MyMedR

MRI of optic tract lesions: review and correlation with visual field defects

Fadzli F, Ramli N, Ramli NM

Clin Radiol, 2013 Oct;68(10):e538-51.

PMID: 23932674 DOI: 10.1016/j.crad.2013.05.104

Visual field defects are a conglomerate of patterns of visual impairment derived from diseases affecting the optic nerve as it extends from the globe to the visual cortex. They are complex signs requiring perimetry or visual confrontation for delineation and are associated with diverse aetiologies. This review considers the chiasmatic and post-chiasmatic causes of visual disturbances, with an emphasis on magnetic resonance imaging (MRI) techniques. Newer MRI sequences are considered, such as diffusion-tensor imaging. MRI images are correlated with perimetric findings in order to demonstrate localization of lesions in the visual pathway. This may serve as a valuable reference tool to clinicians and radiologists in the early diagnostic process of differentiating causes of various visual field defects in daily practice.

Fulltext Outbreak of human infection with Sarcocystis nesbitti, Malaysia, 2012

Abubakar S, Teoh BT, Sam SS, Chang LY, Johari J, Hooi PS, et al.

Emerg Infect Dis, 2013 Dec;19(12):1989-91.

PMID: 24274071 DOI: 10.3201/eid1912.120530

An outbreak of fever associated with myalgia and myositis occurred in 2012 among 89 of 92 college students and teachers who visited Pangkor Island, Malaysia. The Sarcocystis nesbitti 18S rRNA gene and sarcocysts were obtained from muscle tissues of 2 students. Our findings indicate emergence of S. nesbitti infections in humans in Malaysia.

Fulltext Pathogenicity of a microsporidium isolate from the diamondback moth against Noctuid moths: characterization and implications for microbiological pest management

Ghani IA, Dieng H, Abu Hassan ZA, Ramli N, Kermani N, Satho T, et al.

PLoS One, 2013;8(12):e81642.

PMID: 24349104 DOI: 10.1371/journal.pone.0081642

Due to problems with chemical control, there is increasing interest in the use of microsporidia for control of lepidopteran pests. However, there have been few studies to evaluate the susceptibility of exotic species to microsporidia from indigenous Lepidoptera.

Low nocturnal ocular perfusion pressure as a risk factor for normal tension glaucoma

Ramli N, Nurull BS, Hairi NN, Mimiwati Z

Prev Med, 2013;57 Suppl:S47-9.

PMID: 23352960 DOI: 10.1016/j.ypmed.2013.01.007

In the absence of raised intraocular pressure (IOP), haemodynamic parameters have been implicated in the development of normal tension glaucoma (NTG). The purpose of this study is to compare 24-hour IOP and haemodynamic parameters in NTG patients and non-glaucoma patients.

Darkroom prone provocative test in primary angle closure glaucoma relatives

Zahari M, Ong YM, Taharin R, Ramli N

Optom Vis Sci, 2014 Apr;91(4):459-63.

PMID: 24637481 DOI: 10.1097/OPX.0000000000000220

To evaluate ocular biometric parameters and darkroom prone provocative test (DPPT) in family members of primary angle closure (PAC) glaucoma (PACG) patients and to establish any correlation between these biometric parameters and the DPPT response.

Fulltext Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012

Italiano CM, Wong KT, AbuBakar S, Lau YL, Ramli N, Syed Omar SF, et al.

PLoS Negl Trop Dis, 2014 May;8(5):e2876.

PMID: 24854350 DOI: 10.1371/journal.pntd.0002876

From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak.

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Ramli NM, Sidek S, Rahman FA, Peyman M, Zahari M, Rahmat K, et al.

Graefes Arch Clin Exp Ophthalmol, 2014 Jun;252(6):995-1000.

PMID: 24770532 DOI: 10.1007/s00417-014-2622-6

PURPOSE: To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

METHODS: In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp-Anderson-Parish classification. Pearson's correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

RESULTS: Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70 ± 46.28 mm(3); 167.40 ± 45.36 mm(3)) than in the mild glaucoma group (264.03 ± 78.53 mm(3); 264.76 ± 78.88 mm(3)) and the control group (297.80 ± 71.45 mm(3); 296.56 ± 71.02 mm(3)). Moderate correlation was observed between: RNFL thickness and ON volume (r = 0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r = 0.60, p

Glaucoma severity affects diffusion tensor imaging (DTI) parameters of the optic nerve and optic radiation

Sidek S, Ramli N, Rahmat K, Ramli NM, Abdulrahman F, Tan LK

Eur J Radiol, 2014 Aug;83(8):1437-41.

PMID: 24908588 DOI: 10.1016/j.ejrad.2014.05.014

To evaluate whether MR diffusion tensor imaging (DTI) of the optic nerve and optic radiation in glaucoma patients provides parameters to discriminate between mild and severe glaucoma and to determine whether DTI derived indices correlate with retinal nerve fibre layer (RNFL) thickness.

Fulltext Antimalarial activity of Malaysian Plectranthus amboinicus against Plasmodium berghei

Ramli N, Ahamed PO, Elhady HM, Taher M

Pharmacognosy Res, 2014 Oct;6(4):280-4.

PMID: 25276063 DOI: 10.4103/0974-8490.138248

Malaria is a mosquito-borne disease caused by parasitic protozoa from the genus of Plasmodium. The protozoans have developed resistance against many of current drugs. It is urgent to find an alternative source of new antimalarial agent. In the effort to discover new antimalarial agents, this research has been conducted on Plectranthus amboinicus.

Fulltext Reinforcement learning for routing in cognitive radio ad hoc networks

Al-Rawi HA, Yau KL, Mohamad H, Ramli N, Hashim W

ScientificWorldJournal, 2014;2014:960584.

PMID: 25140350 DOI: 10.1155/2014/960584

Cognitive radio (CR) enables unlicensed users (or secondary users, SUs) to sense for and exploit underutilized licensed spectrum owned by the licensed users (or primary users, PUs). Reinforcement learning (RL) is an artificial intelligence approach that enables a node to observe, learn, and make appropriate decisions on action selection in order to maximize network performance. Routing enables a source node to search for a least-cost route to its destination node. While there have been increasing efforts to enhance the traditional RL approach for routing in wireless networks, this research area remains largely unexplored in the domain of routing in CR networks. This paper applies RL in routing and investigates the effects of various features of RL (i.e., reward function, exploitation, and exploration, as well as learning rate) through simulation. New approaches and recommendations are proposed to enhance the features in order to improve the network performance brought about by RL to routing. Simulation results show that the RL parameters of the reward function, exploitation, and exploration, as well as learning rate, must be well regulated, and the new approaches proposed in this paper improves SUs' network performance without significantly jeopardizing PUs' network performance, specifically SUs' interference to PUs.

Fulltext A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections

Van Rostenberghe H, Short J, Ramli N, Geok TB, Subramaniam S, Che Yaakob CA, et al.

Front Pediatr, 2014;2:115.

PMID: 25478550 DOI: 10.3389/fped.2014.00115

Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).

Basaloid squamous cell carcinoma of the sinonasal tract with metastasis to the liver: a case report and literature review

Toe BP, Ramli N, Lam SY, Wong KT, Prepageran N

Ear Nose Throat J, 2015 Feb;94(2):E27-32.

PMID: 25651356

Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma. To date, only 95 cases of sinonasal BSCC have been reported in the English-language literature, and they account for 5% of all cases of head and neck BSCC. We describe what we believe is only the second reported case of a sinonasal tract BSCC that metastasized to the liver. The patient was a 36-year-old woman who presented with right-sided nasal obstruction and a foul-smelling discharge. Clinical examination and imaging identified a large, lobulated, enhancing mass in the right nasal cavity. Following excision of the mass, the patient was scheduled for radiotherapy. However, before it could be administered, follow-up imaging detected a metastasis to the liver and lung, and the patient was switched to chemotherapy. Initially, she responded well clinically, but at 5 months postoperatively, a follow-up CT showed an increasing metastatic presence in the liver and bone. The patient died of her disease 1 year after surgery.

Fulltext Usage of traditional and complementary medicine (T & CM): Prevalence, practice and perception among post stroke patients attending conventional stroke rehabilitation in a teaching hospital in Malaysia

Ali MF, Abdul Aziz AF, Rashid MR, Che Man Z, Amir AA, Lim YS, et al.

Med J Malaysia, 2015 Feb;70(1):18-23.

PMID: 26032524

INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital.
METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data.
RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%).
CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.
Study site: Medical Rehabilitation Services Department, Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Melkersson-Rosenthal syndrome with involvement of masticatory muscles

Kuok SS, Ramli N, Tan CT, Goh KJ

Clin Neurol Neurosurg, 2015 Mar;130:8-10.

PMID: 25562719 DOI: 10.1016/j.clineuro.2014.12.003

Fulltext Avoid haste in defining human muscular sarcocystosis

Italiano CM, Wong KT, AbuBakar S, Lau YL, Ramli N, Syed Omar SF, et al.

Clin Infect Dis, 2015 Apr 1;60(7):1134.

PMID: 25537869 DOI: 10.1093/cid/ciu1163

Differentiating multiple-system atrophy from Parkinson's disease

Ramli N, Nair SR, Ramli NM, Lim SY

Clin Radiol, 2015 May;70(5):555-64.

PMID: 25752581 DOI: 10.1016/j.crad.2015.01.005

The purpose of this review is to illustrate the differentiating features of multiple-system atrophy from Parkinson's disease at MRI. The various MRI sequences helpful in the differentiation will be discussed, including newer methods, such as diffusion tensor imaging, MR spectroscopy, and nuclear imaging.

Ocular Surface Disease in Glaucoma: Effect of Polypharmacy and Preservatives

Ramli N, Supramaniam G, Samsudin A, Juana A, Zahari M, Choo MM

Optom Vis Sci, 2015 Sep;92(9):e222-6.

PMID: 25730335 DOI: 10.1097/OPX.0000000000000542

PURPOSE: To evaluate the prevalence of ocular surface disease (OSD) in glaucoma and nonglaucoma subjects using different clinical tests and to determine the effect of number of antiglaucoma medications and preservatives on OSD.
METHODS: This is a cross-sectional, case-comparison study at the Eye Clinic of the University of Malaya Medical Centre, Malaysia, between June 2012 and January 2013. Glaucoma subjects (n = 105) using topical antiglaucoma medications were compared with control subjects (n = 102) who were not on any topical medications. The presence of OSD was assessed using the tear film breakup time (TBUT) test, corneal staining, Schirmer test, and Ocular Surface Disease Index (OSDI) questionnaire grading.
RESULTS: The prevalence of OSD varied from 37 to 91% in the glaucoma group, depending on the type of clinical test. More subjects in the glaucoma group had corneal staining (63% vs. 36%, p = 0.004), abnormal Schirmer tests (39% vs. 25%, p = 0.049), and moderate OSDI symptoms (17% vs. 7%, p = 0.028). The percentage with abnormal TBUT increased with higher numbers of topical medications and was high with both benzalkonium chloride-containing and preservative-free eye drops (90% and 94%, respectively, both p < 0.001). Benzalkonium chloride was associated with a nearly three times higher odds ratio of showing abnormal OSDI.
CONCLUSIONS: Ocular surface disease is common in those using topical antiglaucoma medications. Abnormal TBUT is associated with increasing number of eye drops and benzalkonium chloride-containing eye drops, although this also occurs with the use of preservative-free eye drops.
Study site: Eye Clinic, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia,

Neuroimaging in refractory epilepsy. Current practice and evolving trends

Ramli N, Rahmat K, Lim KS, Tan CT

Eur J Radiol, 2015 Sep;84(9):1791-800.

PMID: 26187861 DOI: 10.1016/j.ejrad.2015.03.024

Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

Fulltext Diffusion Tensor Imaging Parameters in Mild Traumatic Brain Injury and Its Correlation with Early Neuropsychological Impairment: A Longitudinal Study

Veeramuthu V, Narayanan V, Kuo TL, Delano-Wood L, Chinna K, Bondi MW, et al.

J Neurotrauma, 2015 Oct 1;32(19):1497-509.

PMID: 25952562 DOI: 10.1089/neu.2014.3750

We explored the prognostic value of diffusion tensor imaging (DTI) parameters of selected white matter (WM) tracts in predicting neuropsychological outcome, both at baseline and 6 months later, among well-characterized patients diagnosed with mild traumatic brain injury (mTBI). Sixty-one patients with mTBI (mean age=27.08; standard deviation [SD], 8.55) underwent scanning at an average of 10 h (SD, 4.26) post-trauma along with assessment of their neuropsychological performance at an average of 4.35 h (SD, 7.08) upon full Glasgow Coma Scale recovery. Results were then compared to 19 healthy control participants (mean age=29.05; SD, 5.84), both in the acute stage and 6 months post-trauma. DTI and neuropsychological measures between acute and chronic phases were compared, and significant differences emerged. Specifically, chronic-phase fractional anisotropy and radial diffusivity values showed significant group differences in the corona radiata, anterior limb of internal capsule, cingulum, superior longitudinal fasciculus, optic radiation, and genu of corpus callosum. Findings also demonstrated associations between DTI indices and neuropsychological outcome across two time points. Our results provide new evidence for the use of DTI as an imaging biomarker and indicator of WM damage occurring in the context of mTBI, and they underscore the dynamic nature of brain injury and possible biological basis of chronic neurocognitive alterations.

3 Tesla magnetic resonance imaging noise in standard head and neck sequence does not cause temporary threshold shift in high frequency

Lim EY, Tang IP, Peyman M, Ramli N, Narayanan P, Rajagopalan R

Eur Arch Otorhinolaryngol, 2015 Nov;272(11):3109-13.

PMID: 25205300 DOI: 10.1007/s00405-014-3232-y

High acoustic noise level is one of the unavoidable side effects of 3 T magnetic resonance imaging (MRI). A case of hearing loss after 3 T MRI has been reported in this institution and hence this study. The objective of this study was to determine whether temporary threshold shift (TTS) in high frequency hearing occurs in patients undergoing 3 T MRI scans of the head and neck. A total of 35 patients undergoing head and neck 3 T MRI for various clinical indications were tested with pure tone audiometry in different frequencies including high frequencies, before and after the MRI scan. Any threshold change from the recorded baseline of 10 dB was considered significant. All patients were fitted with foamed 3 M earplugs before the procedure following the safety guidelines for 3 T MRI. The mean time for MRI procedure was 1,672 s (range 1,040-2,810). The noise dose received by each patient amounted to an average of 3,906.29% (1,415-9,170%). The noise dose was derived from a normograph used by Occupational Noise Surveys. This was calculated using the nomograph of L eq, L EX, noise dose and time. There was no statistically significant difference between the hearing threshold before and after the MRI procedures for all the frequencies (paired t test, P > 0.05). For patients using 3 M foamed earplugs, noise level generated by 3 T MRI during routine clinical sequence did not cause any TTS in high frequency hearing.

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