Displaying publications 1 - 20 of 34 in total

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  1. Arashi M, Roozbeh M, Hamzah NA, Gasparini M
    PLoS One, 2021;16(4):e0245376.
    PMID: 33831027 DOI: 10.1371/journal.pone.0245376
    With the advancement of technology, analysis of large-scale data of gene expression is feasible and has become very popular in the era of machine learning. This paper develops an improved ridge approach for the genome regression modeling. When multicollinearity exists in the data set with outliers, we consider a robust ridge estimator, namely the rank ridge regression estimator, for parameter estimation and prediction. On the other hand, the efficiency of the rank ridge regression estimator is highly dependent on the ridge parameter. In general, it is difficult to provide a satisfactory answer about the selection for the ridge parameter. Because of the good properties of generalized cross validation (GCV) and its simplicity, we use it to choose the optimum value of the ridge parameter. The GCV function creates a balance between the precision of the estimators and the bias caused by the ridge estimation. It behaves like an improved estimator of risk and can be used when the number of explanatory variables is larger than the sample size in high-dimensional problems. Finally, some numerical illustrations are given to support our findings.
  2. Hamzah N, Nagarajah M, Leo CP
    Water Sci Technol, 2018 Dec;78(12):2532-2541.
    PMID: 30767918 DOI: 10.2166/wst.2019.016
    Fat, oil and grease in wastewater generated from household kitchens, restaurants and food processing plants affect sewer systems, water resources and environment adversely. Hence, membrane distillation of saline and oily water was studied using a nearly superhydrophobic membrane developed in this work. Polyvinylidene fluoride (PVDF) membrane incorporated SiO2 nanoparticles was synthesized via phase inversion with dual baths and modified using hexadecyltrimethoxy silane. The volume ratio of silane to ethanol was varied between 1:200 to 1:25. The membrane characteristics were examined using a goniometer, a porometer, scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). The PVDF-SiO2 membrane modified using the volume ratio of 1:50 achieved the highest water contact angle of 141.6° and LEP of 2.642 bar. This membrane was further tested in membrane distillation to observe the permeate flux of distilled water, saline solution (1 M NaCl) as well as saline and oily solution (1 M NaCl; 1,000 ppm of palm oil). The modified PVDF/SiO2 showed high permeate flux which is nearly four times of the permeate flux of neat PVDF membrane, but still susceptible of salt and oil fouling as shown in SEM images.
  3. Md Hamzah N, See KF
    BMC Health Serv Res, 2021 Oct 19;21(1):1119.
    PMID: 34663311 DOI: 10.1186/s12913-021-06786-6
    BACKGROUND: Policymakers are faced with the challenge of balancing patient's access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient's willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion.

    METHODS: We matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.

    RESULTS: The utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.

    CONCLUSIONS: Understanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.

  4. Hamzah N, Sarbon NM, Amin AM
    J Food Sci Technol, 2015 Aug;52(8):4773-84.
    PMID: 26243898 DOI: 10.1007/s13197-014-1622-1
    This study aimed to determine the effects of 2-5 wash cycles and the addition of tetrasodium pyrophosphate (TSPP) (0 %, 0.05 Surimi% and 0.1 % w/w)-with or without the addition of 0.4 % calcium chloride (CaCl2)-on the physical properties such as texture, colour, expressible moisture and microstructure of Cobia (Rachycentron canadum) surimi gel. The highest breaking force (484.85 g) was obtained with the addition 0.1 % TSPP alone on the fifth wash. However, a combination of 0.1 and 0.4 % CaCl2 in surimi gels at wash cycle 5 resulted in the highest degree of whiteness (86.8 %), as well as total expressible moisture (2.785 %) and deformation (17.11 mm). The highest surimi gel strength (6,923 g.mm) was obtained after three wash cycles with the addition of 0.1 % TSPP +0.4 % CaCl2. The physical properties of Cobia fish surimi gels were affected by the number of wash cycles and treatments with TSPP and CaCl2.
  5. Hamzah N, Safuan S, Wan Ishak WR
    Molecules, 2021 Jun 16;26(12).
    PMID: 34208534 DOI: 10.3390/molecules26123665
    Endothelial cell dysfunction is considered to be one of the major causes of vascular complications in diabetes. Polyphenols are known as potent antioxidants that can contribute to the prevention of diabetes. Corn silk has been reported to contain polyphenols and has been used in folk medicine in China for the treatment of diabetes. The present study aims to investigate the potential protective role of the phenolic-rich fraction of corn silk (PRF) against injuries to vascular endothelial cells under high glucose conditions in vitro and in vivo. The protective effect of PRF from high glucose toxicity was investigated using human umbilical vein endothelial cells (HUVECs). The protective effect of PRF was subsequently evaluated by using in vivo methods in streptozotocin (STZ)-induced diabetic rats. Results showed that the PRF significantly reduced the cytotoxicity of glucose by restoring cell viability in a dose-dependent manner. PRF was also able to prevent the histological changes in the aorta of STZ-induced diabetic rats. Results suggested that PRF might have a beneficial effect on diabetic patients and may help to prevent the development and progression of diabetic complications such as diabetic nephropathy and atherosclerosis.
  6. Mohd-Aspar MA, Edros R, Hamzah NA
    Trop Biomed, 2021 Sep 01;38(3):226-238.
    PMID: 34362865 DOI: 10.47665/tb.38.3.062
    The study aims to formulate and optimise topical antibacterial preparation by using Malaysian kelulut honey as the active ingredient and xanthan gum as the polymeric agent. Response surface methodology was used to optimise the preparation. The acidity, honey concentration and xanthan gum concentration were the independent variables. The zone of inhibitions on S. aureus ATCC6538 and E. coli ATCC8739 were the response variables. The optimal preparation was evaluated on its physicochemical properties, viscosity, antibacterial efficacy and stability. The antibacterial efficacy of the optimal preparation was compared to the commercially antibacterial gel (MediHoney™, Comvita). The optimal preparation was formulated at pH of 3.5, honey concentration of 90% (w/v) and xanthan gum concentration of 1.5% (w/v) with the inhibition zones measured on S. aureus ATCC6538 was 16.2 mm and E. coli ATCC8739 was 15.8 mm respectively. The factors of acidity and honey concentration have significantly influenced the inhibition zone on S. aureus ATCC6538 and E. coli ATCC8739. The utilisation of xanthan gum as the polymeric agent was fit for the preparation which showed by adequate physicochemical properties and retained of the antibacterial effects. This was supported by constant viscosity and efficacy of the preparation within the six months of stability study indicating stable and reliable preparation. Xanthan gum is a potential polymeric agent due to its effective use in preparing stable preparation with effective antibacterial properties.
  7. Tao W, Mei C, Hamzah N
    J Contam Hydrol, 2020 May;231:103620.
    PMID: 32126294 DOI: 10.1016/j.jconhyd.2020.103620
    Surfactant solutions have been frequently studied for soil remediation. However, since they are expensive, massive consumption of surfactant solution can constrain their application. Surfactant microbubbles, or colloidal gas aphrons (CGAs), can serve as cost effective alternatives of surfactant solution because the use of CGAs reduce the amount of surfactant consumption. Moreover, CGAs can also improve the contact with the contaminated environment due to their unique surface properties, e.g. containing 40-70% of gas, small size, large interfacial areas, water-like flow properties and buoyant rise velocities. In this review paper, the properties and flow character of CGAs in soil matrix reviewed due to their relevance to soil remediation process. A comprehensive overview of the application of CGAs in flushing off organic pollutants and heavy metals, and carrying oxygen, bacteria and dissolved materials for soil remediation were provided. This paper also highlighted the limitation of CGAs application and important future research scopes.
  8. Sreedharan S, Veeramuthu V, Hariri F, Hamzah N, Ramli N, Narayanan V
    Int J Oral Maxillofac Surg, 2020 Sep;49(9):1183-1192.
    PMID: 32224001 DOI: 10.1016/j.ijom.2020.03.002
    Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.
  9. Md Hamzah N, Yu MM, See KF
    Health Care Manag Sci, 2021 Jun;24(2):273-285.
    PMID: 33651316 DOI: 10.1007/s10729-020-09539-9
    Malaysia was faced with a life-threatening crisis in combating COVID-19 with a number of positive cases reaching 5305 and 88 deaths by 18th April 2020 (the first detected case was on 25th January 2020). The government rapidly initiated a public health response and provided adequate medical care to manage the public health crisis during the implementation of movement restrictions, starting 18th March 2020, throughout the country. The objective of this study was to investigate the relative efficiency level of managing COVID-19 in Malaysia using network data envelopment analysis. Malaysia state-level data were extracted from secondary data sources which include variables such as total number of confirmed cases, death cases and recovered cases. These variables were used as inputs and outputs in a network process that consists of 3 sub processes i) community surveillance, ii) medical care I and iii) medical care II. A state-level analysis was performed according to low, medium and high population density categories. The efficiency level of community surveillance was highest compared to medical care processes, indicating that the overall inefficiency is greatly influenced by the inefficiency of the medical care processes rather than the community surveillance process. Results showed that high-density category performed well in both community surveillance and medical care II processes. Meanwhile, low-density category performed better in medical care I process. There was a good overall performance of the health system in Malaysia reflecting a strong preparedness and response level to this pandemic. Furthermore, resource allocation for rapid response was distributed effectively during this challenging period.
  10. Hamzah N, Kjellberg M, Vanninen P
    Rapid Commun Mass Spectrom, 2023 May 15;37(9):e9495.
    PMID: 36799074 DOI: 10.1002/rcm.9495
    RATIONALE: This paper describes an in vitro study designed to identify metabolic biomarkers resulting from the conjugation of nitrogen mustards (NMs) with glutathione (GSH). The method developed is essential in providing evidence in the event of NM exposure in biomedical samples.

    METHODS: The mass spectral characterization of the proposed NMs-GSH conjugates was performed with liquid chromatography high-resolution tandem mass spectrometry (LC-HRMS/MS). The final reaction mixtures were analysed in positive electrospray ionisation (ESI) at different incubation times.

    RESULTS: This study identified three types of conjugates in addition to ethanolamines, the hydrolysis products of NMs. Monoglutathionyl, diglutathionyl and phosphorylated conjugates were produced for each of the NMs, bis(2-chloroethyl)ethylamine (HN1), bis(2-chloroethyl)methylamine (HN2) and tris(2-chloroethyl)amine (HN3). The monoglutathionyl conjugates consisted of HN1-GSH, HN2-GSH and HN3-GSH. The spontaneous and primary conjugates of diglutathionyl were HN1-GSH2, HN2-GSH2 and HN3-GSH2. These included phosphorylated conjugates, namely HN1-GSH-PO4 , HN2-GSH-PO4 and HN3-GSH-PO4 , as might have formed due to hydrolysis in phosphate buffer.

    CONCLUSIONS: The mass spectral data of all conjugates formed in the presence of all NMs and GSH are reported in this study. These GSH metabolites can be used to confirm NMs toxicity in biological samples such as urine.

  11. Hamzah N, Kasmuri N, Tao W, Singhal N, Padhye L, Swift S
    Braz J Microbiol, 2020 Sep;51(3):1317-1326.
    PMID: 32399689 DOI: 10.1007/s42770-020-00295-0
    Bacterial adhesion on surfaces is an essential initial step in promoting bacterial mobilization for soil bioremediation process. Modification of the cell surface is required to improve the adhesion of bacteria. The modification of physicochemical properties by rhamnolipid to Pseudomonas putida KT2442, Rhodococcus erythropolis 3586 and Aspergillus brasiliensis ATCC 16404 strains was analysed using contact angle measurements. The surface energy and total free energy of adhesion were calculated to predict the adhesion of both bacteria strains on the A. brasiliensis surface. The study of bacterial adhesion was carried out to evaluate experimental value with the theoretical results. Bacteria and fungi physicochemical properties were modified significantly when treated with rhamnolipid. The adhesion rate of P. putida improved by 16% with the addition of rhamnolipid (below 1 CMC), while the increase of rhamnolipid concentration beyond 1 CMC did not further enhance the bacterial adhesion. The addition of rhamnolipid did not affect the adhesion of R. erythropolis. A good relationship has been obtained in which water contact angle and surface energy of fungal surfaces are the major factors contributing to the bacterial adhesion. The adhesion is mainly driven by acid-base interaction. This finding provides insight to the role of physicochemical properties in controlling the bacterial adhesion on the fungal surface to enhance bacteria transport in soil bioremediation.
  12. Hamzah NM, Perera PN, Rannan-Eliya RP
    BMC Health Serv Res, 2020 Jun 05;20(1):509.
    PMID: 32503539 DOI: 10.1186/s12913-020-05362-8
    BACKGROUND: Malaysia's public healthcare sector provides a greater volume of medicines at lower overall cost compared to the private sector, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH) has concerns about the continuous increase in the public sector medicines budget, and achieving efficiencies in medicines procurement is an important goal. The objectives of this study were to assess the overall trend in public sector pharmaceutical procurement efficiency from 2010 to 2014, and determine if the three different ways in which MOH procures medicines influence efficiency.

    METHODS: We matched medicines from the public sector procurement report by medicine formulation to medicines with a Management Sciences for Health (MSH) International Reference Price (IRP) for each year. Price ratios were calculated, and utilizing the information on quantity and expenditure for each product, summary measures of procurement efficiency were reported as quantity- and expenditure-weighted average price ratios (WAPRs) for each year. Utilizing MOH procurement data to obtain information on procurement type, a multiple regression analysis, controlling for factors that can influence prices, assessed whether procured efficiency (relative to IRPs) differed by MOH procurement type.

    RESULTS: Malaysia's public sector purchased medicines at two to three times the IRP throughout the study period. However, procurement prices were relatively stable in terms of WAPRs each year (2.2 and 3.2 in 2010 to 1.9 and 2.9 in 2014 for quantity and expenditure WAPRs, respectively). Procurement efficiency did not vary between the three different methods of MOH procurement. Procurement efficiency of both imported originators and imported generics were significantly lower (P 

  13. Subbiah D, Asiff NH, Hamzah N, Samsudin A
    Cureus, 2022 Dec;14(12):e32498.
    PMID: 36644099 DOI: 10.7759/cureus.32498
    Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome is a neurocutaneous disorder of the skin, eye, and central nervous system. A three-month-old girl was referred to our center for further management of a large left eye corneal dermoid. At birth, a small lesion was noted. Magnetic resonance imaging (MRI) around the first week of life showed an extraocular dermoid cyst measuring 1 mm x 7 mm, dysplasia of the left greater wing of sphenoid, closed-lip schizencephaly of the left parietal lobe, and polymicrogyria. During examination under anesthesia at our center, we found that the corneal dermoid had grown in size to 17 mm x 16 mm, with posterior embryotoxon, a hazy cornea, and intraocular pressure of 26 mmHg. With the anterior segment dysgenesis and secondary glaucoma, we started Gutt Timo-Comod BD. Serial MRI imaging at four months of age revealed further enlargement of the dermoid, a new left retrobulbar mass, and multiple intracranial lipomas. A diagnosis of ECCL was made at this point based on the MRI and clinical findings. A multidisciplinary meeting was held among ophthalmology, neurosurgery, radiology, and otorhinolaryngology (ORL) teams, which concluded that surgical intervention such as tumor debulking might cause more harm than benefit. Hence, she was planned to undergo close monitoring with serial MRIs and only for surgical intervention, in the presence of airway compression or any neurological deficits. The ophthalmologist should be aware of the specific radiological and clinical findings in ECCL as management of the condition would be best through a multidisciplinary approach.
  14. Wai YZ, Radhakrishnan DM, Lingam G, Hamzah N, Rahmat J
    Taiwan J Ophthalmol, 2023;13(4):527-534.
    PMID: 38249495 DOI: 10.4103/tjo.TJO-D-22-00162
    PURPOSE: We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.

    MATERIALS AND METHODS: This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.

    RESULTS: The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage (P = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).

    CONCLUSION: Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.

  15. Al-Hardan NH, Abdul Hamid MA, Ahmed NM, Jalar A, Shamsudin R, Othman NK, et al.
    Sensors (Basel), 2016 Jun 07;16(6).
    PMID: 27338381 DOI: 10.3390/s16060839
    In this study, porous silicon (PSi) was prepared and tested as an extended gate field-effect transistor (EGFET) for pH sensing. The prepared PSi has pore sizes in the range of 500 to 750 nm with a depth of approximately 42 µm. The results of testing PSi for hydrogen ion sensing in different pH buffer solutions reveal that the PSi has a sensitivity value of 66 mV/pH that is considered a super Nernstian value. The sensor considers stability to be in the pH range of 2 to 12. The hysteresis values of the prepared PSi sensor were approximately 8.2 and 10.5 mV in the low and high pH loop, respectively. The result of this study reveals a promising application of PSi in the field for detecting hydrogen ions in different solutions.
  16. Hisham R, Ng CJ, Liew SM, Hamzah N, Ho GJ
    BMJ Open, 2016 Mar 09;6(3):e010565.
    PMID: 26962037 DOI: 10.1136/bmjopen-2015-010565
    OBJECTIVE: To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors' views and experiences.
    RESEARCH DESIGN: The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach.
    PARTICIPANTS: 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings.
    SETTING: The study was conducted across three primary care settings-an academic primary care practice, private and public health clinics in Klang Valley, Malaysia.
    RESULTS: The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors' daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors' practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience.
    CONCLUSIONS: Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace 'EBM culture' had an important influence on the doctors' behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care.
    Study site: klinik kesihatan, general practice clinics, Klang Valley, Malaysia
  17. Othman AK, Udin N, Shab MS, Hamzah NA, Mat Azmi IS, Naing NN
    Med J Malaysia, 2020 11;75(6):705-709.
    PMID: 33219181
    INTRODUCTION: Brain tumour (BT) is a tremendous burden on patients, families as well as the surrounding communities, especially the healthcare services. It can be classified into either a benign slow growing tumour (non-cancerous) and malignant tumour (cancerous). The purpose of this study was to determine the incidence and pattern of brain tumour admitted to the Neurosurgery Department in Hospital Sultanah Nurzahirah (HSNZ), Terengganu, Malaysia.

    METHODS: This is a retrospective study of incidence and pattern of BT admitted to the Neurosurgery Department in HSNZ. Data was collected from the yearly census of BT registered from 2013 to 2018.

    RESULTS: A total number of 386 new cases of primary BT were registered. The number of cases of BT was found to be lowest among children (0 to 10 years old) with only 4.4% but at peak among elderly aged between 51 to 60 years old (26.2%). As for gender, males constituted about 44.5% (n=172) whereas females accounted for 55.5% (n= 214) of the cases. In total, meningioma was found to have the highest incidence (27.2%) followed by metastases brain tumour (18.1%) and glioma (17.4%).

    CONCLUSIONS: This study has shown that the incidence of BT was led by meningioma which had a high prevalence among the elderly population, followed by metastasis BT and gliomas.

  18. Sulaiman NS, Hamzah N, Zakaria SF, Che Othman SF, Mohamed Suffian IF
    Nanomedicine (Lond), 2021 01;16(2):81-84.
    PMID: 33356530 DOI: 10.2217/nnm-2020-0420
  19. Liu CC, Mohmood A, Hamzah N, Lau JH, Khaliddin N, Rahmat J
    PLoS One, 2020;15(5):e0232249.
    PMID: 32357178 DOI: 10.1371/journal.pone.0232249
    AIM: To report our first three-and-a-half years' experience with intra-arterial chemotherapy (IAC) in managing retinoblastoma (RB).

    METHODS: Single institution, retrospective, interventional case series of 14 retinoblastoma patients managed with IAC from December 2014 to June 2018. Demographics were described. Outcomes measures were tumor response, treatment complications and globe salvage.

    RESULTS: Subjects' mean age at the first administration of IAC was 31.4 months. 57.1% of the eyes were Group D and E retinoblastoma, while 79% were bilateral disease. 93% of the eyes were as secondary treatment. Of 32 IAC cannulations performed, 23 (71.8%) were successful and received chemotherapy drug melphalan. Each eye received a mean of 1.8 (range 1-4) IAC injections. 53% of the eyes showed regression post treatment. After a mean follow up period of 19 months, globe salvage rate was 38%. Most of the adverse effects experienced were localized and transient.

    CONCLUSION: IAC has provided an added recourse in the armamentarium of retinoblastoma treatment in our center. IAC treatment is a viable alternative in the treatment of retinoblastoma to salvage globe, for eyes that would conventionally require enucleation especially in bilateral disease.

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