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Fulltext Indications, Measurements, and Complications of Ten Essential Neonatal Procedures

Zubi ZBH, Abdullah AFB, Helmi MABM, Hasan TH, Ramli N, Ali AABM, et al.

Int J Pediatr, 2023;2023:3241607.
PMID: 37705709 DOI: 10.1155/2023/3241607

About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
The effect of calcium hydroxide addition on enhancing ammonia recovery during thermophilic composting in a self-heated pilot-scale reactor

Tie HO, Che Man H, Koyama M, Syukri F, Md Yusoff F, Toda T, et al.

Waste Manag, 2023 Jul 01;166:194-202.
PMID: 37178588 DOI: 10.1016/j.wasman.2023.04.046

A modified outdoor large-scale nutrient recycling system was developed to compost organic sludge and aimed to recover clean nitrogen for the cultivation of high-value-added microalgae. This study investigated the effect of calcium hydroxide addition on enhancing NH3 recovery in a pilot-scale reactor self-heated by metabolic heat of microorganisms during thermophilic composting of dewatered cow dung. 350 kg-ww of compost was prepared at the ratio of 5: 14: 1 (dewatered cowdung: rice husk: compost-seed) in a 4 m3 cylindrical rotary drum composting reactor for 14 days of aerated composting. High compost temperature up to 67 °C was observed from day 1 of composting, proving that thermophilic composting was achieved through the self-heating process. The temperature of compost increases as microbial activity increases and temperature decreases as organic matter decreases. The high CO2 evolution rate on day 0-2 (0.02-0.08 mol/min) indicated that microorganisms are most active in degrading organic matter. The increasing conversion of carbon demonstrated that organic carbon was degraded by microbial activity and emitted as CO2. The nitrogen mass balance revealed that adding calcium hydroxide to the compost and increasing the aeration rate on day 3 volatilized 9.83 % of the remaining ammonium ions in the compost, thereby improving the ammonia recovery. Moreover, Geobacillus was found to be the most dominant bacteria under elevated temperature that functions in the hydrolysis of non-dissolved nitrogen for better NH3 recovery. The presented results show that by thermophilic composting 1 ton-ds of dewatered cowdung for NH3 recovery, up to 11.54 kg-ds of microalgae can be produced.
Integrated nutrient recycling: Ammonia recovery from thermophilic composting of shrimp aquaculture sludge via self-heated bench-scale reactor and mango plant growth enhancement by the compost

Tie HO, Che Man H, Koyama M, Syukri F, Md Yusoff F, Toda T, et al.

Waste Manag, 2024 May 15;180:55-66.
PMID: 38520898 DOI: 10.1016/j.wasman.2024.03.021

Due to the rapid growth of the aquaculture industry, large amounts of organic waste are released into nature and polluted the environment. Traditional organic waste treatment such as composting is a time-consuming process that retains the ammonia (NH3) in the compost, and the compost produced has little economic value as organic fertilizer. Illegal direct discharge into the environment is therefore widespread. This study investigates the recovery of NH3 through thermophilic composting of shrimp aquaculture sludge (SAS) and its application as a soil conditioner for the growth of mango plants. A maximum composting temperature of 57.10 °C was achieved through self-heating in a 200 L bench-scale reactor, resulting in NH3 recovery of 224.04 mol/ton-ds after 14 days. The addition of calcium hydroxide and increased aeration have been shown to increase NH3 volatilization. The recovered NH3 up to 3 kg-N can be used as a source of clean nitrogen for high-value microalgae cultivation, with a theoretical yield of up to 34.85 kg-algae of microalgae biomass from 1 ton-ds of SAS composting. Despite the high salinity, SAS compost improved mango plant growth and disease resistance. These results highlight the potential of SAS compost as a sustainable source of clean nitrogen for microalgae cultivation and soil conditioner, contributing to a waste-free circular economy through nutrient recycling and sustainable agriculture.
The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients

Raman P, Khy Ching Y, Sivagurunathan PD, Ramli N, Mohd Khalid KH

J Glaucoma, 2019 08;28(8):685-690.
PMID: 31033782 DOI: 10.1097/IJG.0000000000001269

PRECIS: This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD).
AIM: Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients.
METHODS: This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model.
RESULTS: Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=-0.20, P=0.03; rs=-0.20, P=0.04; rs=-0.28, P=0.003; rs=0.21, P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation.
CONCLUSION: Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.
A decision tree for differentiating multiple system atrophy from Parkinson's disease using 3-T MR imaging

Nair SR, Tan LK, Mohd Ramli N, Lim SY, Rahmat K, Mohd Nor H

Eur Radiol, 2013 Jun;23(6):1459-66.
PMID: 23300042 DOI: 10.1007/s00330-012-2759-9

OBJECTIVE: To develop a decision tree based on standard magnetic resonance imaging (MRI) and diffusion tensor imaging to differentiate multiple system atrophy (MSA) from Parkinson's disease (PD).
METHODS: 3-T brain MRI and DTI (diffusion tensor imaging) were performed on 26 PD and 13 MSA patients. Regions of interest (ROIs) were the putamen, substantia nigra, pons, middle cerebellar peduncles (MCP) and cerebellum. Linear, volumetry and DTI (fractional anisotropy and mean diffusivity) were measured. A three-node decision tree was formulated, with design goals being 100 % specificity at node 1, 100 % sensitivity at node 2 and highest combined sensitivity and specificity at node 3.
RESULTS: Nine parameters (mean width, fractional anisotropy (FA) and mean diffusivity (MD) of MCP; anteroposterior diameter of pons; cerebellar FA and volume; pons and mean putamen volume; mean FA substantia nigra compacta-rostral) showed statistically significant (P < 0.05) differences between MSA and PD with mean MCP width, anteroposterior diameter of pons and mean FA MCP chosen for the decision tree. Threshold values were 14.6 mm, 21.8 mm and 0.55, respectively. Overall performance of the decision tree was 92 % sensitivity, 96 % specificity, 92 % PPV and 96 % NPV. Twelve out of 13 MSA patients were accurately classified.
CONCLUSION: Formation of the decision tree using these parameters was both descriptive and predictive in differentiating between MSA and PD.
KEY POINTS: • Parkinson's disease and multiple system atrophy can be distinguished on MR imaging. • Combined conventional MRI and diffusion tensor imaging improves the accuracy of diagnosis. • A decision tree is descriptive and predictive in differentiating between clinical entities. • A decision tree can reliably differentiate Parkinson's disease from multiple system atrophy.
Fulltext Lipid Alterations in Glioma: A Systematic Review

Abdul Rashid K, Ibrahim K, Wong JHD, Mohd Ramli N

Metabolites, 2022 Dec 16;12(12).
PMID: 36557318 DOI: 10.3390/metabo12121280

Gliomas are highly lethal tumours characterised by heterogeneous molecular features, producing various metabolic phenotypes leading to therapeutic resistance. Lipid metabolism reprogramming is predominant and has contributed to the metabolic plasticity in glioma. This systematic review aims to discover lipids alteration and their biological roles in glioma and the identification of potential lipids biomarker. This systematic review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Extensive research articles search for the last 10 years, from 2011 to 2021, were conducted using four electronic databases, including PubMed, Web of Science, CINAHL and ScienceDirect. A total of 158 research articles were included in this study. All studies reported significant lipid alteration between glioma and control groups, impacting glioma cell growth, proliferation, drug resistance, patients' survival and metastasis. Different lipids demonstrated different biological roles, either beneficial or detrimental effects on glioma. Notably, prostaglandin (PGE2), triacylglycerol (TG), phosphatidylcholine (PC), and sphingosine-1-phosphate play significant roles in glioma development. Conversely, the most prominent anti-carcinogenic lipids include docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and vitamin D3 have been reported to have detrimental effects on glioma cells. Furthermore, high lipid signals were detected at 0.9 and 1.3 ppm in high-grade glioma relative to low-grade glioma. This evidence shows that lipid metabolisms were significantly dysregulated in glioma. Concurrent with this knowledge, the discovery of specific lipid classes altered in glioma will accelerate the development of potential lipid biomarkers and enhance future glioma therapeutics.
Involuntary movements in an elderly woman with recently diagnosed diabetes

Lim SY, Ramli N, Tai SM, Nair SR

J Clin Neurosci, 2011 Apr;18(4):539, 590.
PMID: 21476221
Fulltext Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes

Sreedharan S, Veeramuthu V, Hariri F, Hamzah N, Ramli N, Narayanan V

Int J Oral Maxillofac Surg, 2020 Sep;49(9):1183-1192.
PMID: 32224001 DOI: 10.1016/j.ijom.2020.03.002

Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.
Fulltext R54C Mutation of NOTCH3 Gene in the First Rungus Family with CADASIL

Lim KS, Tan AH, Lim CS, Chua KH, Lee PC, Ramli N, et al.

PLoS One, 2015;10(8):e0135470.
PMID: 26270344 DOI: 10.1371/journal.pone.0135470

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary stroke caused by mutations in NOTCH3 gene. We report the first case of CADASIL in an indigenous Rungus (Kadazan-Dusun) family in Kudat, Sabah, Malaysia confirmed by a R54C (c.160C>T, p.Arg54Cys) mutation in the NOTCH3. This mutation was previously reported in a Caucasian and two Korean cases of CADASIL. We recruited two generations of the affected Rungus family (n = 9) and found a missense mutation (c.160C>T) in exon 2 of NOTCH3 in three siblings. Two of the three siblings had severe white matter abnormalities in their brain MRI (Scheltens score 33 and 50 respectively), one of whom had a young stroke at the age of 38. The remaining sibling, however, did not show any clinical features of CADASIL and had only minimal changes in her brain MRI (Scheltens score 17). This further emphasized the phenotype variability among family members with the same mutation in CADASIL. This is the first reported family with CADASIL in Rungus subtribe of Kadazan-Dusun ethnicity with a known mutation at exon 2 of NOTCH3. The penetrance of this mutation was not complete during the course of this study.
Fulltext Diagnostic Efficacy of Synthesized 2D Digital Breast Tomosynthesis in Multi-ethnic Malaysian Population

Mumin NA, Rahmat K, Fadzli F, Ramli MT, Westerhout CJ, Ramli N, et al.

Sci Rep, 2019 02 06;9(1):1459.
PMID: 30728394 DOI: 10.1038/s41598-018-37451-4

Synthesized 2D images can be reconstructed from tomosynthesis images in breast imaging. This study aims to investigate the diagnostic efficacy of synthesized 2D images (C-View) in comparison to full field digital mammography (FFDM) when used with digital breast tomosynthesis (DBT) in multi-ethnic Malaysian population. FFDM and C-View images (n = 380) were independently evaluated by three readers through Breast Imaging Reporting and Data System (BI-RADS) categorisation, breast density and lesion characterisation. Statistical analysis was done comparing sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of C-View + DBT with FFDM + DBT as standard of reference. Very good interreader agreement in BI-RADS category and density assessment between C-View + DBT and FFDM + DBT, with high sensitivity, specificity, PPV and NPV of C-View + DBT when compared with FFDM + DBT. There was comparable PPV between C-View + DBT and FFDM + DBT, with histopathology as gold standard. High level of interreader agreement in BI-RADS category and density assessment for FFDM + DBT and C-View + DBT. There was good agreement between FFDM + DBT and C-View + DBT in mass characterization, and almost perfect agreement in calcification and asymmetric density. 52.2% lower radiation dose incurred when using C-View + DBT. Hence, synthesized 2D images are comparable to FFDM with reduction in radiation dose within the limits of Malaysian multi-ethnic population.
Fulltext Caffeine and theobromine levels in chocolate couverture and coating products

Ramli N, Abdul Rahman S, Hassan O, Mohd Yatim A, Said M, Lim LS, et al.

Malays J Nutr, 2000 Mar;6(1):55-63.
PMID: 22692392

Thirty-two samples of chocolate products were analysed by HPLC for caffeine and theobromine contents. Defatted residues of samples were extracted with 80% aqueous acetone. After extraction into boiling water, the methylxanthines were identified and quantified with the use of μ-Bondapak column and mobile phase of methanol:water:acetic acid (20:79:1). Levels of caffein and theobromine in 32 samples of chocolate products averaged 0.62-1.14 mg/g and 0.026-0.153 mg/g respectively. Mean values for theobromine and caffeine content for chocolate coating were 0.82 and 0.07 mg/g respectively. The chocolate coating made from fat substitute had theobromine and caffeine levels ranging from 0.36-0.70 mg/g and 0.027-0.061 mg/g respectively, with mean values of 0.49 mg theobromine/g and 0.039 mg caffeine/g. In local chocolate, the mean theobromine and caffeine levels respectively were 0.72 mg/g and 0.04 mg/g in milk chocolate, and 0.85 mg/g and 0.06 mg/g in dark chocolate. Meanwhile, for imported chocolate, the mean theobromine and caffeine levels respectively were 1.05 mg/g and 0.12 mg/g in dark chocolate; 0.76 mg/g and 0.04 mg/g in milk chocolate; and 0.74 mg/g and 0.03 mg/g in white chocolate. Compared with the local chocolates, imported chocolates had higher levels of theobromine and caffeine at 1.141 mg/g and 0.1533mg/g. The average theobromine and caffeine concentrations in local chocolate were 0.082mg/g and 0.066mg/g. Theobromine concentration in chocolate samples is within the range of 0.62mg/g-1.141mg/g and the range of caffeine concentration is 0.026mg/g-0.153mg/g respectively. Bittersweet chocolates were found to have higher theobromine and caffeine concentrations than normal sweet chocolates and milk chocolates.
Frequencies of A(TA)7TAA, G71R, and G493R mutations of the UGT1A1 gene in the Malaysian population

Yusoff S, Van Rostenberghe H, Yusoff NM, Talib NA, Ramli N, Ismail NZ, et al.

Biol. Neonate, 2006;89(3):171-6.
PMID: 16210851

Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. These mutations differ among different populations and many of them have been found to be genetic risk factors for the development of neonatal jaundice.
Microstructural abnormalities found in uncinate fasciculus and superior cerebellar tracts in children with global developmental delay: a feasibility study

Ramli N, Yap A, Muridan R, Seow P, Rahmat K, Fong CY, et al.

Clin Radiol, 2020 01;75(1):77.e15-77.e22.
PMID: 31668796 DOI: 10.1016/j.crad.2019.09.134

AIM: To evaluate the microstructural abnormalities of the white matter tracts (WMT) using diffusion tensor imaging (DTI) in children with global developmental delay (GDD).
MATERIALS AND METHODS: Sixteen children with GDD underwent magnetic resonance imaging (MRI) and cross-sectional DTI. Formal developmental assessment of all GDD patients was performed using the Mullen Scales of Early Learning. An automated processing pipeline for the WMT assessment was implemented. The DTI-derived metrics of the children with GDD were compared to healthy children with normal development (ND).
RESULTS: Only two out of the 17 WMT demonstrated significant differences (p<0.05) in DTI parameters between the GDD and ND group. In the uncinate fasciculus (UF), the GDD group had lower mean values for fractional anisotropy (FA; 0.40 versus 0.44), higher values for mean diffusivity (0.96 versus 0.91×10-3 mm2/s) and radial diffusivity (0.75 versus 0.68×10-3 mm2/s) compared to the ND group. In the superior cerebellar peduncle (SCP), mean FA values were lower for the GDD group (0.38 versus 0.40). Normal myelination pattern of DTI parameters was deviated against age for GDD group for UF and SCP.
CONCLUSION: The UF and SCP WMT showed microstructural changes suggestive of compromised white matter maturation in children with GDD. The DTI metrics have potential as imaging markers for inadequate white matter maturation in GDD children.
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.
Optic Canal Analysis in Syndromic Craniosynostosis: Volumetric and Surface Area Validation Study Using Different Measurement Modalities

Hariri F, Zainudin NAA, Anuar AMS, Ibrahim N, Abdullah NA, Aziz IA, et al.

J Craniofac Surg, 2020 11 7;32(1):355-359.
PMID: 33156163 DOI: 10.1097/SCS.0000000000006981

BACKGROUND: In syndromic craniosynostosis (SC), unlike persistent corneal irritation due to severe exophthalmos and increased intracranial pressure, optic canal (OC) stenosis has been scarcely reported to cause visual impairment. This study aimed to validate the OC volumetric and surface area measurement among SC patients.
METHODS: Sixteen computed tomography scan of SC patients (8 months-6 years old) were imported to Materialise Interactive Medical Image Control System (MIMICS) and Materialise 3-matics software. Three-dimensional (3D) OC models were fabricated, and linear measurements were obtained. Mathematical formulas were used for calculation of OC volume and surface area from the 3D model. The same measurements were obtained from the software and used as ground truth. Data normality was investigated before statistical analyses were performed. Wilcoxon test was used to validate differences of OC volume and surface area between 3D model and software.
RESULTS: The mean values for OC surface area for 3D model and MIMICS software were 103.19 mm2 and 31.27 mm2, respectively, whereas the mean for OC volume for 3D model and MIMICS software were 184.37 mm2 and 147.07 mm2, respectively. Significant difference was found between OC volume (P = 0.0681) and surface area (P = 0.0002) between 3D model and software.
CONCLUSION: Optic canal in SC is not a perfect conical frustum thus making 3D model measurement and mathematical formula for surface area and volume estimation not ideal. Computer software remains the best modality to gauge dimensional parameter and is useful to elucidates the relationship of OC and eye function as well as aiding intervention in SC patients.
Fulltext Ptosis due to cavernous sinus syndrome as a rare presentation of advanced breast metastasis in a patient with delayed diagnosis

Khaw K, Ramli N, Rahmat K

Malays Fam Physician, 2012;7(1):31-3.
PMID: 25606243 MyJurnal

Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).
Fulltext Novel application of chemical shift gradient echo in- and opposed-phase sequences in 3 T MRI for the detection of H-MRS visible lipids and grading of glioma

Ramli N, Khairy AM, Seow P, Tan LK, Wong JH, Ganesan D, et al.

Eur Radiol, 2016 Jul;26(7):2019-29.
PMID: 26560718 DOI: 10.1007/s00330-015-4045-0

OBJECTIVES: We evaluated the feasibility of using chemical shift gradient-echo (GE) in- and opposed-phase (IOP) imaging to grade glioma.
METHODS: A phantom study was performed to investigate the correlation of (1)H MRS-visible lipids with the signal loss ratio (SLR) obtained using IOP imaging. A cross-sectional study approved by the institutional review board was carried out in 22 patients with different glioma grades. The patients underwent scanning using IOP imaging and single-voxel spectroscopy (SVS) using 3T MRI. The brain spectra acquisitions from solid and cystic components were obtained and correlated with the SLR for different grades.
RESULTS: The phantom study showed a positive linear correlation between lipid quantification at 0.9 parts per million (ppm) and 1.3 ppm with SLR (r = 0.79-0.99, p
Fulltext Quantitative and Qualitative Analysis of 18 Deep Convolutional Neural Network (CNN) Models with Transfer Learning to Diagnose COVID-19 on Chest X-Ray (CXR) Images

Chow LS, Tang GS, Solihin MI, Gowdh NM, Ramli N, Rahmat K

SN Comput Sci, 2023;4(2):141.
PMID: 36624807 DOI: 10.1007/s42979-022-01545-8

Coronavirus disease 2019 (COVID-19) is a disease caused by a novel strain of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), severely affecting the lungs. Our study aims to combine both quantitative and qualitative analysis of the convolutional neural network (CNN) model to diagnose COVID-19 on chest X-ray (CXR) images. We investigated 18 state-of-the-art CNN models with transfer learning, which include AlexNet, DarkNet-19, DarkNet-53, DenseNet-201, GoogLeNet, Inception-ResNet-v2, Inception-v3, MobileNet-v2, NasNet-Large, NasNet-Mobile, ResNet-18, ResNet-50, ResNet-101, ShuffleNet, SqueezeNet, VGG-16, VGG-19, and Xception. Their performances were evaluated quantitatively using six assessment metrics: specificity, sensitivity, precision, negative predictive value (NPV), accuracy, and F1-score. The top four models with accuracy higher than 90% are VGG-16, ResNet-101, VGG-19, and SqueezeNet. The accuracy of these top four models is between 90.7% and 94.3%; the F1-score is between 90.8% and 94.3%. The VGG-16 scored the highest accuracy of 94.3% and F1-score of 94.3%. The majority voting with all the 18 CNN models and top 4 models produced an accuracy of 93.0% and 94.0%, respectively. The top four and bottom three models were chosen for the qualitative analysis. A gradient-weighted class activation mapping (Grad-CAM) was used to visualize the significant region of activation for the decision-making of image classification. Two certified radiologists performed blinded subjective voting on the Grad-CAM images in comparison with their diagnosis. The qualitative analysis showed that SqueezeNet is the closest model to the diagnosis of two certified radiologists. It demonstrated a competitively good accuracy of 90.7% and F1-score of 90.8% with 111 times fewer parameters and 7.7 times faster than VGG-16. Therefore, this study recommends both VGG-16 and SqueezeNet as additional tools for the diagnosis of COVID-19.
Fulltext Diagnostic accuracy of tomosynthesis-guided vacuum assisted breast biopsy of ultrasound occult lesions

Bohan S, Ramli Hamid MT, Chan WY, Vijayananthan A, Ramli N, Kaur S, et al.

Sci Rep, 2021 01 08;11(1):129.
PMID: 33420200 DOI: 10.1038/s41598-020-80124-4

This study aims to evaluate the diagnostic accuracy of digital breast tomosynthesis-guided vacuum assisted breast biopsy (DBT-VABB) of screening detected suspicious mammographic abnormalities comprising of calcifications, asymmetric densities, architectural distortions and spiculated masses. In this institutionally approved study, a total of 170 (n = 170) DBT-VABB were performed, 153 (90%) were for calcifications, 8 (4.7%) for spiculated mass, 5 (2.9%) for asymmetric density and 4 (2.4%) for architectural distortion. All these lesions were not detected on the corresponding ultrasound. Histopathology results revealed 140 (82.4%) benign, 9 (5.3%) borderline and 21 (12.4%) malignant lesions. The total upgrade rate at surgery was 40% for atypical ductal hyperplasia and 5.9% for ductal carcinoma in-situ. 3.6% discordant benign lesions showed no upgrade. DBT-VABB showed 100% specificity, 91.3% sensitivity and 100% positive predictive value (PPV) for detecting malignant lesions. The negative predictive value (NPV) was 80%. 2 (1.2%) patients had mild complications and 1 (0.6%) had severe pain. Our study showed that DBT-VABB was a safe and reliable method, with high sensitivity, specificity, PPV and NPV in the diagnosis of non-palpable benign and malignant breast lesions. Our data also confirmed the accuracy of DBT-VABB in detecting malignant lesions and we suggest further surgical excision in borderline lesions for a more accurate diagnostic evaluation.
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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