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Fulltext Minimal solution of singular LR fuzzy linear systems

Nikuie M, Ahmad MZ

ScientificWorldJournal, 2014;2014:517218.
PMID: 24737977 DOI: 10.1155/2014/517218

In this paper, the singular LR fuzzy linear system is introduced. Such systems are divided into two parts: singular consistent LR fuzzy linear systems and singular inconsistent LR fuzzy linear systems. The capability of the generalized inverses such as Drazin inverse, pseudoinverse, and {1}-inverse in finding minimal solution of singular consistent LR fuzzy linear systems is investigated.
Fulltext Hamming distance method with subjective and objective weights for personnel selection

Saad R, Ahmad MZ, Abu MS, Jusoh MS

ScientificWorldJournal, 2014;2014:865495.
PMID: 24782670 DOI: 10.1155/2014/865495

Multicriteria decision making (MCDM) is one of the methods that popularly has been used in solving personnel selection problem. Alternatives, criteria, and weights are some of the fundamental aspects in MCDM that need to be defined clearly in order to achieve a good result. Apart from these aspects, fuzzy data has to take into consideration that it may arise from unobtainable and incomplete information. In this paper, we propose a new approach for personnel selection problem. The proposed approach is based on Hamming distance method with subjective and objective weights (HDMSOW's). In case of vagueness situation, fuzzy set theory is then incorporated onto the HDMSOW's. To determine the objective weight for each attribute, the fuzzy Shannon's entropy is considered. While for the subjective weight, it is aggregated into a comparable scale. A numerical example is presented to illustrate the HDMSOW's.
Fulltext Solving fuzzy fractional differential equations using Zadeh's extension principle

Ahmad MZ, Hasan MK, Abbasbandy S

ScientificWorldJournal, 2013;2013:454969.
PMID: 24082853 DOI: 10.1155/2013/454969

We study a fuzzy fractional differential equation (FFDE) and present its solution using Zadeh's extension principle. The proposed study extends the case of fuzzy differential equations of integer order. We also propose a numerical method to approximate the solution of FFDEs. To solve nonlinear problems, the proposed numerical method is then incorporated into an unconstrained optimisation technique. Several numerical examples are provided.
Fulltext Periodicity computation of generalized mathematical biology problems involving delay differential equations

Jasim Mohammed M, Ibrahim RW, Ahmad MZ

Saudi J Biol Sci, 2017 Mar;24(3):737-740.
PMID: 28386204 DOI: 10.1016/j.sjbs.2017.01.050

In this paper, we consider a low initial population model. Our aim is to study the periodicity computation of this model by using neutral differential equations, which are recognized in various studies including biology. We generalize the neutral Rayleigh equation for the third-order by exploiting the model of fractional calculus, in particular the Riemann-Liouville differential operator. We establish the existence and uniqueness of a periodic computational outcome. The technique depends on the continuation theorem of the coincidence degree theory. Besides, an example is presented to demonstrate the finding.
Fulltext Periodicity and positivity of a class of fractional differential equations

Ibrahim RW, Ahmad MZ, Mohammed MJ

Springerplus, 2016;5(1):824.
PMID: 27390664 DOI: 10.1186/s40064-016-2386-z

Fractional differential equations have been discussed in this study. We utilize the Riemann-Liouville fractional calculus to implement it within the generalization of the well known class of differential equations. The Rayleigh differential equation has been generalized of fractional second order. The existence of periodic and positive outcome is established in a new method. The solution is described in a fractional periodic Sobolev space. Positivity of outcomes is considered under certain requirements. We develop and extend some recent works. An example is constructed.
Fulltext Differential inequalities imposed by the extended hypergeometric function

Ibrahim RW, Ahmad MZ, Al-Janaby HF

Springerplus, 2016;5:375.
PMID: 27066382 DOI: 10.1186/s40064-016-1996-9

Recently, the generalized hypergeometric function is extended by utilizing the Beta function. Based on this type of function, we introduce a new operator in the open unit disk. The present article investigates some subordination and superordination results for certain normalized analytic functions in the open unit disk, which are acted upon by the generalized Noor integral operator. Some of outcomes improve and generalize previously known outcomes.
Fulltext Mathematical model for adaptive evolution of populations based on a complex domain

Ibrahim RW, Ahmad MZ, Al-Janaby HF

Saudi J Biol Sci, 2016 Jan;23(1):S45-9.
PMID: 26858564 DOI: 10.1016/j.sjbs.2015.09.012

A mutation is ultimately essential for adaptive evolution in all populations. It arises all the time, but is mostly fixed by enzymes. Further, most do consider that the evolution mechanism is by a natural assortment of variations in organisms in line for random variations in their DNA, and the suggestions for this are overwhelming. The altering of the construction of a gene, causing a different form that may be communicated to succeeding generations, produced by the modification of single base units in DNA, or the deletion, insertion, or rearrangement of larger units of chromosomes or genes. This altering is called a mutation. In this paper, a mathematical model is introduced to this reality. The model describes the time and space for the evolution. The tool is based on a complex domain for the space. We show that the evolution is distributed with the hypergeometric function. The Boundedness of the evolution is imposed by utilizing the Koebe function.
Fulltext Compensatory renal hypertrophy in reflux nephropathy presenting as hypertensive emergency

Othman Tan SES, Mohamad SD, Ahmad MZ

Oxf Med Case Reports, 2021 Feb;2021(2):omaa132.
PMID: 33614043 DOI: 10.1093/omcr/omaa132

Hypertensive emergency in the paediatric population is not uncommon. However, due to its numerous etiologies, care should be taken in determining the approach of management. We report a case of a child who presented with double vision, giddiness and elevated blood pressure. Blood investigations were normal. Renal ultrasound and magnetic resonance imaging of the abdomen were performed which both showed findings suspicious of a large heterogeneous mass at the lower pole of the left kidney with dysplastic right kidney. A final diagnosis of bilateral vesicoureteric reflux with left compensatory hypertrophy was made based upon micturating cystourethrography findings and was later confirmed by 99mTc-dimercaptosuccinic acid (DMSA) study. The objective of this case is to share the importance of the appropriate choice of radiological examinations, not only in achieving an accurate diagnosis but to ensure that unnecessary investigations are avoided.
OPTIMIZATION OF RADIATION DOSE IN CT IMAGING: ESTABLISHING THE INSTITUTIONAL DIAGNOSTIC REFERENCE LEVELS AND PATIENT DOSE AUDITING

Razali MASM, Ahmad MZ, Shuaib IL, Osman ND

Radiat Prot Dosimetry, 2020 Jun 13;188(2):213-221.
PMID: 31885043 DOI: 10.1093/rpd/ncz278

The aim of this study was to propose local diagnostic reference levels (LDRLs) for the most common computed tomography (CT) examinations (including contrast and non-contrast scan phase) performed at Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia (USM), Malaysia. A retrospective CT dose survey of 1488 subjects from January 2015 until December 2018 was performed at AMDI USM, Malaysia. The proposed DRLs were established at 50th and 75th percentile of dose distribution for all dose metrics (CT dose index [CTDI]; CTDIvol, CTDIw and dose-length product). The proposed LDRLs were compared with national DRLs and other established DRLs. The 10 most common CT examinations at AMDI were thorax-abdomen-pelvis (TAP) CT (46%), followed by pelvis CT (17%), abdomen-pelvis CT (10%), brain/head CT (9%) and other CT protocols. The local DRLs were established using the third quartile values of dose distribution and were categorized based on CT region protocols. Most of the proposed DRLs were exceeded the national DRLs (63%) and other international DRLs (67%). From the dose auditing, almost half of the recent dose data (for year 2018) exceeded the proposed local DRLs and the unusual dose were observed in TAP, brain/head and pelvis CT examinations. The unusual higher dose could be due to higher mAs settings, higher number of scan phase for contrast study and higher pitch factor. The local DRLs should be established for dose optimization and reduction of the occurrence of excessive radiation exposure to the patients. The establishment of the Ads and LDRLs should also consider all the factors that affect the variation in DRLs such as CT technology, scanning protocols and population characteristics. The local dose distribution should always be revised for improvement of the current local practice.
Fulltext Polymer Pen Lithography-Fabricated DNA Arrays for Highly Sensitive and Selective Detection of Unamplified Ganoderma Boninense DNA

Rani E, Mohshim SA, Ahmad MZ, Goodacre R, Alang Ahmad SA, Wong LS

Polymers (Basel), 2019 Mar 25;11(3).
PMID: 30960545 DOI: 10.3390/polym11030561

There is an increasing demand for lithography methods to enable the fabrication of diagnostic devices for the biomedical and agri-food sectors. In this regard, scanning probe lithography methods have emerged as a possible approach for this purpose, as they are not only convenient, robust and accessible, but also enable the deposition of "soft" materials such as complex organic molecules and biomolecules. In this report, the use of polymer pen lithography for the fabrication of DNA oligonucleotide arrays is described, together with the application of the arrays for the sensitive and selective detection of Ganoderma boninense, a fungal pathogen of the oil palm. When used in a sandwich assay format with DNA-conjugated gold nanoparticles, this system is able to generate a visually observable result in the presence of the target DNA. This assay is able to detect as little as 30 ng of Ganoderma-derived DNA without any pre-amplification and without the need for specialist laboratory equipment or training.
Fulltext Case Report-Staged brachytherapy achieving complete metabolic response in unresectable oligometastatic colorectal cancer to the liver

Appalanaido GK, Bahajjaj SIBZ, Shukor SA, Ahmad MZ, Francis HCH

Oxf Med Case Reports, 2021 Apr;2021(4):omab016.
PMID: 33948189 DOI: 10.1093/omcr/omab016

Liver is the most common site for metastasis from colorectal cancer (CRC). Non-surgical treatment options for oligometastatic CRC confined to the liver which represents an intermediate state in the metastatic cascade are fast expanding. Currently, several liver-directed local therapeutic options are available, such as hepatic arterial infusion (HAI) therapy, radio-frequency ablation (RFA), transarterial chemoembolization (TACE), stereotactic body radiotherapy and high dose rate brachytherapy (HDRBT). Many factors such as patient's fitness, liver function (LF), tumour size, location of the tumour in the liver and scheduling of systemic therapy need to be considered when selecting patients for surgery or local liver-directed therapy. This case report illustrates a successful local treatment with staged HDRBT for a large and unresectable, liver only oligometastatic disease from CRC. This patient underwent 4 cycles of chemotherapy (FOLFOX 4) followed by primary tumour resection and first stage of HDRBT to liver for a residual 14 cm tumour after the chemotherapy. After completing a further 4 cycles of chemotherapy with the same regimen, the tumour remained stable at 8 cm. She underwent a second stage of HDRBT to the same lesion and a repeat PET-CT scan done 8 weeks after the second HDRBT showed complete metabolic response. To our knowledge, this is the largest CRC metastatic liver lesion that has been successfully treated with HDRB.
Fulltext High Sensitivity Microfiber Interferometer Sensor in Aqueous Solution

Girei SH, Lim HN, Ahmad MZ, Mahdi MA, Md Zain AR, Yaacob MH

Sensors (Basel), 2020 Aug 21;20(17).
PMID: 32825539 DOI: 10.3390/s20174713

The need for environmental protection and water pollution control has led to the development of different sensors for determining many kinds of pollutants in water. Ammonia nitrogen presence is an important indicator of water quality in environmental monitoring applications. In this paper, a high sensitivity sensor for monitoring ammonia nitrogen concentration in water using a tapered microfiber interferometer (MFI) as a sensor platform and a broad supercontinuum laser as the light source is realized. The MFI is fabricated to the waist diameter of 8 µm producing a strong interference pattern due to the coupling of the fundamental mode with the cladding mode. The MFI sensor is investigated for a low concentration of ammonia nitrogen in water in the wide wavelength range from 1500-1800 nm with a high-power signal provided by the supercontinuum source. The broad source allows optical sensing characteristics of the MFI to be evaluated at four different wavelengths (1505, 1605, 1705, and 1785 nm) upon exposure towards various ammonia nitrogen concentrations. The highest sensitivity of 0.099 nm/ppm that indicates the wavelength shift is observed at 1785 nm operating wavelength. The response is linear in the ammonia nitrogen range of 5-30 ppm with the best measurement resolution calculated to be 0.5 ppm. The low concentration ammonia nitrogen detected by the MFI in the unique infrared region reveals the potential application of this optical fiber-based sensor for rivers and drinking water monitoring.
Fulltext Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis

Foo TY, Mohd Noor N, Yazid MB, Fauzi MH, Abdull Wahab SF, Ahmad MZ

BMC Emerg Med, 2020 10 08;20(1):81.
PMID: 33032544 DOI: 10.1186/s12873-020-00373-4

OBJECTIVES: The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia.
METHOD: The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol.
RESULTS: Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: - 14.30 to - 5.46; P = 0.0003; I2 = 92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: - 6.24 to 7.74; P < 0.001; I2 = 98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P = 0.001; I2 = 90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I2 = 0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I2 = 0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I2 = 21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P = 0.2; I2 = 38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P = 0.18; I2 = 42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P = 0.76; I2 = 0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P = 0.09; I2 = 53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P = 0.11; I2 = 61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P = 0.12; I2 = 59%).
CONCLUSION: There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents.
TRIAL REGISTRATION: PROSPERO CRD42019127278 .
Factors associated with severe envenomation of snakebite cases at emergency department, Hospital Sultan Abdul Halim, Kedah, Malaysia

Mhd Nizar MNF, Rahman A, Baharuddin KA, Ahmad MZ, Mohamed Ismail M

Med J Malaysia, 2022 Jan;77(1):20-25.
PMID: 35086990

INTRODUCTION: Snakebite envenomation is a medical emergency and cases continue to be encountered in Malaysian hospitals. This study aims to determine the prevalence of snakebite presentations and the associated factors with severe envenomation of snakebite in Sungai Petani, Kedah, Malaysia.
MATERIALS AND METHODS: This was a retrospective, crosssectional study involving snakebite patients presented at the Emergency Department (ED), Hospital Sultan Abdul Halim (HSAH), Kedah from 1 July 2015 to 30 June 2019. The cases were extracted from the computerized system and the case records of patients were retrieved from the Medical Record Unit. Patients that met the study criteria were included and their sociodemographic features, clinical presentations including use of anti-venom were collected. Logistic regression analysis was performed to determine the factors associated with severe envenomation.
RESULTS: A total of 220 snakebite cases with the mean age of patients was 39.66 (SD±21.79) years old. Majority of them were Malay and males. 41.4% of snakebite cases occurred in late evenings and the mean time-lapsed to arrive at HSAH was 108.6 minutes. 81.4% of snakebite cases occurred while engaging in outdoor activities and 43.6% of the snakebite cases involved work-related incidents. 58.2% of the patients were bitten in the lower limb. 78.6% of patients were bitten by the identified snake species, predominantly from Viperidae family. The prevalence of severe envenomation was 50.9%. Malay ethnicity (adj. OR =2.549, 95% CI =1.277,5.089), bite to the upper limb (adj. OR =2.125, 95% CI =1.192, 3.790), and bite by snakes from Viperidae family (adj. OR =3.017, 95% CI =1.613, 5.642) were found to have significant associations with severe envenomation of snakebite.
CONCLUSION: The prevalence of severe envenomation was more than 50% of snakebite cases. Malay ethnicity, upper limb snake bites, and snakebite from a Viperidae family had a higher chance of severe envenomation.
Sensitive Leptospira DNA detection using tapered optical fiber sensor

Zainuddin NH, Chee HY, Ahmad MZ, Mahdi MA, Abu Bakar MH, Yaacob MH

J Biophotonics, 2018 08;11(8):e201700363.
PMID: 29570957 DOI: 10.1002/jbio.201700363

This paper presents the development of tapered optical fiber sensor to detect a specific Leptospira bacteria DNA. The bacteria causes Leptospirosis, a deadly disease but with common early flu-like symptoms. Optical single mode fiber (SMF) of 125 μm diameter is tapered to produce 12 μm waist diameter and 15 cm length. The novel DNA-based optical fiber sensor is functionalized by incubating the tapered region with sodium hydroxide (NaOH), (3-Aminopropyl) triethoxysilane and glutaraldehyde. Probe DNA is immobilized onto the tapered region and subsequently hybridized by its complementary DNA (cDNA). The transmission spectra of the DNA-based optical fiber sensor are measured in the 1500 to 1600 nm wavelength range. It is discovered that the shift of the wavelength in the SMF sensor is linearly proportional with the increase in the cDNA concentrations from 0.1 to 1.0 nM. The sensitivity of the sensor toward DNA is measured to be 1.2862 nm/nM and able to detect as low as 0.1 fM. The sensor indicates high specificity when only minimal shift is detected for non-cDNA testing. The developed sensor is able to distinguish between actual DNA of Leptospira serovars (Canicola and Copenhageni) against Clostridium difficile (control sample) at very low (femtomolar) target concentrations.
Fulltext A Case of Linear Scleroderma in a Young Child: A Diagnosis Easily Missed in Primary Care

Bin Ahmad MZ, Mat Nasir N, Md Yasin M, Yusof ANM, Bakrin IH, Lim SC

Am J Case Rep, 2023 May 19;24:e940148.
PMID: 37202915 DOI: 10.12659/AJCR.940148

BACKGROUND This case illustrates the challenges in diagnosing linear scleroderma (LS) in a child who presented to a primary care setting. Diagnosis of LS is easily missed due to the lack of prominent symptoms, subtle visible skin changes, and under-recognition of this condition. CASE REPORT A 7-year-old boy presented with a linear, painless, non-itchy rash at the center of his forehead, which has been present for 6 months. The rash extends vertically from the hairline to the bridge of the nose. The color gradually evolved from reddish to purplish-grey and shiny within 3 months. He had underlying eczema, allergic rhinitis, and allergic conjunctivitis since birth. His condition remained unrecognized despite consultations with various medical specialties, including family medicine specialist, ophthalmologist, otorhinolaryngologist, and a general pediatrician. Six months after the onset of his lesion, he was subsequently referred to a pediatric dermatologist and pediatric rheumatologist, who made the diagnosis of LS. Laboratory investigations for autoimmune disease showed that negative antinuclear antibodies (ANA) and inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were normal. Skin biopsy provided a tissue confirmation of the diagnosis. MRI of the lesion showed no extension into the underlying muscle or bone erosions. The patient was initially treated with intravenous (IV) methylprednisolone for 3 days, followed by oral methotrexate weekly and prednisolone. The lesion improved after 1 month of treatment, and after 15 months it was less pigmented and less noticeable. CONCLUSIONS LS is the commonest form of localized scleroderma in children. LS on the forehead can erode into the underlying tissues and is sometimes associated with extensive hemifacial atrophy. Treatment should be instituted early to prevent late irreversible fibrotic sequelae. This report aims to highlight the importance of early diagnosis and treatment of an uncommon but potentially disfiguring condition.
Fulltext Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East coast of Peninsular Malaysia

Asha'ari ZA, Ahmad MZ, Jihan WS, Che CM, Leman I

Ann Saudi Med, 2013;33(5):469-75.
PMID: 24188941 DOI: 10.5144/0256-4947.2013.469

BACKGROUND AND OBJECTIVES: The role of honey in the treatment of allergic rhinitis (AR) is controversial. We studied the complementary effect of ingestion of a high dose of honey, in addition to standard medications, on AR.
DESIGN AND SETTINGS: Prospective randomized placebo-controlled study. Subjects were recruited from an otolaryngology clinic in 2 tertiary referral centers in the East coast of Peninsular Malaysia. The study period ranged from April 2010-April 2011.
METHODS: Forty AR patients were divided equally into a case group and a control group. All the subjects received a daily dose of 10 mg of loratadine for 4 weeks. The case group ingested 1 g/kg body weight of honey daily in separate doses for the 4-week period. The control group ingested the same dose of honey-flavored corn syrup as placebo. AR symptoms were scored at the start, week 4, and week 8 of the study.
RESULTS: There were no significant differences between the mean total symptom score of the case and the control groups at the start of the study. At week 4, both groups showed progressive improvement in the symptoms; at week 8, only the case group showed a continuous improvement in the symptom score. Only the group that ingested honey showed a significant improvement in individual AR symptoms. The improvement persisted for a month after the cessation of the treatment.
CONCLUSION: Honey ingestion at a high dose improves the overall and individual symptoms of AR, and it could serve as a complementary therapy for AR.
Antioxidant and Wound Healing Activity of Polyherbal Fractions of Clinacanthus nutans and Elephantopus scaber

Aslam MS, Ahmad MS, Mamat AS, Ahmad MZ, Salam F

Evid Based Complement Alternat Med, 2016;2016:4685246.
PMID: 27528881 DOI: 10.1155/2016/4685246

Elephantopus scaber and Clinacanthus nutans are traditionally used as wound healing herb. The objective of the present study is to develop a new polyherbal formulation, by comparison, the herbal combination of Elephantopus scaber and Clinacanthus nutans as an in vitro antioxidant activity with their individual herbal activity followed by fractionation of polyherbal formulation for in vivo wound healing activities and identification of bioactive compounds from their active fractions. Antioxidant activity was performed in vitro by DPPH scavenging antioxidant activity followed by in vivo wound healing activities using excision wound model, incision wound model, and burn wound model. Toxicity of the fractions of the polyherbal formulation was performed by a dermal toxicity test. The result showed that Elephantopus scaber crude extract on the basis of EC50 performs a much faster action (15.67 μg/mL) but with less % inhibition (87.66%) as compared to the combination of the new polyherbal formulation of crude extract (30 μg/mL). The polyherbal formulation has the highest % inhibition (89.49%) at the same dose as compared to Elephantopus scaber (87.66%). In comparison among all crude and fractions of new polyherbal formulation, it was found that the ethyl acetate fraction of polyherbal formulation has the fastest activity (EC50 14.83 μg/mL) with % inhibition (89.28%). Furthermore, during evaluation of wound contraction on excision and incision wound model, ethyl acetate fraction possesses the highest activity with (P < 0.001) and (P < 0.0001), respectively. During burn wound model, aqueous fraction (P < 0.001) possesses the highest activity followed by an ethyl acetate fraction (P < 0.0001). LC-MS analysis discovered the presence of several flavonoid-based compounds that work synergistically with sesquiterpene lactone and other bioactive compounds. In conclusion, flavonoid increases the antioxidant activity that surges the rate of wound contraction and works synergistically with other bioactive compounds.
Fulltext Early onset muscarinic manifestations after wild mushroom ingestion

Chew KS, Mohidin MA, Ahmad MZ, Tuan Kamauzaman TH, Mohamad N

Int J Emerg Med, 2008 Sep;1(3):205-8.
PMID: 19384518 DOI: 10.1007/s12245-008-0054-y

Despite being a favorite delicacy, only 200-300 of the 5,000 known mushroom species have been clearly established to be safe for consumption. Cases of mushroom poisoning have been reported with diverse clinical syndromes. A syndromic classification of mushroom poisoning has recently been developed to facilitate early interventions. We present a series of five cases of mushroom poisoning with muscarinic manifestations to highlight the difficulties we faced with exact species and toxin identification and the importance of this syndromic classification. The common symptoms in our case series are blurred vision, diarrhea, vomiting, and abdominal cramps.
Fulltext Telemedicine for gastrointestinal endoscopy: The Endoscopic Club E-conference in the Asia Pacific Region

Ho SH, Rerknimitr R, Kudo K, Tomimatsu S, Ahmad MZ, Aso A, et al.

Endosc Int Open, 2017 Apr;5(4):E244-E252.
PMID: 28382322 DOI: 10.1055/s-0043-102935

Background and study aims An Endoscopic Club E-conference (ECE) was set up in May 2014 to cater to increased demand for gastrointestinal endoscopy-related teleconferences in the Asia-Pacific region which were traditionally organized by the medical working group (MWG) of Asia-Pacific Advanced Network. This study describes how the ECE meeting was run, examines the group dynamics, outlines feedback and analyzes factors affecting the enthusiasm of participants. It is hoped that the findings here can serve as guidance for future development of other teleconference groups. Methods The preparation, running of and feedback on the ECE teleconference were evaluated and described. The country's economic situation, time zone differences, connectivity with a research and education network (REN) and engineering cooperation of each member were recorded and analyzed with regard to their association with participant enthusiasm, which was taken as participation in at least 50 % of the meetings since joining. Associations were calculated using 2-way table with chi-square test to generate odds ratio and P value. Results To date, ECE members have increased from 7 to 29 (increment of 314 %). Feedback received indicated a high level of satisfaction with program content, audiovisual transmission and ease of technical preparation. Upper gastrointestinal luminal endoscopy-related topics were the most favored program content. Those topics were presented mainly via case studies with a focus on management challenges. Time zone differences of more than 6 hours and poor engineering cooperation were independently associated with inactive participation (P values of 0.04 and 0.001 respectively). Conclusions Good program content and high-quality audiovisual transmission are keys to the success of an endoscopic medical teleconference. In our analysis, poor engineering cooperation and discordant time zones contributed to inactive participation while connectivity with REN and a country's economic situation were not significantly associated with participant enthusiasm.

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