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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 Quantitative magnetic resonance imaging and radiogenomic biomarkers for glioma characterisation: a systematic review

Seow P, Wong JHD, Ahmad-Annuar A, Mahajan A, Abdullah NA, Ramli N

Br J Radiol, 2018 Dec;91(1092):20170930.
PMID: 29902076 DOI: 10.1259/bjr.20170930

OBJECTIVE:: The diversity of tumour characteristics among glioma patients, even within same tumour grade, is a big challenge for disease outcome prediction. A possible approach for improved radiological imaging could come from combining information obtained at the molecular level. This review assembles recent evidence highlighting the value of using radiogenomic biomarkers to infer the underlying biology of gliomas and its correlation with imaging features.
METHODS:: A literature search was done for articles published between 2002 and 2017 on Medline electronic databases. Of 249 titles identified, 38 fulfilled the inclusion criteria, with 14 articles related to quantifiable imaging parameters (heterogeneity, vascularity, diffusion, cell density, infiltrations, perfusion, and metabolite changes) and 24 articles relevant to molecular biomarkers linked to imaging.
RESULTS:: Genes found to correlate with various imaging phenotypes were EGFR, MGMT, IDH1, VEGF, PDGF, TP53, and Ki-67. EGFR is the most studied gene related to imaging characteristics in the studies reviewed (41.7%), followed by MGMT (20.8%) and IDH1 (16.7%). A summary of the relationship amongst glioma morphology, gene expressions, imaging characteristics, prognosis and therapeutic response are presented.
CONCLUSION:: The use of radiogenomics can provide insights to understanding tumour biology and the underlying molecular pathways. Certain MRI characteristics that show strong correlations with EGFR, MGMT and IDH1 could be used as imaging biomarkers. Knowing the pathways involved in tumour progression and their associated imaging patterns may assist in diagnosis, prognosis and treatment management, while facilitating personalised medicine.
ADVANCES IN KNOWLEDGE:: Radiogenomics can offer clinicians better insight into diagnosis, prognosis, and prediction of therapeutic responses of glioma.
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 Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol

Hamzah N, Narayanan V, Ramli N, Mustapha NA, Mohammad Tahir NA, Tan LK, et al.

BMJ Open, 2019 09 18;9(9):e028711.
PMID: 31537559 DOI: 10.1136/bmjopen-2018-028711

OBJECTIVES: To measure the clinical, structural and functional changes of an individualised structured cognitive rehabilitation in mild traumatic brain injury (mTBI) population.
SETTING: A single centre study, Malaysia.
PARTICIPANTS: Adults aged between 18 and 60 years with mTBI as a result of road traffic accident, with no previous history of head trauma, minimum of 9 years education and abnormal cognition at 3 months will be included. The exclusion criteria include pre-existing chronic illness or neurological/psychiatric condition, long-term medication that affects cognitive/psychological status, clinical evidence of substance intoxication at the time of injury and major polytrauma. Based on multiple estimated calculations, the minimum intended sample size is 50 participants (Cohen's d effect size=0.35; alpha level of 0.05; 85% power to detect statistical significance; 40% attrition rate).
INTERVENTIONS: Intervention group will receive individualised structured cognitive rehabilitation. Control group will receive the best patient-centred care for attention disorders. Therapy frequency for both groups will be 1 hour per week for 12 weeks.
OUTCOME MEASURES: Primary: Neuropsychological Assessment Battery-Screening Module (S-NAB) scores. Secondary: Diffusion Tensor Imaging (DTI) parameters and Goal Attainment Scaling score (GAS).
RESULTS: Results will include descriptive statistics of population demographics, CogniPlus cognitive program and metacognitive strategies. The effect of intervention will be the effect size of S-NAB scores and mean GAS T scores. DTI parameters will be compared between groups via repeated measure analysis. Correlation analysis of outcome measures will be calculated using Pearson's correlation coefficient.
CONCLUSION: This is a complex clinical intervention with multiple outcome measures to provide a comprehensive evidence-based treatment model.
ETHICS AND DISSEMINATION: The study protocol was approved by the Medical Research Ethics Committee UMMC (MREC ID NO: 2016928-4293). The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.
TRIAL REGISTRATION NUMBER: NCT03237676.
Randomised controlled trial of single phototherapy with reflecting curtains versus double phototherapy in term newborns with hyperbilirubinaemia

Abd Hamid IJ, M Iyen MI, Ibrahim NR, Abd Majid N, Ramli N, Van Rostenberghe H

J Paediatr Child Health, 2013 May;49(5):375-9.
PMID: 23573836 DOI: 10.1111/jpc.12192

The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice.
Randomised controlled trial: Shoulder-umbilicus length versus body weight measurement for optimal endotracheal tube depth estimation in ventilated infants

Mat Ali AAB, Nasir A, Ramli N, Ibrahim NR, Van Rostenberghe H

J Paediatr Child Health, 2020 05;56(5):704-709.
PMID: 31821664 DOI: 10.1111/jpc.14705

AIM: The optimal placement of the endotracheal tube (ETT) in ventilated infants is essential, but birthweight may be not the best parameter to predict it. The aim of this study was a direct comparison of shoulder-umbilical length (experimental group) versus birthweight (control group) as predictor of optimal ETT placement in Malaysian ventilated infants.
METHODS: All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation.
RESULTS: One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06).
CONCLUSION: In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.
Fulltext Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study

Mrkobrada M, Chan MTV, Cowan D, Spence J, Campbell D, Wang CY, et al.

BMJ Open, 2018 07 06;8(7):e021521.
PMID: 29982215 DOI: 10.1136/bmjopen-2018-021521

OBJECTIVES: Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function.
SETTING AND PARTICIPANTS: We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents.
PARTICIPANTS: We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia.
PRIMARY AND SECONDARY OUTCOME MEASURES: Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction.
CONCLUSIONS: The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery.
TRIAL REGISTRATION NUMBER: NCT01980511; Pre-results.
Fulltext Real-Time In-Vehicle Air Quality Monitoring System Using Machine Learning Prediction Algorithm

Goh CC, Kamarudin LM, Zakaria A, Nishizaki H, Ramli N, Mao X, et al.

Sensors (Basel), 2021 Jul 21;21(15).
PMID: 34372192 DOI: 10.3390/s21154956

This paper presents the development of a real-time cloud-based in-vehicle air quality monitoring system that enables the prediction of the current and future cabin air quality. The designed system provides predictive analytics using machine learning algorithms that can measure the drivers' drowsiness and fatigue based on the air quality presented in the cabin car. It consists of five sensors that measure the level of CO2, particulate matter, vehicle speed, temperature, and humidity. Data from these sensors were collected in real-time from the vehicle cabin and stored in the cloud database. A predictive model using multilayer perceptron, support vector regression, and linear regression was developed to analyze the data and predict the future condition of in-vehicle air quality. The performance of these models was evaluated using the Root Mean Square Error, Mean Squared Error, Mean Absolute Error, and coefficient of determination (R2). The results showed that the support vector regression achieved excellent performance with the highest linearity between the predicted and actual data with an R2 of 0.9981.
Recurrent bilateral eyelid and conjunctival granulomatosis in Churg-Strauss syndrome

Jainuddin NF, Aliff IC, Chiew SF, Ramli N

Med J Malaysia, 2020 01;75(1):86-87.
PMID: 32008029

A 47-year-old woman with poorly controlled asthma and allergic rhinitis presented with recurrent episodes of bilateral upper eyelid swelling associated with forniceal conjunctival mass for the past 10 years. Routine blood investigations showed raised IgE levels and raised eosinophil counts. The diagnosis of Churg-Strauss syndrome (CSS) was made following biopsy of the conjunctival mass. The symptoms responded well to oral steroid treatment but recurred following cessation of the therapy. The patient was co-managed with a rheumatologist and the patient currently remains stable and is on oral Methotrexate and low dose oral steroids. Ocular involvement in CSS is unusual but this unique presentation of CSS was successfully managed, and the patient remains in remission.
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.
Relapsing encephalopathy with dancing eyes and jerky limbs

Mohd Fauzi NA, Abdullah S, Tan AH, Mohd Ramli N, Tan CY, Lim SY

Parkinsonism Relat Disord, 2020 06;75:110-113.
PMID: 30846242 DOI: 10.1016/j.parkreldis.2019.02.025

We report a case of relapsing-remitting opsoclonus-myoclonus-ataxia syndrome (OMAS) in a patient with Hashimoto's encephalopathy, diagnosed after comprehensive evaluation. OMAS as a manifestation of Hashimoto's encephalopathy has been reported once previously. It is hoped that recognition of this entity and early initiation of immunotherapy will improve clinical outcomes for patients.
Fulltext Resistance and resilience of small-scale recirculating aquaculture systems (RAS) with or without algae to pH perturbation

Mohamed Ramli N, Giatsis C, Md Yusoff F, Verreth J, Verdegem M

PLoS One, 2018;13(4):e0195862.
PMID: 29659617 DOI: 10.1371/journal.pone.0195862

The experimental set-up of this study mimicked recirculating aquaculture systems (RAS) where water quality parameters such as dissolved oxygen, pH, temperature, and turbidity were controlled and wastes produced by fish and feeding were converted to inorganic forms. A key process in the RAS was the conversion of ammonia to nitrite and nitrite to nitrate through nitrification. It was hypothesized that algae inclusion in RAS would improve the ammonia removal from the water; thereby improving RAS water quality and stability. To test this hypothesis, the stability of the microbiota community composition in a freshwater RAS with (RAS+A) or without algae (RAS-A) was challenged by introducing an acute pH drop (from pH 7 to 4 during three hours) to the system. Stigeoclonium nanum, a periphytic freshwater microalga was used in this study. No significant effect of the algae presence was found on the resistance to the acute pH drop on ammonia conversion to nitrite and nitrite conversion to nitrate. Also the resilience of the ammonia conversion to the pH drop disruption was not affected by the addition of algae. This could be due to the low biomass of algae achieved in the RAS. However, with regard to the conversion step of nitrite to nitrate, RAS+A was significantly more resilient than RAS-A. In terms of overall bacterial communities, the composition and predictive function of the bacterial communities was significantly different between RAS+A and RAS-A.
Retinal Vessel Analysis as a Novel Screening Tool to Identify Childhood Acute Lymphoblastic Leukemia Survivors at Risk of Cardiovascular Disease

Azanan MS, Chandrasekaran S, Rosli ES, Chua LL, Oh L, Chin TF, et al.

J Pediatr Hematol Oncol, 2020 08;42(6):e394-e400.
PMID: 32118813 DOI: 10.1097/MPH.0000000000001766

BACKGROUND: Microvascular endothelial dysfunction is central to the pathogenesis of cardiovascular disease (CVD). The eye offers direct access for endothelial health assessment via the retinal microvasculature. The aim of the study was to investigate whether image-based retinal vessel analysis is a feasible method of assessing endothelial health in survivors of childhood acute lymphoblastic leukemia (cALL).
MATERIALS AND METHODS: Cardiovascular risk factors (CRFs) were estimated using the 30-year Framingham Risk Score in 73 childhood leukemia survivors (median age: 25; median years from diagnosis: 19) and 78 healthy controls (median age: 23). Radial arterial stiffness was measured using pulse wave analyzer, while endothelial activation markers were measured by soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1). Retinal fundus images were analyzed for central retinal artery/vein equivalents (CRAE/CRVE) and arteriolar-venular ratio (AVR).
RESULTS: cALL survivors had higher CRF (P<0.0001), arterial stiffness (P=0.001), and sVCAM-1 (P=0.007) compared with controls. Survivors also had significantly higher CRVE (P=0.021) while AVR was significantly lower (P=0.026) in survivors compared with controls, compatible with endothelial dysfunction. In cALL survivors with intermediate risk for CVD, CRAE, and AVR are significantly lower, while sVCAM-1 and sICAM-1 are significantly higher when compared with survivors with low CVD risk after adjusting with covariates (age, sex, and smoking status).
CONCLUSIONS: cALL survivors have an increased risk of CVD compared with age-matched peers. The survivors demonstrated microvasculopathy, as measured by retinal vascular analysis, in addition to physical and biochemical evidence of endothelial dysfunction. These changes predate other measures of CVD. Retinal vessel analysis may be utilized as a robust screening tool for identifying survivors at increased risk for developing CVD.
Fulltext Right-sided patent ductus arteriosus with bovine aortic arch, tetralogy of Fallot, dextrocardia and situs inversus

Sayuti KA, Shamsuddin AM, Mamat AZ, Zain MRM, Ramli N, Mokhtar AM, et al.

J Surg Case Rep, 2021 Jul;2021(7):rjab307.
PMID: 34316346 DOI: 10.1093/jscr/rjab307

A neonate with cyanosis at birth was found to have a rare type of tetralogy of Fallot. Echocardiography showed dextrocardia, left aortic arch with constricting and tortuous patent ductus arteriosus (PDA). Computed tomography angiography thorax revealed visceroatrial situs inversus, mirror image dextrocardia, tetralogy anatomy and tortuous right PDA arising from bovine brachiocephalic artery. In view of severe cyanosis, emergency division of PDA and modified right Blalock-Taussig shunt through median sternotomy were performed under cardiopulmonary bypass. Post-operatively, the sternum was left open and he developed pulmonary overcirculation requiring prolonged ICU stay. He was discharged well at Day 26 post surgery. This case highlights a rare association tetralogy of Fallot, dextrocardia and situs inversus, with concomitant unilateral right PDA and bovine aortic arch.
Salivary trace elements in relation to dental caries in a group of multi-ethnic schoolchildren in Shah Alam, Malaysia

Hussein AS, Ghasheer HF, Ramli NM, Schroth RJ, Abu-Hassan MI

Eur J Paediatr Dent, 2013 Jun;14(2):113-8.
PMID: 23758460

AIM: To assess the salivary levels of Copper (Cu), Zinc (Zn), Manganese (Mn) and Iron (Fe) obtained from children of different ethnic backgrounds in Shah Alam, Malaysia and investigate the possible relationships with caries.
MATERIALS AND METHODS: One hundred and twenty primary school children were included. They were divided into caries and caries-free groups. Unstimulated whole saliva was collected from each participant using spitting method. The salivary elements were measured using an Atomic Absorption Spectrophotometer. Descriptive statistics, bivariate and Pearson's correlation analysis were performed.
RESULTS: Salivary Cu and Zn levels were significantly higher in children with dental caries compared to those caries-free (p < 0.05). Moreover, these elements had a positive correlation with dental caries (Cu: r=0.698, p<0.001; Zn: r=0.181, p<0.05). No significant variations in Mn and Fe were observed between caries and caries-free group (p>0.05). Additionally, there were significant differences in salivary Zn and Fe among different age groups (p<0.05) and highly significant differences in salivary Cu, Mn and Fe among different ethnic groups (p<0.001). However, all elements exhibited no significant differences between males and females.
CONCLUSION: The salivary Cu and Zn levels showed significant differences between caries and caries-free groups. The findings also revealed significant variations in the levels of salivary Cu, Mn and Fe among different ethnic groups and salivary Zn and Fe among different age groups.
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.
Seeking key microorganisms for enhancing methane production in anaerobic digestion of waste sewage sludge

Mustapha NA, Hu A, Yu CP, Sharuddin SS, Ramli N, Shirai Y, et al.

Appl Microbiol Biotechnol, 2018 Jun;102(12):5323-5334.
PMID: 29696331 DOI: 10.1007/s00253-018-9003-8

Efficient approaches for the utilization of waste sewage sludge have been widely studied. One of them is to use it for the bioenergy production, specifically methane gas which is well-known to be driven by complex bacterial interactions during the anaerobic digestion process. Therefore, it is important to understand not only microorganisms for producing methane but also those for controlling or regulating the process. In this study, azithromycin analogs belonging to macrolide, ketolide, and lincosamide groups were applied to investigate the mechanisms and dynamics of bacterial community in waste sewage sludge for methane production. The stages of anaerobic digestion process were evaluated by measuring the production of intermediate substrates, such as protease activity, organic acids, the quantification of bacteria and archaea, and its community dynamics. All azithromycin analogs used in this study achieved a high methane production compared to the control sample without any antibiotic due to the efficient hydrolysis process and the presence of important fermentative bacteria and archaea responsible in the methanogenesis stage. The key microorganisms contributing to the methane production may be Clostridia, Cladilinea, Planctomycetes, and Alphaproteobacteria as an accelerator whereas Nitrosomonadaceae and Nitrospiraceae may be suppressors for methane production. In conclusion, the utilization of antibiotic analogs of macrolide, ketolide, and lincosamide groups has a promising ability in finding the essential microorganisms and improving the methane production using waste sewage sludge.
Solid waste collection and recycling in Nibong Tebal, Penang, Malaysia: a case study

Isa MH, Asaari FA, Ramli NA, Ahmad S, Siew TS

Waste Manag Res, 2005 Dec;23(6):565-70.
PMID: 16379126

The implementation of a suitable solid waste management programme with appropriate methods of recycling as an inherent element is vital to the alleviation of the problems associated with solid waste generation, handling and disposal, environmental conservation, public hygiene, etc. The present work is a case study on solid waste collection and recycling practices in Nibong Tebal town, Penang, Malaysia. The amount and types of domestic waste generated, household participation in recycling, identification of existing problems related to the implementation of the recycling programme, etc. formed the basis of this study. Surveys (interviews/questionnaires) and on-site observations were conducted to gather information on the solid waste collection and recycling practice of the residents. A focus group of 60 individuals was selected and their response to a questionnaire, prepared according to a Likert scale, was obtained and analysed. The majority of the respondents expressed concerns about recycling and wanted more to be done in this regard. Illegal collection, aesthetically displeasing sites and a lack of public awareness were problems of major concern. Issues related to inadequate funding and manpower as well as end market are also addressed and suggestions made.
Survivability of Alcaligenaceae and Chromatiaceae as palm oil mill effluent pollution bioindicators under fluctuations of temperature, pH and total suspended solid

Mohamad-Zainal NSL, Ramli N, Zolkefli N, Mustapha NA, Hassan MA, Maeda T

J Biosci Bioeng, 2021 Aug;132(2):174-182.
PMID: 34074597 DOI: 10.1016/j.jbiosc.2021.04.014

Alcaligenaceae and Chromatiaceae were previously reported as the specific pollution bioindicators in the receiving river water contaminated by palm oil mill effluent (POME) final discharge. Considering the inevitable sensitivity of bacteria under environmental stresses, it is crucial to assess the survivability of both bacteria in the fluctuated environmental factors, proving their credibility as POME pollution bioindicators in the environment. In this study, the survivability of Alcaligenaceae and Chromatiaceae from facultative pond, algae (aerobic) pond and final discharge were evaluated under varying sets of temperature (25-40°C), pH (pH 7-9) and low/high total suspended solid (TSS) contents of POME collected during low/high crop seasons of oil palm, respectively. Following treatment, the viability status and compositions of the bacterial community were assessed using flow cytometry-based assay and high-throughput Illumina MiSeq, respectively, in correlation with the changes of physicochemical properties. The changes in temperature, pH and TSS indeed changed the physicochemical properties of POME. The functionality of bacterial cells was also shifted where the viable cells and high nucleic acid contents reduced at elevated levels of temperature and pH but increased at high TSS content. Interestingly, the Alcaligenaceae and Chromatiaceae continuously detected in the samples which accounted for more than 0.5% of relative abundance, with a positive correlation with biological oxygen demand (BOD5) concentration. Therefore, either Alcaligenaceae or Chromatiaceae or both could be regarded as the reliable and specific bacterial indicators to indicate the pollution in river water due to POME final discharge despite the fluctuations in temperature, pH and TSS.
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.

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