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Fulltext Good Visual Outcome Following Corticosteroid Treatment for Compressive Optic Neuropathy Secondary to Sinonasal Carcinoma

Mohammad Razali A, Mohd Zain A, Bt Wan Abdul Halim WH, Md Din N

Cureus, 2020 Apr 18;12(4):e7732.
PMID: 32440379 DOI: 10.7759/cureus.7732

Most patients with sinonasal carcinoma present to the otorhinolaryngologist with nasal symptoms. It is however uncommon for them to present with acute visual loss at first presentation. We report a case of compressive optic neuropathy secondary to sinonasal carcinoma, which presented acutely with right eye blurring of vision upon waking up. Computed tomography (CT) of the brain and orbit with contrast showed a locally invasive nasopharyngeal mass extending into the right orbit and cranial fossa. Histopathological examination revealed squamous cell sinonasal carcinoma. Her visual acuity improved with a three-day course of pulsed intravenous methylprednisolone 1 g per day, followed by a gradual tapering dose of oral prednisolone (1 mg/kg/day).
Fulltext Dipeptidyl Peptidase-4 inhibitors use in type II diabetic patients in a tertiary hospital

Mak WY, Nagarajah JR, Abdul Halim H, Ramadas A, Mohd Pauzi Z, Pee LT, et al.

J Pharm Policy Pract, 2020;13:34.
PMID: 32566235 DOI: 10.1186/s40545-020-00238-y

Background: In Malaysia, for more than a decade, dipeptidyl peptidase-4 inhibitors (DPP-4i) are among the oral antidiabetic medications used as monotherapy or in combination to manage type II diabetes mellitus (T2DM). These medications are known for the efficacy in glycated haemoglobin (HbA1c) reduction and weight neutral effect with minimal hypoglycaemia occurrence. This study aimed to identify the outcomes of DPP-4i use in one of the largest tertiary public hospital in Southeast Asia.
Methods: This is a retrospective cross sectional study conducted in 2016, where stratified sampling method was used. Patients with T2DM treated with available DPP-4i; namely Linagliptin, Saxagliptin, Sitagliptin and Vildagliptin, for at least 3 months were identified from the pharmacy record. Medical records from Physician Clinic in Hospital Kuala Lumpur (HKL) were reviewed. Data on demographic, anthropometric, antidiabetic treatment modalities, laboratory and documented outcomes were collected. Outcomes endpoints which include changes in HbA1c, fasting blood glucose (FBG), and body weight were recorded and analysed. Adverse drug reactions (ADR) documented were also reported.
Results and discussion: A total of one hundred and five patients were recruited. The patients were 49.5% men (n = 52), with a mean age of 57 years, mean HbA1c of 8.5% (69 mmol/mol) and mean BMI of 29.5 kg/m2. At least 50% of the patients had T2DM for more than 10 years and more than two third of these patients had both T2DM and hypertension. Thirty nine patients were on Vildagliptin, 32 on Sitagliptin, 26 on Saxagliptin and the remaining on Linagliptin. The most commonly prescribed DPP-4i were Vildagliptin and Sitagliptin. Majority of the patients (90.4%) were prescribed with Metformin, with 62.8% of patients on fixed-dose combination, and the remaining on add-on Metformin therapy. Use of DPP-4i as an adjunct was associated with a mean reduction of 0.9% (9 mmol/mol) in HbA1c (p
Fulltext Leptospirosis and Coinfection: Should We Be Concerned?

Md-Lasim A, Mohd-Taib FS, Abdul-Halim M, Mohd-Ngesom AM, Nathan S, Md-Nor S

Int J Environ Res Public Health, 2021 09 06;18(17).
PMID: 34502012 DOI: 10.3390/ijerph18179411

Pathogenic Leptospira is the causative agent of leptospirosis, an emerging zoonotic disease affecting animals and humans worldwide. The risk of host infection following interaction with environmental sources depends on the ability of Leptospira to persist, survive, and infect the new host to continue the transmission chain. Leptospira may coexist with other pathogens, thus providing a suitable condition for the development of other pathogens, resulting in multi-pathogen infection in humans. Therefore, it is important to better understand the dynamics of transmission by these pathogens. We conducted Boolean searches of several databases, including Google Scholar, PubMed, SciELO, and ScienceDirect, to identify relevant published data on Leptospira and coinfection with other pathogenic bacteria. We review the role of the host-microbiota in determining the synanthropic interaction of Leptospira sp. with other bacteria, thus creating a suitable condition for the leptospira to survive and persist successfully. We also discuss the biotic and abiotic factors that amplify the viability of Leptospira in the environment. The coinfection of leptospira with pathogenic bacteria has rarely been reported, potentially contributing to a lack of awareness. Therefore, the occurrence of leptospirosis coinfection may complicate diagnosis, long-lasting examination, and mistreatment that could lead to mortality. Identifying the presence of leptospirosis with other bacteria through metagenomic analysis could reveal possible coinfection. In conclusion, the occurrence of leptospirosis with other diseases should be of concern and may depend on the success of the transmission and severity of individual infections. Medical practitioners may misdiagnose the presence of multiple infections and should be made aware of and receive adequate training on appropriate treatment for leptospirosis patients. Physicians could undertake a more targeted approach for leptospirosis diagnosis by considering other symptoms caused by the coinfected bacteria; thus, more specific treatment could be given.
Corneal Nodules and Possible Pathologies: A Case Series

Kuan HC, Ivan Cheng EY, Yong MH, Wan Abdul Halim WH, Othman O

Cureus, 2021 Dec;13(12):e20822.
PMID: 35141078 DOI: 10.7759/cureus.20822

Corneal nodular lesions are not uncommon in clinical practice. Diagnosing and managing this condition can be challenging due to its variable causes. This article highlights three cases of corneal nodular lesions. A common clinical pathway for the diagnosis and treatment of cornea nodular lesions is discussed. Two young females and an elderly man presented with a unilateral corneal nodule of variable duration, which was further demonstrated on anterior segment optical coherence tomography (AS-OCT). Several diagnoses were made after thorough history and examination which include herpetic stromal keratitis, phlyctenular keratoconjunctivitis secondary to blepharitis, and Salzmann nodular degeneration. All cases were initiated on topical antibiotics and topical steroids with additional medication or surgical procedure onboard according to their clinical condition. The corneal nodules resolved with scarring after a period of treatment. In conclusion, corneal nodular lesions can be associated with various pathologies. Thorough history, examination, and appropriate investigations are needed to reveal the underlying causes. Serial anterior segment images and AS-OCT are useful to monitor progression and treatment response. Prompt diagnosis and initiation of treatment are crucial to prevent further complications.
Fulltext Melanocytoma of the optic nerve head - a diagnostic dilemma

Mohmad Z, Kah TA, Yong KC, Abdul Halim WH, Kong Yong T

Clin Pract, 2011 Jul 01;1(3):e60.
PMID: 24765321 DOI: 10.4081/cp.2011.e60

The clinical features, autofluorescence, B-scan ultrasonography, optical coherence tomography and fluorescein angiography of the lesion were described. Multiple investigation modalities are needed to confirm the benign nature of the lesion. Careful evaluation and follow-up is crucial to avoid misdiagnosis and erroneous management.
Fulltext Anticoagulation Control in Different Ethnic Groups Receiving Vitamin K Antagonist for Stroke Prevention in Atrial Fibrillation

Zawawi NA, Abdul Halim Zaki I, Ming LC, Goh HP, Zulkifly HH

Front Cardiovasc Med, 2021;8:736143.
PMID: 34869639 DOI: 10.3389/fcvm.2021.736143

Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of "prevalence," "atrial fibrillation," "stroke prevention," "oral anticoagulants," "warfarin," "ethnicities," "race" "time in therapeutic range," "adverse clinical outcome," "stroke, bleeding." Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence (n = 14 studies), time in therapeutic range (n = 18 studies), adverse clinical outcome (n = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.
Fulltext Understanding the determinants of e-wallet continuance usage intention in Malaysia

Abdul-Halim NA, Vafaei-Zadeh A, Hanifah H, Teoh AP, Nawaser K

Qual Quant, 2021 Nov 09.
PMID: 34776542 DOI: 10.1007/s11135-021-01276-7

The present research aims to investigate the determinants of e-wallet continuance usage intention in Malaysia using extending Technology Continuance Theory (TCT) via examining four variables, namely price benefit, trust, habit, and operational constraints. This paper adopts a quantitative approach to collect data with non-probability sampling using the purposive sampling technique. An online survey was conducted and a total of 379 respondents submitted their answers. The obtained results have shown that continue use of e-wallet is not affected by perceived usefulness (PU) and trust. However, there is a significant influence associated with perceived ease of use (PEU), PU, and satisfaction toward user's attitude that, in turn, substantially impacts the users' intention to continue to use e-wallet. This is one of the prior studies exploring Malaysian's intention to continue using e-wallet, using the TCT model as the research framework, and through examining four variables adopted from the literature, including price benefit, habit, trust, and operational constraints. The practical implications for the service providers and policymakers from the present findings can be used to develop strategies to gain a sustainable, competitive advantage, and promote continuous intention of e-wallet usage.
Fulltext Honeycomb and necklace signs in liver abscesses secondary to melioidosis

Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA

BMJ Case Rep, 2017 Oct 19;2017.
PMID: 29054959 DOI: 10.1136/bcr-2017-222342

Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for Burkholderia pseudomallei He was subsequently treated with ceftazidime for a month followed by oral trimethoprim-sulfamethoxazole for 3 months. Follow-up CT of abdomen a month after diagnosis and treatment showed resolving hepatic and splenic lesions.
Fulltext CMV endotheliitis: a cause for recurrent failed corneal transplant

Shahrudin NA, Mohd Zahidin AZ, Md Noh UK, Wan Abdul Halim WH, Md Din N

GMS Ophthalmol Cases, 2017;7:Doc31.
PMID: 29326863 DOI: 10.3205/oc000082

Objective: To highlight the clinical presentation of CMV endotheliitis and the challenge in diagnosing this condition in recurrent failed penetrating keratoplasty (PK). Methods: Case series Results: There are 3 cases of recurrent failure in PK secondary to CMV endotheliitis presented. Case 1 and 2 were pseudophakic patients, while in case 3, the patient had a previous history of recurrent anterior uveitis. Case 1 and 3 had four and one previous failed PK respectively, while case 2 had endothelial keratoplasty twice before the diagnosis of CMV endotheliitis was made, following positive culture of aqueous humour. The visual acuity ranged from 1/60 to hand movement. All patients had pigmented KP, and two of them had typical coin-shaped KP. Oral valganciclovir was instituted for all patients consisting of 900 mg bidaily for two weeks, followed by 900 mg once daily for six months. Additionally, topical ganciclovir eyedrop 0.5% was given every four hours with topical dexaminim four times a day. Repeated anterior chamber (AC) tap after six months of treatment was negative for CMV in case 3 while cases 1 and 2 are still on treatment. CMV endotheliitis is an increasingly important cause of failed corneal transplant. We recommend anterior chamber tap in suspicious cases of repeatedly failed corneal transplant, regardless of the presence of coin-shaped KP or not. Minimum treatment with oral valganciclovir is important to eradicate the problem, before proceeding with another corneal transplant. Conclusion: It is important to make an accurate early diagnosis by good clinical judgement in preventing loss of corneal endothelial cells. High index of suspicion for CMV endotheliitis as a cause of graft failure must be made especially when the patient presents with coin-shaped KP. Therefore unnecessary treatment resulting from misdiagnosis in these patients can be prevented. Early recognition and treatment of this condition is important to prevent permanent endothelial cell loss and corneal decompensation.
Fulltext The complete mitochondrial genomes of Pangasius nasutus and P. conchophilus (Siluriformes: Pangasiidae)

Abdul Halim SAA, Esa Y, Gan HM, Zainudin AA, Mohd Nor SA

Mitochondrial DNA B Resour, 2023;8(1):38-41.
PMID: 36620317 DOI: 10.1080/23802359.2022.2158694

The catfish, Pangasius nasutus and P. conchophilus, are often misidentified between each other due to their similar morphology. Thus, the current study was conducted to differentiate them based on a molecular approach. The complete mitochondrial genomes of P. nasutus and P. conchophilus obtained from the Pahang River (Peninsular Malaysia) were sequenced, assembled, and annotated using next-generation sequencing (NGS). A 16,465 bp and 16,470 bp length mitogenome sequence of P. nasutus and P. conchophilus, respectively, was generated, each containing 13 protein genes, 22 tRNAs, and two rRNAs, typical of most vertebrates. This is the first report of the complete mitochondrial genome sequences of P. nasutus and P. conchophilus. These data are a valuable genetic resource for future studies of these two commercially important species.
Fulltext Determination of Factors Influencing the Health Belief Model (HBM) and Adherence to Intravitreal Anti-vascular Endothelial Growth Factor (VEGF) Among Patients With Diabetic Macular Edema (DME)

Ting Yih Ling J, Mohd Zain A, Naffi AA, Mustapha M, Wan Abdul Halim WH

Cureus, 2023 Feb;15(2):e34669.
PMID: 36909105 DOI: 10.7759/cureus.34669

Background Diabetic macular edema (DME) is becoming one of the leading causes of blindness worldwide with a significant impact on quality of life. The effectiveness of intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) therapy has been established by clinical trials and has become the treatment of choice in the majority of DME patients in reducing macular edema and improving visual acuity. Frequent drop-out and discontinuation of treatment are major issues. Lack of compliance can lead to worsening outcomes and be a burden to patients and the healthcare system. Purpose The purpose of this study is to assess multiple factors that affect adherence to IVT anti-VEGF treatment among patients with DME, including socioeconomic causes and the Health Belief Model (HBM) domains, in addition to exploring the relationship between them. Methods This cross-sectional study was conducted among DME patients in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia, from December 2020 to June 2021. We identified eligible patients using a retrospective chart review of clinical findings and optical coherence tomography (OCT) findings. Included subjects were of Malaysian nationality, aged 18 years and above, who were initiated or re-initiated IVT anti-VEGF treatment regime and on follow-up for at least six months from initial injection from January 2019 onwards. A translated and validated self-administered questionnaire was given to the respondents. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Demographics of the patient were summarized using descriptive statistics, independent sample t-test was used to compare the difference in components of the HBM questionnaire. Linear regression was further used to explore the relationship between patients' demographics and the HBM component. Results A total of 141 patients participated in this study, of whom 56.2% patients were adherent to treatment. The majority were aged 60 years and above (56.7%), male (52.5%), Malay (38.9%), and married (71.6%). There was a significant statistical difference in patients who were adherent to treatment, in terms of life entourage (p=0.004, Fisher Exact test). HBM domains that influenced adherence to treatment included perceived severity, perceived barriers, perceived benefits, cues to action, and self-efficacy (p<0.05, independent sample t-test). Further, multiple logistic regression tests on sociodemographic factors and HBM domains after eliminating confounding factors narrowed down the significant variables to perceived susceptibility (p= 0.023), perceived benefits (p< 0.001), and self-efficacy (p< 0.001). Conclusion Patients' adherence to IVT anti-VEGF is influenced by perceived susceptibility to complications from DME, perceived benefits to the treatment, and self-efficacy.
Fulltext Medication discrepancies among elderly patients discharged from a tertiary hospital: prevalence and risk factors

Abdul Halim Zaki I, Razali RM, Gnanasan S, Alias R, Karuppannan M

Singapore Med J, 2021 Jul;62(7):362-365.
PMID: 34409484 DOI: 10.11622/smedj.2021093
Fulltext Subthalamic Nucleus (STN)-Deep Brain Stimulation Reduces the Power of Mu and Beta Rhythms and Enhances Synchrony at the Motor Cortices in Parkinson's Disease: A Report of Two Cases

Zakaria Z, Idris Z, Abdul Halim S, Ghani ARI, Abdullah JM

Cureus, 2023 Feb;15(2):e35057.
PMID: 36942168 DOI: 10.7759/cureus.35057

The motor circuit in Parkinson's disease (PD) involves the basal ganglia, thalamus, motor cortex, and cerebellum. Hence, subthalamic nucleus (STN) or globus pallidus internus deep brain stimulation is commonly used in treating refractory Parkinson's patients. During the procedure, the local field potential (LPF) is commonly made along the trajectory of the STN. Two cases were assessed, where an electroencephalographic recording at the sensorimotor cortices was also performed with and without stimulation at the optimal STN electrode site. The 'on' stimulation state associated with clinical improvement correlated with a marked reduction in the late theta (7.5 Hz), alpha (10.5 Hz) (Mu wave), and beta (20 Hz) wave power. Besides, more synchronized and coherent brainwaves were noted when the stimulation was 'on'.
Fulltext The Determinants of Non-compliance on Rabies Vaccination in North-West Peninsular Malaysia

Mohammad Basir MF, Mohd Hairon S, Tengku Ismail TA, Che' Muda CM, Abdul Halim HI

J Epidemiol Glob Health, 2023 Mar;13(1):1-10.
PMID: 36622636 DOI: 10.1007/s44197-022-00080-2

INTRODUCTION: Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020.
METHODS: A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients.
RESULTS: Most of dog bite patients were age group of 46-60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV.
CONCLUSION: 19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV.
Fulltext The long-term assessment of air quality on an island in Malaysia

Abdul Halim ND, Latif MT, Ahamad F, Dominick D, Chung JX, Juneng L, et al.

Heliyon, 2018 Dec;4(12):e01054.
PMID: 30603693 DOI: 10.1016/j.heliyon.2018.e01054

This study aims to evaluate the air quality on Langkawi Island, a famous tourist destination in Malaysia, using 13 years of data (1999-2011) recorded by the Malaysian Department of Environment. Variations of seven air pollutants (O3, CO, NO, NO2, NOx, SO2 and PM10) and three meteorological factors (temperature, humidity and wind speed) were analysed. Statistical methods used to analyse the data included principal component regression (PCR) and sensitivity analysis. The results showed PM10 was the dominant air pollutant in Langkawi and values ranged between 5.0 μg m-3 and 183.2 μg m-3. The patterns of monthly values showed that the concentrations of measured air pollutants on Langkawi were higher during the south-west monsoon (June-September) due to seasonal biomass burning activities. High CO/NOx ratio values (between 28.3 and 43.6), low SO2/NOx ratio values (between 0.04 and 0.12) and NO/NO2 ratio values exceeding 2.2 indicate the source of air pollutants in this area was motor vehicles. PCR analysis grouped the seven variables into two factor components: the F1 component consisted of SO2, NO and NOx and the F2 component consisted of PM10. The F1 component (R2 = 0.931) indicated a stronger standardized coefficient value for meteorological variables compared to the F2 component (R2 = 0.059). The meteorological variables were statistically significant (p < 0.05) in influencing the distribution of the air pollutants. The status of air quality on the island could be improved through control on motor vehicle emissions as well as collaborative efforts to reduce regional air pollution, especially from biomass burning.
A new approach to detecting sugar syrup addition to honey: Stable isotope analysis of hexamethylenetetramine synthesised from honey monosaccharides (fructose and glucose)

Li A, Abrahim A, Islam M, Mejías E, Hafizati Abdul Halim N, Frew R, et al.

Food Chem, 2024 Feb 15;434:137451.
PMID: 37748289 DOI: 10.1016/j.foodchem.2023.137451

One of the most common types of adulteration of honey involves the addition of invert sugar syrups. A new method was developed to measure the stable isotope ratios of carbon and carbon-bound non-exchangeable (CBNE) hydrogen from specific molecular positions in fructose and glucose in honey. This was achieved through periodate oxidation of the sugars to produce formaldehyde, followed by reaction with ammonia to form hexamethylenetetramine (HMT). The preparation was simplified, optimized, and validated by isotopic analysis of replicate syntheses of HMT from fructose, glucose, sugar syrup and a representative authentic honey sample. The optimized method had a repeatability standard deviation from 1.5‰ to 3.0‰ and from 0.1‰ to 0.4‰ for δ2H and δ13C, respectively. This methodology has advantages over alternative isotopic methods, for measuring CBNE hydrogen isotope ratios in sugars, in terms of time, sensitivity and operability and offers a complementary method to differentiate authentic honey from invert sugar syrups.
Fulltext Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting With Orbital Apex Syndrome

Sulaiman FN, Kamardin NF, Sultan Abdul Kader MI, Ch'ng H, Wan Abdul Halim WH

Cureus, 2023 May;15(5):e38975.
PMID: 37313108 DOI: 10.7759/cureus.38975

A 36-year-old man presented with an acute onset of a right eye monocular altitudinal defect associated with pain on eye movement upon waking up from sleep. His right eye subsequently developed outward deviation and a total loss of vision. Clinical examination of the right eye revealed a visual acuity of no light perception (NLP) with the presence of relative afferent pupillary defect (RAPD) and involvement of cranial nerves II, III, IV, and VI. A marked optic disc swelling and peripapillary hemorrhages were seen in the right fundus. Contrast-enhanced computed tomography of the brain and orbit showed a unilateral enlargement and enhancement of the right intraorbital and intracanalicular segments of the optic nerve with surrounding fat stranding and orbital apex crowding. Magnetic resonance imaging showed T2/fluid-attenuated inversion recovery hyperintensity and enhancement of the optic nerve and the myelin sheath. Serum anti-myelin oligodendrocyte glycoprotein antibodies were detected. He was treated with corticosteroids, plasma exchange, and intravenous immunoglobulin. His vision improved slowly after treatment. This case report shows the diverse manifestations of myelin oligodendrocyte glycoprotein antibody disease, which includes the orbital apex syndrome.
Fulltext Comparison of 3 Grading Systems (House-Brackmann, Sunnybrook, Sydney) for the Assessment of Facial Nerve Paralysis and Prediction of Neural Recovery

Mat Lazim N, Ismail H, Abdul Halim S, Nik Othman NA, Haron A

Medeni Med J, 2023 Jun 20;38(2):111-119.
PMID: 37338861 DOI: 10.4274/MMJ.galenos.2023.42383

OBJECTIVE: Currently, multiple classification systems exist for the assessment of facial nerve paralysis. This study was designed to choose the most practical system for use in a clinical setting depending on the clinician need. We compared the responsiveness of the 3 facial nerve grading systems, i.e., House-Brackmann, Sydney, and Sunnybrook, as the subjective method and compared the outcomes with the objective method, i.e., the nerve conduction study. The correlation between the subjective and objective assessments was determined.
METHODS: A total of 22 consented participants with facial palsy was assessed with photos and videography recordings where they performed 10 standard facial expressions. The severity of facial paralysis was evaluated with the House-Brackmann, Sydney, and Sunnybrook grading scales subjectively and with the facial nerve conduction study objectively. The assessments were repeated after 3 months.
RESULTS: A Wilcoxon signed-rank test showed that there were statistically significant change in all three gradings after 3-month of assessment. The responsiveness of the nerve conduction study was significant for the nasalis and orbicularis oris muscles. It was not significant for the orbicularis oculi muscle. The nasalis and orbicularis oculi showed statistically significant correlation with the three classification systems except for the orbicularis oculi muscle.
CONCLUSIONS: All three grading systems, House-Brackmann, Sydney, and Sunnybrook, showed statistically significant responsiveness after 3 months of evaluation. The nasalis and orbicularis oculi muscle can be used to predict facial palsy recovery because they showed strong positive and negative correlations with the extent of facial nerve degeneration from the nerve conduction study.
Fulltext Usage of topical insulin for the treatment of diabetic keratopathy, including corneal epithelial defects

Leong CY, Naffi AA, Wan Abdul Halim WH, Bastion MC

World J Diabetes, 2023 Jun 15;14(6):930-938.
PMID: 37383598 DOI: 10.4239/wjd.v14.i6.930

BACKGROUND: Diabetic keratopathy (DK) occurs in 46%-64% of patients with diabetes and requires serious attention. In patients with diabetes, the healing of corneal epithelial defects or ulcers takes longer than in patients without diabetes. Insulin is an effective factor in wound healing. The ability of systemic insulin to rapidly heal burn wounds has been reported for nearly a century, but only a few studies have been performed on the effects of topical insulin (TI) on the eye. Treatment with TI is effective in treating DK.
AIM: To review clinical and experimental animal studies providing evidence for the efficacy of TI to heal corneal wounds.
METHODS: National and international databases, including PubMed and Scopus, were searched using relevant keywords, and additional manual searches were conducted to assess the effectiveness of TI application on corneal wound healing. Journal articles published from January 1, 2000 to December 1, 2022 were examined. The relevancy of the identified citations was checked against predetermined eligibility standards, and relevant articles were extracted and reviewed.
RESULTS: A total of eight articles were found relevant to be discussed in this review, including four animal studies and four clinical studies. According to the studies conducted, TI is effective for corneal re-epithelialization in patients with diabetes based on corneal wound size and healing rate.
CONCLUSION: Available animal and clinical studies have shown that TI promotes corneal wound healing by several mechanisms. The use of TI was not associated with adverse effects in any of the published cases. Further studies are needed to enhance our knowledge and understanding of TI in the healing of DK.
Fulltext Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review

Jane Ling MY, Abdul Halim AFN, Ahmad D, Ahmad N, Safian N, Mohammed Nawi A

Int J Environ Res Public Health, 2023 Feb 22;20(5).
PMID: 36900893 DOI: 10.3390/ijerph20053883

The use of e-cigarettes in adolescents remains a major public health concern. Like other tobacco products, e-cigarettes pose health risks to adolescents. Understanding the magnitude of this problem and identification of its associated factors will serve as a guide for development of preventive interventions. This systematic review aims to identify and discuss current epidemiological data on the prevalence and associated factors of e-cigarette use among adolescents in Southeast Asia. The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original English-language articles published between 2012 and 2021. A total of 10 studies were included in this review. The prevalence of current e-cigarette uses ranges from 3.3% to 11.8%. Several associated factors of e-cigarette use were identified, including sociodemographic factors, traumatic childhood experience, peer and parental influence, knowledge and perception, substance use, and accessibility of e-cigarettes. These factors should be addressed though multifaceted interventions which simultaneously target multiple factors. Laws, policies, programs, and interventions must be strengthened and tailored to the needs of adolescents at risk of using e-cigarettes.

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