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Intracranial haemorrhage and child abuse

Cheah IG, Kasim MS, Shafie HM, Khoo TH

Ann Trop Paediatr, 1994;14(4):325-8.
PMID: 7880096

Intracranial haemorrhage is a major cause of severe morbidity and mortality in child abuse cases in developed countries. However, similar data are not available in most developing countries. This study therefore aimed to determine the incidence of intracranial haemorrhage amongst all cases of child physical abuse, the nature of the injuries incurred, and the morbidity and mortality resulting therefrom. Among 369 cases of physical abuse seen over a 4-year period, 41 (11.4%) had intracranial haemorrhage, of whom 37 (90%) were 2 years old or less. A history of trauma was present in only eight (20%), of which only two were compatible with the injuries incurred. Subdural haemorrhages accounted for 80% of the cases, with skull fractures present in only nine cases. Fifty-four per cent of the 37 children aged 2 years of age or less had no external signs of trauma, but 11 of them had retinal haemorrhages. This is in contrast to the children older than 2 years of age who all had external signs of trauma. The overall prognosis was dismal with an early mortality of almost 30% (13 cases) and at least seven cases with severe neurological sequelae. These findings are comparable with studies from developed countries which have established that non-accidental injury must be considered as a cause of intracranial haemorrhage in any young child, despite the absence of external signs of trauma.
Periventricular haemorrhage in very low birth weight Malaysian neonates

Boo NY, Ong LC, Lye MS, Wong KP, Mastura M

J Trop Pediatr, 1993 Aug;39(4):224-9.
PMID: 8411316

A prospective study was carried out to determine the incidence, clinical presentation, early outcome, and risk factors associated with periventricular haemorrhage (PVH) in 88 (84 per cent) of the 105 consecutive very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound findings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 per cent confidence intervals: 95 to 101). Seventeen (20 per cent) of them had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grade III and 10 (12 per cent) had grade IV PVH. PVH was detected in all the affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0.01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.019) were significantly more common in the neonates with severe PVH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per cent confidence interval: 39-61 per cent) of the neonates with PVH before their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common problem in the Malaysian VLBW neonates. To reduce the incidence and severity of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help.
Development of animal disease data bank in Malaysia

Jamaluddin AA, Chang KW, Johar MS, Yaacob H

Acta Vet Scand Suppl, 1988;84:194-6.
PMID: 3232606
Brachial plexus injuries in Malaysian neonates: incidence and associated risk factors

Boo NY, Lye MS, Kanchanamala M, Ching CL

J Trop Pediatr, 1991 12;37(6):327-30.
PMID: 1791654 DOI: 10.1093/tropej/37.6.327

A prospective study was carried out on 26,176 Malaysian neonates born in the Maternity Hospital, Kuala Lumpur over a 12-month period to determine the incidence and associated risk factors of brachial plexus injuries. This condition was found in 42/26,176 neonates (1.6 per 1000 livebirths). Multiple logistic regression analysis of affected and control neonates from a nested case-control study showed that increasing birth weights and breech deliveries were the significant risk factors. Our study suggests that to reduce the occurrence of this condition, there is a need for: (i) better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and (ii) review of the indications and techniques of breech delivery.
Fulltext Hereditary ovalocytosis in Malays

George E, Mohandas N, Duraisamy G, Adeeb N, Zainuddin ZA, Teng MS, et al.

Med J Malaysia, 1988 Dec;43(4):327-31.
PMID: 3241598
Fulltext Suprahyoid pharyngotomy for base of tongue carcinoma

Gopalan KN, Primuharsa Putra SHA, Kenali MS

Med J Malaysia, 2003 Oct;58(4):617-20.
PMID: 15190642

Carcinoma of the tongue remain one of the greatest management challenges for the head and neck surgeon because of the adverse effects of treatment on oral and pharyngeal function. In early carcinoma of the base of tongue however, the prognosis is encouraging and function of swallowing and speech is preserved despite surgery. Suprahyoid pharyngotomy is one of the surgical approaches advocated for resection of base of tongue tumours with primary anastomosis.
Observations of Breinlia booliati in a new host, Rattus rattus jalorensis, from Kuantan, state of Pahang, Malaysia

Tucker MS, Price DL, Kwa BH, DeBaldo AC

J Parasitol, 2003 Dec;89(6):1220-6.
PMID: 14740913

Breinlia booliati Singh and Ho, 1973 is described from the Malaysian wood rat, Rattus rattus jalorensis Bonhote. The parasites presented here were originally discovered in 1955 in Kuantan, Malaysia, but were not classified until now. On the basis of morphological observations of anatomical structures and comparisons with other species of Breinlia, it was determined that the parasites were B. booliati. The parasites discussed here show slight deviation from B. booliati, but they do not warrant a new species classification. There is some variation in anatomical measurements, the number of male caudal papillae, and the morphology of the microfilariae. Breinlia booliati from a new host is described in this article, with a brief discussion on Rattus species that are hosts of B. booliati and vectors that transmit the parasite. The occurrence of B. booliati in R. r. jalorensis represents the first report of the parasite in this host.
Fulltext Unusual Posterior Epidural Migration of Intervertebral Herniated Disc: A Report of Two Cases

Tamburrelli FC, Perna A, Oliva MS, Giannelli I, Genitiempo M

Malays Orthop J, 2018 Nov;12(3):47-49.
PMID: 30555647 DOI: 10.5704/MOJ.1811.012

Disc herniation is one of most common causes of spine surgery. Because of the presence of posterior longitudinal ligaments, disc fragments often migrate into the ventral epidural space. A posterior epidural herniation of a disc fragment is a rare occurrence. We report two cases of posterior migrated disc fragments, with, radiological and clinical findings. Because of the rarity of a posterior migration of the intervertebral disc fragments, a differential diagnosis can be challenging. This painful syndrome associated with neurological lower limb deficits can be confused initially, with other posterior epidural space-occupying lesions such as tumours, abscess or hematomas. A gadolinium-enhanced MRI scan is the gold standard for a correct diagnosis. Early surgical decompression of the spine with a posterior approach remains the optimal technique in ensuring the best possible outcome for the patient.
Stature estimation in the South-East Asian population: A systematic review

Ismail NA, Abu Bakar SN, Abdullah N, Shafie MS, Mohd Nor F

Malays J Pathol, 2019 Aug;41(2):83-89.
PMID: 31427544

INTRODUCTION: Stature estimation is population dependent, and population-specific regression equations should be generated for accurate anthropological assessments. Nevertheless, stature estimation data was inaccessible and limited in some of the South-East Asian countries. The systematic review was conducted to analyse the regression equations of stature estimations developed in South-East Asian region.
MATERIALS AND METHODS: A systematic literature search was performed through SCOPUS database and Google Scholar from January till March 2018. All published articles which developed stature estimation from different types of bone, methods and type of statures (i.e. living stature, forensic stature and cadaveric stature) were included in this study. Risks of biases were also assessed. Population studies with no regression equations were excluded from the study.
RESULTS: Seven studies that met the inclusion criteria were identified. In the South-East Asia region, regression equations for stature estimation were developed in Thailand and Malaysia. In these studies, bone measurements were done either by radiography, direct bone measurement, or palpation on body surface for anatomical bony prominence. All of these studies used various parts of bones for stature estimation.
CONCLUSION: The most widely used regression equations for stature estimation in South-East Asian population were from the Thailand population. Further research is recommended to develop regression equations for other South-East Asian countries.
Fulltext Pleuritic chest pain and fever: An unusual presentation of aortic dissection

Mohamed-Yassin MS, Baharudin N, Ramli AS, Hashim H

Malays Fam Physician, 2019;14(1):47-52.
PMID: 31289633

It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not always present. This case describes an atypical presentation of aortic dissection, in which the patient walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein. Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for aortic dissection in the absence of classic features. The case is discussed with reference to the literature on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this frequently lethal condition.
Non-syndromic craniosynostosis treated by frontal orbital advancement: A case report

Khoo KW, Arman Zaharil MS, Mohd Ali MZ

Med J Malaysia, 2018 12;73(6):423-424.
PMID: 30647221

Craniosynostosis is a premature pathologic fusion of one or more cranial vault sutures leading to abnormally-shaped skull. It can occur in isolated event (non-syndromic), or it can occur in conjunction with other anomalies in welldefined patterns (syndromic). The diagnosis rests on clinical examination and confirmation is generally on the computed tomography scan. The need for surgery is both for cosmetic and functional reasons. Here we describe a case of nonsyndromic craniosynostosis that was treated with frontal orbital advancement (FOA). The potential benefits of FOA need to be carefully weighed against the potential complications when deciding for any surgical intervention.
Investigation of the antibacterial activity of Ag-NPs conjugated with a specific antibody against Staphylococcus aureus after photoactivation

Al-Sharqi A, Apun K, Vincent M, Kanakaraju D, Bilung LM, Sum MSH

J Appl Microbiol, 2020 Jan;128(1):102-115.
PMID: 31596989 DOI: 10.1111/jam.14471

AIM: This work reports a new method for the use of lasers for the selective killing of bacteria targeted using light-absorbing Silver nanoparticles (Ag-NPs) conjugated with a specific antibody against the Gram-positive bacterium Staphylococcus aureus (S. aureus).
METHODS AND RESULTS: Ag-NPs were synthesized using a chemical reduction method and characterized with respect to their surface plasmon resonance, surface morphology via transmission electron microscopy (TEM) and dynamic light scattering (DLS). The bacterial surface was targeted using 20 nm Ag-NPs conjugated with an anti-protein A antibody. Labelled bacteria were irradiated with blue visible laser at 2·04 W/cm2 . The antibacterial activity of functionalized Ag-NPs was investigated by fluorescence microscopy after irradiation, and morphological changes in S. aureus after laser treatment were assessed using scanning electron microscopy (SEM). The laser-irradiated, functionalized Ag-NPs exhibited significant bactericidal activity, and laser-induced bacterial damage was observed after 10 min of laser irradiation against S. aureus. The fluorescence microscopic analysis results supported that bacterial cell death occurred in the presence of the functionalized Ag-NPs.
CONCLUSIONS: The results of this study suggest that a novel method for the preparation of functionalized nanoparticles has potential as a potent antibacterial agent for the selective killing of resistant disease-causing bacteria.
SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that Ag-NPs functionalized with a specific antibody, could be used in combination with laser radiation as a novel treatment to target resistant bacterial and fungal pathogens with minimal impact on normal microflora.
Analysis of Changes in Oil Palm Canopy Architecture From Basal Stem Rot Using Terrestrial Laser Scanner

Azuan NH, Khairunniza-Bejo S, Abdullah AF, Kassim MSM, Ahmad D

Plant Dis, 2019 Dec;103(12):3218-3225.
PMID: 31596688 DOI: 10.1094/PDIS-10-18-1721-RE

Basal stem rot (BSR), caused by the Ganoderma fungus, is an infectious disease that affects oil palm (Elaeis guineensis) plantations. BSR leads to a significant economic loss and reductions in yields of up to Malaysian Ringgit (RM) 1.5 billion (US$400 million) yearly. By 2020, the disease may affect ∼1.7 million tonnes of fresh fruit bunches. The plants appear symptomless in the early stages of infection, although most plants die after they are infected. Thus, early, accurate, and nondestructive disease detection is crucial to control the impact of the disease on yields. Terrestrial laser scanning (TLS) is an active remote-sensing, noncontact, cost-effective, precise, and user-friendly method. Through high-resolution scanning of a tree's dimension and morphology, TLS offers an accurate indicator for health and development. This study proposes an efficient image processing technique using point clouds obtained from TLS ground input data. A total of 40 samples (10 samples for each severity level) of oil palm trees were collected from 9-year-old trees using a ground-based laser scanner. Each tree was scanned four times at a distance of 1.5 m. The recorded laser scans were synched and merged to create a cluster of point clouds. An overhead two-dimensional image of the oil palm tree canopy was used to analyze three canopy architectures in terms of the number of pixels inside the crown (crown pixel), the degree of angle between fronds (frond angle), and the number of fronds (frond number). The results show that the crown pixel, frond angle, and frond number are significantly related and that the BSR severity levels are highly correlated (R2 = 0.76, P < 0.0001; R2 = 0.96, P < 0.0001; and R2 = 0.97, P < 0.0001, respectively). Analysis of variance followed post hoc tests by Student-Newman-Keuls (Newman-Keuls) and Dunnett for frond number presented the best results and showed that all levels were significantly different at a 5% significance level. Therefore, the earliest stage that a Ganoderma infection could be detected was mildly infected (T1). For frond angle, all post hoc tests showed consistent results, and all levels were significantly separated except for T0 and T1. By using the crown pixel parameter, healthy trees (T0) were separated from unhealthy trees (moderate infection [T2] and severe infection [T3]), although there was still some overlap with T1. Thus, Ganoderma infection could be detected as early as the T2 level by using the crown pixel and the frond angle parameters. It is hard to differentiate between T0 and T1, because during mild infection, the symptoms are highly similar. Meanwhile, T2 and T3 were placed in the same group, because they showed the same trend. This study demonstrates that the TLS is useful for detecting low-level infection as early as T1 (mild severity). TLS proved beneficial in managing oil palm plantation disease.
Ultralow volume application of Bacillus thuringiensis ssp. israelensis for the control of mosquitoes

Lee HL, Gregorio ER, Khadri MS, Seleena P

J Am Mosq Control Assoc, 1996 Dec;12(4):651-5.
PMID: 9046471

Evaluation of the effectiveness of Bacillus thuringiensis ssp. israelensis (B.t.i.) against mosquito larvae dispersed by ultralow volume (ULV) spraying was conducted in simulated field trials. Effectiveness was measured using 3 different indicators: larval mortality, colony-forming unit enumeration, and droplet analysis. B.t.i. was dispersed with a ULV generator using 2 different flow rates: 0.3 and 0.5 liter/min on 2 different days. Based on the results of this study, it can be concluded that an output of 0.3 liter/min is effective for controlling Aedes aegypti. although a dosage of 0.5 liter/min can be used when high residual activity is desired. For Culex quinquefasciatus control, both dosages were effective but with low residual activity. For Anopheles maculatus control, only a discharge rate of 0.5 liter/min was effective with low residual activity. B.t.i. application at both dosages penetrated tires well, indicating that B.t.i. ULV application is an effective method for controlling container-inhabiting mosquitoes. Good coverage of target area and penetration were attributed to satisfactory droplet profiles.
Idiopathic ileal volvulus with multiple concomitant infections in a starving man

Tan LJ, Othman MS, Hiu J, Wong KT, Lai SK

Malays J Pathol, 2021 Apr;43(1):81-85.
PMID: 33903310

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.
CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.
CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.
Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation - a narrative review

Plotino G, Abella Sans F, Duggal MS, Grande NM, Krastl G, Nagendrababu V, et al.

Int Endod J, 2020 Dec;53(12):1636-1652.
PMID: 32869292 DOI: 10.1111/iej.13396

Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day-by-day clinical practice; however, the re-emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation.
Pathological changes in the respiratory tract of goats infected by Pasteurella multocida B:2

Shafarin MS, Zamri-Saad M, Khairani BS, Saharee AA

J Comp Pathol, 2009 Feb-Apr;140(2-3):194-7.
PMID: 19110260 DOI: 10.1016/j.jcpa.2008.10.005

Clinical and pathological changes are described in groups of five goats pretreated with dexamethasone and then infected with a large dose of Pasteurella multocida B:2 (the cause of haemorrhagic septicaemia) by the intratracheal, subcutaneous or intranasal route (groups A, B and C, respectively). In group A, two goats died (on day 1 and 4 post-inoculation); in group B three died (days 2, 5 and 14); and in group C one died (day 20). The infecting organism was recovered from the four goats that died within < or =5 days. The major pulmonary lesions included acute pneumonia, congestion, oedema and hydrothorax. Subcutaneous oedema of the lower jaw and brisket, typically seen in cattle and buffalo, was absent in goats.
Fulltext Radiological hazard associated with amang processing industry in Peninsular Malaysia and its environmental impacts

Sanusi MSM, Ramli AT, Hashim S, Lee MH

Ecotoxicol Environ Saf, 2021 Jan 15;208:111727.
PMID: 33396058 DOI: 10.1016/j.ecoenv.2020.111727

Continuous depletion in tin productions has led to a newly emerging industry that is a tin by-product (amang) processing industry to harness mega tons of tin by-products produced in the past. Amang composed of profitable multi-heavy minerals and rare-earth elements. With poorly established safety and health practices in operating plant, amang poses extremely high radioactivity problem associated with high occupational ionizing radiation exposures to workers and continuously impacting the local environment with radioactive contamination from industrial effluent and solid waste into lithosphere and water bodies. The radioactivity level of 238U and 232Th series in the mineral varies from few hundreds up to ~200,000 and ~400,000 Bq kg-1 respectively and are potential to yield more than ~ 30,000 nGy h-1 of gamma (γ) radiation exposure to plant workers. The study found out that for 8 h of work time, a worker is estimated to receive an average effective dose of 0.1 mSv per day from external γ radiation source with a maximum up to 2 mSv per day for extreme exposure situation. Interferences of different exposure routes for examples inhalation of equivalent equilibrium concentration (ECC) of 222Rn and 220Rn progenies and airborne long-lived α particles from the dusty working environment could pose a higher total effective dose as much as 5 mSv per day and 115 mSv per year. The value is 5 times higher than the annual dose limit for designated radiation worker (20 mSv) in Peninsular Malaysia. The study found that 41% of the total received an effective dose received by a worker is contributed by 222Rn, 32% of airborne particulates and dust, 23% from external γ exposure and 4% from 220Rn. Based on radioecological risk assessment, the study found out that the aquatic environment is the highly exposed group to ionizing radiation from industrial effluent discharge and sand residues. With the impotent establishment of radiation protection in the industry, plus the country newly introduced long-term plan to revive tin mining as well as its accessory amang mineral, it is necessary for the government to harmonize current regulation to improve the worker safety and health as well as sustaining local environment.
Growth outcomes in Hirschsprung disease patients following pull-through

Gunadi, Juwitasari T, Damayanti NNR, Kaniashari DS, Kencana SMS, Hastuti J

Med J Malaysia, 2020 05;75(Suppl 1):28-31.
PMID: 32483104

INTRODUCTION: Despite various definitive methods that are used for treating Hirschsprung's disease (HSCR), there are few studies comparing the effect of different pull-through methods on the growth outcomes of patients. We aimed to compare the effect of three different pull-through methods, namely Duhamel, Soave and transanal endorectal pullthrough (TEPT), on HSCR growth outcomes of patients.
METHODS: Medical records of all HSCR patients who underwent pull-through at the Dr. Sardjito Hospital, Indonesia between January 2010 and August 2016 were reviewed for their growth outcomes before and after the surgery.
RESULTS: We included 64 HSCR patients, 45 males and 19 females, of which 14, 17, and 33 patients underwent Duhamel, Soave, and TEPT respectively. There were no nutritional status differences in HSCR patients after Duhamel, Soave, and TEPT surgery (p=0.07, 0.17, and 0.79, respectively). Z-score average of weight-for-age did not differ between three surgical methods (p=0.77 and 0.15 for preoperative and postoperative, respectively). In addition, the improvement of nutritional status was achieved in 21.2% HSCR patients after TEPT, 14.3% post Duhamel and 5.9% following Soave procedure, but these differences did not reach a significant level (p=0.34).
DISCUSSION: Our study shows no difference in effect on the growth outcomes in HSCR patients following Duhamel, Soave and TEPT procedure. Further study with a larger sample size is important to give valuable long-term growth outcomes for HSCR patients after pull-through.
Fulltext Discrete-time predator-prey model with flip bifurcation and chaos control

Khan AQ, Ahmad I, Alayachi HS, M Noorani MS, Khaliq A

Math Biosci Eng, 2020 09 09;17(5):5944-5960.
PMID: 33120584 DOI: 10.3934/mbe.2020317

We explore the local dynamics, flip bifurcation, chaos control and existence of periodic point of the predator-prey model with Allee effect on the prey population in the interior of $\mathbb{R}^*{_+^2}$. Nu-merical simulations not only exhibit our results with the theoretical analysis but also show the complex dynamical behaviors, such as the period-2, 8, 11, 17, 20 and 22 orbits. Further, maximum Lyapunov exponents as well as fractal dimensions are also computed numerically to show the presence of chaotic behavior in the model under consideration.

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