic Cigarette Smokers

Chew RP, Kwan Joo Ern K, Muhammed J, Zamli AH

Cureus, 2024 Jun;16(6):e62148.
PMID: 38993422 DOI: 10.7759/cureus.62148

Introduction The emergence of electronic cigarettes as the "healthier" version of smoking has been popular, especially among young adults. However, knowledge about the potential effects of e-cigarettes on ocular structures is scarce. Objective To compare the mean change in dry eye parameters between e-cigarette smokers and non-smokers and to correlate between dry eye parameters with device power output. Methodology A cross-sectional, single-visit study was conducted involving 85 e-cigarette smokers and 85 non-smokers. All participants were evaluated on dry eye parameters, including the Ocular Surface Disease Index (OSDI) score, tear meniscus height (TMH), tear break-up time (TBUT), cornea fluorescein staining, and Schirmer's I test. The mean change in dry eye parameters was compared between e-cigarette smokers and non-smokers. The correlation between dry eye parameters with device power output was analyzed. Results Specifically, 32.94% of e-cigarette smokers were found to have a TMH <0.2 mm, compared to only 5.88% of non-smokers (p<0.001). A significant change in mean TBUT was found between the e-cigarette smokers (10.41+2.65 seconds) and non-smokers (12.66+3.14 seconds, p<0.001). The lower mean Schirmer's I test was found among e-cigarette smokers (12.75+7.24 mm, p<0.001). No significant change in the median OSDI score and corneal fluorescein staining. The OSDI score and device power output were found to have a significant positive correlation (p=0.003). There was a significant association between dry eye signs and device power output, including TMH (p=0.047), TBUT (p=0.002), Schirmer's I test (p<0.001), and corneal fluorescein staining (p<0.001). Conclusion Electronic cigarette smokers are prone to develop dry eyes. Concern should be raised on the risk of electronic cigarette use on ocular health, and regulation on e-cigarette ban should be revisited.
Post-COVID-19 Condition Characterization: Insights From a Cross-Sectional Study in a Malaysian Rehabilitation Center

Zamli AH, Misnan NA, Lim SY, Zohdi WNWM, Baharum N, Andiappan K

Asia Pac J Public Health, 2023 Nov;35(8):516-523.
PMID: 37798930 DOI: 10.1177/10105395231203118

Although post-COVID-19 condition (PCC) is a major public health concern, studies on PCC in Southeast Asia are lacking. This study aimed to describe PCC symptoms and its functional impact among COVID-19 survivors undergoing outpatient rehabilitation in Malaysia. We evaluated 3037 patients with confirmed COVID-19, referred between November 2020 and September 2022, 3 to 6 months after infection. PCC was diagnosed in 71.1%. Fatigue and dyspnea were the most common symptoms. The PCC patients had reduced respiratory, ambulatory, and musculoskeletal function, and higher fatigue and pain scores, and were less likely to return to work (odds ratio [OR] = 0.55) compared with non-PCC patients. Recognition of PCC symptoms and its functional impact can guide early, tailored, rehabilitation interventions.