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The optimisation of electrokinetic remediation for heavy metals and radioactivity contamination on Holyrood-Lunas soil (acrisol species) in Sri Gading Industrial Area, Batu Pahat, Johor, Malaysia

Mohamed Johar S, Embong Z

Radiat Prot Dosimetry, 2015 Nov;167(1-3):160-4.
PMID: 25920778 DOI: 10.1093/rpd/ncv236

The optimisation of electrokinetic remediation of an alluvial soil, locally named as Holyrood-Lunas from Sri Gading Industrial Area, Batu Pahat, Johor, Malaysia, had been conducted in this research. This particular soil was chosen due to its relatively high level of background radiation in a range between 139.2 and 539.4 nGy h(-1). As the background radiation is correlated to the amount of parent nuclides, (238)U and (232)Th, hence, a remediation technique, such as electrokinetic, is very useful in reducing these particular concentrations of heavy metal and radionuclides in soils. Several series of electrokinetics experiments were performed in laboratory scale in order to study the influence of certain electrokinetic parameters in soil. The concentration before (pre-electrokinetic) and after the experiment (post-electrokinetic) was determined via X-ray fluorescence (XRF) analysis technique. The best electrokinetic parameter that contributed to the highest achievable concentration removal of heavy metals and radionuclides on each experimental series was incorporated into a final electrokinetic experiment. Here, High Pure Germanium (HPGe) was used for radioactivity elemental analysis. The XRF results suggested that the most optimised electrokinetic parameters for Cr, Ni, Zn, As, Pb, Th and U were 3.0 h, 90 volts, 22.0 cm, plate-shaped electrode by 8 × 8 cm and in 1-D configuration order whereas the selected optimised electrokinetic parameters gave very low reduction of (238)U and (232)Th at 0.23 ± 2.64 and 2.74 ± 23.78 ppm, respectively.
Fulltext Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report

Ismail AS, Taharin R, Embong Z

Int Med Case Rep J, 2012;5:33-7.
PMID: 23754920 DOI: 10.2147/IMCRJ.S29960

Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.
Fulltext Gallium scan in diagnosing ocular sarcoidosis

Ismail S, Embong Z, Hitam WH

Malays J Med Sci, 2005 Jan;12(1):64-7.
PMID: 22605949

A 40-year-old man presented with floaters and painless progressive blurring of vision in the right eye for one month duration. Visual acuity in the right eye was 6/24. There was mild anterior chamber reaction and vitritis. The optic disc was swollen and elevated with presence of granulomatous lesion in the optic disc head. Blood investigations were unremarkable. Serum angiotensin converting enzyme (ACE) was normal and conjunctival biopsy showed presence of inflammatory cells. B-Scan ultrasound revealed an echo-dense lesion in the optic nerve head. There was increased uptake of the right lacrimal gland and presence of 'Panda sign' with Gallium scan. A diagnosis of right ocular sarcoidosis was made base on the clinical features and Gallium scan.
Fulltext Dental infection presenting with ipsilateral parapharyngeal abscess and contralateral orbital cellulitis - a case report

Embong Z, Ismail S, Thanaraj A, Hussein A

Malays J Med Sci, 2007 Jul;14(2):62-6.
PMID: 22993494 MyJurnal

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.
The Effect of H2S Pressure on the Formation of Multiple Corrosion Products on 316L Stainless Steel Surface

Shah M, Ayob MTM, Rosdan R, Yaakob N, Embong Z, Othman NK

ScientificWorldJournal, 2020;2020:3989563.
PMID: 32774180 DOI: 10.1155/2020/3989563

H2S gas when exposed to metal can be responsible for both general and localized corrosion, which depend on several parameters such as H2S concentration and the corrosion product layer formed. Therefore, the formation of passive film on 316L steel when exposed to H2S environment was investigated using several analysis methods such as FESEM and STEM/EDS analyses, which identified a sulfur species underneath the porous structure of the passive film. X-ray photoelectron spectroscopy analysis demonstrated that the first layer of CrO3 and Cr2O3 was dissolved, accelerated by the presence of H2S-Cl-. An FeS2 layer was formed by incorporation of Fe and sulfide; then, passivation by Mo took place by forming a MoO2 layer. NiO, Ni(OH)2, and NiS barriers are formed as final protection for 316L steel. Therefore, Ni and Mo play an important role as a dual barrier to maintain the stability of 316L steel in high pH2S environments. For safety concern, this paper is aimed to point out a few challenges dealing with high partial pressure of H2S and limitation of 316L steel under highly sour condition for the oil and gas production system.
Fulltext Neovascularization Detection and Localization in Fundus Images Using Deep Learning

Tang MCS, Teoh SS, Ibrahim H, Embong Z

Sensors (Basel), 2021 Aug 06;21(16).
PMID: 34450766 DOI: 10.3390/s21165327

Proliferative Diabetic Retinopathy (PDR) is a severe retinal disease that threatens diabetic patients. It is characterized by neovascularization in the retina and the optic disk. PDR clinical features contain highly intense retinal neovascularization and fibrous spreads, leading to visual distortion if not controlled. Different image processing techniques have been proposed to detect and diagnose neovascularization from fundus images. Recently, deep learning methods are getting popular in neovascularization detection due to artificial intelligence advancement in biomedical image processing. This paper presents a semantic segmentation convolutional neural network architecture for neovascularization detection. First, image pre-processing steps were applied to enhance the fundus images. Then, the images were divided into small patches, forming a training set, a validation set, and a testing set. A semantic segmentation convolutional neural network was designed and trained to detect the neovascularization regions on the images. Finally, the network was tested using the testing set for performance evaluation. The proposed model is entirely automated in detecting and localizing neovascularization lesions, which is not possible with previously published methods. Evaluation results showed that the model could achieve accuracy, sensitivity, specificity, precision, Jaccard similarity, and Dice similarity of 0.9948, 0.8772, 0.9976, 0.8696, 0.7643, and 0.8466, respectively. We demonstrated that this model could outperform other convolutional neural network models in neovascularization detection.
Fulltext Clinical profile and aetiology of optic neuritis in Hospital Universiti Sains Malaysia--5 years review

Ismail S, Wan Hazabbah WH, Muhd-Nor NI, Daud J, Embong Z

Med J Malaysia, 2012 Apr;67(2):159-64.
PMID: 22822635

Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.
Fulltext Prediction error and accuracy of intraocular lens power calculation in pediatric patient comparing SRK II and Pediatric IOL Calculator

Jasman AA, Shaharuddin B, Noor RA, Ismail S, Ghani ZA, Embong Z

BMC Ophthalmol, 2010;10:20.
PMID: 20738840 DOI: 10.1186/1471-2415-10-20

Despite growing number of intraocular lens power calculation formulas, there is no evidence that these formulas have good predictive accuracy in pediatric, whose eyes are still undergoing rapid growth and refractive changes. This study is intended to compare the prediction error and the accuracy of predictability of intraocular lens power calculation in pediatric patients at 3 month post cataract surgery with primary implantation of an intraocular lens using SRK II versus Pediatric IOL Calculator for pediatric intraocular lens calculation. Pediatric IOL Calculator is a modification of SRK II using Holladay algorithm. This program attempts to predict the refraction of a pseudophakic child as he grows, using a Holladay algorithm model. This model is based on refraction measurements of pediatric aphakic eyes. Pediatric IOL Calculator uses computer software for intraocular lens calculation.
Spontaneous bilateral anterior lens dislocation in an 8-year-old girl

Ismail S, Khairy-Shamel ST, Hussein A, Shaharuddin B, Embong Z, Ibrahim M

J Pediatr Ophthalmol Strabismus, 2010 Mar-Apr;47(2):111-3.
PMID: 20349906 DOI: 10.3928/01913913-20100308-11

The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.
Fulltext High Coke-Resistance Pt/Mg1-xNixO Catalyst for Dry Reforming of Methane

Al-Doghachi FA, Islam A, Zainal Z, Saiman MI, Embong Z, Taufiq-Yap YH

PLoS One, 2016;11(1):e0145862.
PMID: 26745623 DOI: 10.1371/journal.pone.0145862

A highly active and stable nano structured Pt/Mg1-xNixO catalysts was developed by a simple co-precipitation method. The obtained Pt/Mg1-xNixO catalyst exhibited cubic structure nanocatalyst with a size of 50-80 nm and realized CH4 and CO2 conversions as high as 98% at 900°C with excellent stability in the dry reforming of methane. The characterization of catalyst was performed using various kinds of analytical techniques including XRD, BET, XRF, TPR-H2, TGA, TEM, FESEM, FT-IR, and XPS analyses. Characterization of spent catalyst further confirms that Pt/Mg1-xNixO catalyst has high coke-resistance for dry reforming. Thus, the catalyst demonstrated in this study, offers a promising catalyst for resolving the dilemma between dispersion and reducibility of supported metal, as well as activity and stability during high temperature reactions.
Fulltext Investigation of natural environmental radioactivity concentration in soil of coastaline area of Ado-Odo/Ota Nigeria and its radiological implications

Joel ES, Maxwell O, Adewoyin OO, Olawole OC, Arijaje TE, Embong Z, et al.

Sci Rep, 2019 03 12;9(1):4219.
PMID: 30862825 DOI: 10.1038/s41598-019-40884-0

Natural radioactivity in coastaline area soil of Ado-Odo/Ota has been carried out to ascertain the presence of radionuclides using gamma-ray spectroscopy (HPGe detector). The result showed that U-238, Th-232 and K-40 ranged from 24 ± 7-49 ± 10; 67 ± 6-120 ± 9 and 88 ± 17-139 ± 20 Bqkg-1 respectively. The radium equivalent for the samples ranged from 132.51 to 230.91 Bqkg-1 with mean value of 185.89 Bqkg-1. The mean value for the gamma dose rate for the soil samples was estimated to be 81.32 nGyh-1. The estimated values of annual effective dose equivalent ranged from 0.61 to 1.07 mSv y-1. The estimation of alpha index representative (Iα) ranged from 0.12 to 0.24 with mean value of 0.21 while the gamma representative index ranged between 0.465 and 0.810. The activity utilization index of the soil samples ranged from 1.09 to 1.89 with mean value of 1.53. The radiological implication in the study area has shown that the soil samples with gamma dose rate value of 89.99 nGyh-1, 94.39 nGyh-1, 97.40 nGyh-1 and 101.04 nGyh-1 respectively are higher than the recommended value of 80 nGyh-1 and may pose health implication for long term exposure.
Fulltext Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Abdul-Salim I, Embong Z, Khairy-Shamel ST, Raja-Azmi MN

Clin Ophthalmol, 2013;7:703-6.
PMID: 23589678 DOI: 10.2147/OPTH.S42208

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.
A STUDY OF NATURAL RADIOACTIVITY IN SOME BUILDING MATERIALS IN NIGERIA

Maxwell O, Emmanuel JS, Olusegun AO, Cyril EO, Ifeanyi AT, Embong Z

Radiat Prot Dosimetry, 2019 May 01;183(3):332-335.
PMID: 30085254 DOI: 10.1093/rpd/ncy121

Building materials of different brands were assessed for the concentrations of 226Ra, 232Th and 40K using HPGe detector. The activity concentrations in the measured samples ranged from 27 ± 8 to 82 ± 8 Bq kg-1 for 226Ra, 41 ± 4 to 101 ± 8 Bq kg-1 for 232Th and 140 ± 8 to 940 ± 19 Bq kg-1 for 40K, respectively. The Radium equivalent (Raeq) activity from the samples was found to be <370 Bq kg-1 as the recommended value for construction materials. This study will set a baseline data for significant standards on radiation exposure of the measured radionuclides in the selected building materials used in Nigeria.
Fulltext Radionuclides proportion and radiological risk assessment of soil samples collected in Covenant University, Ota, Ogun State Nigeria

Adewoyin OO, Omeje M, Joel ES, Akinwumi SA, Ehi-Eromoseled CO, Embong Z

MethodsX, 2018;5:1419-1426.
PMID: 30456176 DOI: 10.1016/j.mex.2018.10.023

The activity levels of 238U, 232Th and 40K in soil surrounding major office complexes in Covenant University were analyzed for radiological hazards to determine the safety of the residents in such environment. Sixteen (16) soil samples were collected, prepared and sent to Acme laboratory in Canada for analysis with the use of high purity germanium detector. The mean activity concentrations of 238U, 232Th and 40K were found to be 45 ± 10, 135 ± 8 and 195 ± 20 respectively. The concentrations of 238U and 232Th were found to be higher than the world recommended standard of 35 and 30, while the result for 40K was noted to be lower than the world safe limit. The average values of Raeq, D, AED, Iyr, Hex and ELCR in this study were estimated to be 252.33 Bq/kg, 110.15 nGy/h, 0.13 mSv/y, 1.78, 0.68 and 0.47 × 10-3 respectively. It was noticed that none of the measured parameters was higher than the internationally recommended safe limits. 232Th was found to be the major contributor to the environmental radionuclides in the area of study. Therefore, the inhabitants of the office complexes whose environment was assessed are considered not be exposed to any radiological hazards.
Fulltext Detection of FZD4, LRP5 and TSPAN12 Genes Variants in Malay Premature Babies with Retinopathy of Prematurity

Mohd Khair SZN, Ismail AS, Embong Z, Mohamed Yusoff AA

J Ophthalmic Vis Res, 2019 5 23;14(2):171-178.
PMID: 31114654 DOI: 10.4103/jovr.jovr_210_17

Purpose: To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community.
Methods: A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP).
Results: We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3'UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively).
Conclusion: Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.
Fulltext In-situ assessment of natural terrestrial-radioactivity from Uranium-238 (238U), Thorium-232 (232Th) and Potassium-40 (40K) in coastal urban-environment and its possible health implications

Joel ES, Omeje M, Olawole OC, Adeyemi GA, Akinpelu A, Embong Z, et al.

Sci Rep, 2021 09 02;11(1):17555.
PMID: 34475416 DOI: 10.1038/s41598-021-96516-z

The risk of natural terrestrial radioactivity on human health is often underestimated, and environmental safety awareness is necessary. Hence, this study aims to assess natural sources of gamma radiation emitter in coastal urban-environment using the radiometric technique. The dosage of gamma radiation from a parent radionuclide such as Uranium-238 (238U), Thorium-232 (232Th) and Potassium-40 (40K) and were measured using portable gamma spectroscopy. The result showed that the measured value of 238U activity was between 10.81 [Formula: see text] 0.69 and 46.31 [Formula: see text] 1.43 Bqkg-1. The mean value was estimated to be 35.44 [Formula: see text] 0.97 Bqkg-1 which is slightly higher than the world average. Meanwhile, 232Th activity ranges from 28.42 [Formula: see text] 1.12 to 69.43 [Formula: see text] 1.76 Bqkg-1 with the calculated mean value of 92.57 [Formula: see text] 1.17 Bqkg-1 while 40K activity ranged between 31.30 ± 1.32 and 328.65 ± 2.32 Bqkg-1 with the estimated mean 137.59 [Formula: see text] 2.42 Bqkg-1. Radiological parameters such as radium equivalent (Req), internal hazard (Hint) and external hazard (Hext) assessment were in the range of 66.00 Bqkg-1 to 141.76 Bqkg-1, 0.232 to 0.452 and 0.178 to 0.383, respectively. The measured values of gamma dose-rates ranged between 54.283 ± 0.78 and 117.531 ± 1.14 nGyh-1 with the calculated mean value of 84.770 ± 0.97 nGyh-1.
Fulltext Estimation of activity concentrations of radionuclides and their hazard indices in coastal plain sand region of Ogun state

Adewoyin OO, Maxwell O, Akinwumi SA, Adagunodo TA, Embong Z, Saeed MA

Sci Rep, 2022 Feb 08;12(1):2108.
PMID: 35136130 DOI: 10.1038/s41598-022-06064-3

Assessment of natural background radionuclides emanating from the subsurface geological features was carried out with the use of gamma-ray spectrometry at various locations at one of the secondary school in Canaan land, Ota, Ogun State. The activity concentrations of 226Ra, 232Th and 40K were revealed to be 12.66 ± 0.76-42.33 ± 1.37, 44.96 ± 1.41-128.70 ± 1.56, 31.30 ± 1.18-453.85 ± 2.43 Bq kg-1 respectively. The mean value of 232Th reported higher than the world reference standard of 50 Bq kg-1. Moreover, the stations closest to the school's laboratory were noticed to be prone to more gamma radiations than the other buildings in the school. Similarly, the results of the radiological parameters estimated varied between 86.04-243.7 Bq kg-1, 40.02-115.4 nGy h-1, 0.049-0.142 mSv y-1 and 0.232-0.658 for Raeq, D(out), AEDE and Hex, respectively. Although, the results of the radiological parameters did not exceed the world safe limits, higher values of these parameters were reported at some stations closer to the school laboratory. It can be concluded that the school laboratory is prone to more gamma radiation than the class rooms and the administrative block. Therefore, the laboratory instructors and staff, who spend longer time in the laboratory, are more liable to the health risk that could result from years of exposure to gamma radiation in the laboratory.
Fulltext Assessment of natural radioactivity in various commercial tiles used for building purposes in Nigeria

Joel ES, Maxwell O, Adewoyin OO, Ehi-Eromosele CO, Embong Z, Oyawoye F

MethodsX, 2018;5:8-19.
PMID: 29387568 DOI: 10.1016/j.mex.2017.12.002

In this study, we evaluated the activity concentration of natural radionuclides (226Ra, 232Th and 40K) for fifteen (15) different brands of tile samples used for building purposes in Nigeria. The tile samples were analyzed using High purity Germanium gamma detector. The mean activity concentrations of 226Ra, 232Th, and 40K were observed to be 61.1 ± 5.5 Bq/kg, 70.2 ± 6.08 Bq/kg and 514.7 ± 59.8 Bq/kg respectively. Various hazard indices such as absorbed dose rate, external and internal hazard index, annual effective dose rate, Gamma activity Index (Iγ) and Alpha Index (Iα) were calculated. The obtained results showed that the mean radium equivalent activity (Raeq), the absorbed dose rate (D), external and internal hazard index, the annual effective dose (AEDR) equivalent, Gamma activity Index (Iγ) and Alpha Index (Iα) were: 204.42 Bq/kg, 177.61 nGyh-1, 0.55, 0.77, 0.96 mSvyr-1, 0.74 and 0.32 respectively. The average value of radium equivalent obtained in this study is less than that of the recommended value of 370 Bq/kg but the average values of the other radiological hazards for some samples are found to be slightly above international recommended values except Hex, Hin and AEDE which are within the international reference value of unity. The measured concentrations of these radioactive materials were correlated with other previous result obtained from similar tile materials used in other countries and found to be in good agreement with the international standard, however, the tiles are recommended for decoration purposes in Nigeria.
Fulltext Syphilitic uveitis: report of 3 cases

Pan SW, Yusof NS, Hitam WH, Noor RA, Embong Z

Int J Ophthalmol, 2010;3(4):361-4.
PMID: 22553594 DOI: 10.3980/j.issn.2222-3959.2010.04.21

AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients.
METHODS: Case series of three patients with syphilitic uveitis who were managed in Hospital USM.
RESULTS: Three patients were diagnosed to have uveitis secondary to Syphilis. All three patients were not known to have syphilis prior to presentation but have positive history of sexual promiscuity. All patients presented with progressive blurring of vision for average of one-month duration. Two of them have association with fever, ocular pain and floaters. Visual acuity at presentation ranges from 6/12 to hand movement. Mild anterior uveitis (non-granulomatous), vitritis and papillitis were presence in all the patients. First patient has multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinal detachment while the third patient has chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral.
CONCLUSION: Ocular syphilis presented here as non-granulomatous inflammation associated with exudative retinal detachment. Final visual outcome is generally good despite slow improvement after treatment.
Fulltext Orbital apex syndrome after tooth extraction in an immunocompromised patient

Subramaniam S, Min Tet C, Hazabbah Wan Hitam W, Hussein A, Ahmed Khan S, Kanti Pal H, et al.

Int J Ophthalmol, 2011;4(1):112-4.
PMID: 22553623 DOI: 10.3980/j.issn.2222-3959.2011.01.26

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

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