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Adult dengue haemorrhagic fever at Kuala Lumpur Hospital: retrospective study of 102 cases

Ibrahim NM, Cheong I

Br J Clin Pract, 1995 Jul-Aug;49(4):189-91.
PMID: 7547159

A retrospective study involving 102 adults with dengue haemorrhagic fever (DHF) was conducted to investigate the demographic aspect, clinical presenting features, laboratory investigations, complications, and mortality associated with the disease. The clinical diagnosis of DHF was in accordance with WHO recommendations. Epistaxis, gingivitis, haematemesis and gastritis were among the common complications. Platelet levels tended to decline from a higher value on admission (mean 67,000/mm3) to lower levels on subsequent days, with the lowest (mean 61,000/mm3) being on day 6 of the fever. Hyponatraemia (46.8%) was commonly observed. Morbidity of DHF was significant (29.4%) but the case fatality rate remained low (2.0%) in our adults, suggesting that adults are less likely than children to suffer from shock syndrome.
Fulltext Unilateral epiphora in an adolescent

Tevaraj P, Ibrahim NM

Malays Fam Physician, 2014;9(2):58-60.
PMID: 25883767 MyJurnal
Teaching Video NeuroImages: Choreoathetosis and Focal Dystonia in Vitamin B12 Deficiency

Ng CF, Ibrahim NM

Neurology, 2021 May 13.
PMID: 33986132 DOI: 10.1212/WNL.0000000000012190
Fulltext Management of Parkinson's Disease in the COVID-19 Pandemic and Future Perspectives in the Era of Vaccination

Lau YH, Lau KM, Ibrahim NM

J Mov Disord, 2021 Sep;14(3):177-183.
PMID: 34315207 DOI: 10.14802/jmd.21034

The current coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a serious global health crisis. Increasing evidence suggests that elderly individuals with underlying chronic diseases, including Parkinson's disease (PD), are particularly vulnerable to this infection. Changes in the routine care of PD patients should be implemented carefully without affecting the quality provided. The utilization of telemedicine for clinical consultation, assessment and rehabilitation has also been widely recommended. Therefore, the aim of this review is to provide recommendations in the management of PD during the pandemic as well as in the early phase of vaccination programs to highlight the potential sequelae and future perspectives of vaccination and further research in PD. Even though a year has passed since COVID- 19 emerged, most of us are still facing great challenges in providing a continuum of care to patients with chronic neurological disorders. However, we should regard this health crisis as an opportunity to change our routine approach in managing PD patients and learn more about the impact of SARS-CoV-2. Hopefully, PD patients can be vaccinated promptly, and more detailed research related to PD in COVID-19 can still be carried out.
Fulltext Antioxidant Activity and Phenolic Content of Streblus asper Leaves from Various Drying Methods

Ibrahim NM, Mat I, Lim V, Ahmad R

Antioxidants (Basel), 2013;2(3):156-66.
PMID: 26784343 DOI: 10.3390/antiox2030156

Aqueous and ethanol extracts of oven and freeze-dried Streblus asper leaves were investigated using DPPH assay. The presence of phenolic compounds and flavonoids in the extracts, which were detected by Folin and colorimetric assays, respectively, may be responsible for the antioxidant activities of S. asper. The different drying treatments resulted in significant differences (p < 0.05) in the antioxidant properties as well as the phenolic and flavonoid contents of the S. asper extracts. Freeze-dried S. asper leaf extracts exhibited high DPPH radical scavenging activity ranging from 69.48% ± 0.03% to 89.25% ± 0.01% at concentrations ranging from 0 to 1 mg/mL, significantly higher compared with the oven-dried extracts which were in the range of 68.56% ± 0.01% to 86.68% ± 0.01%. Generally, the 70% ethanol extract of the freeze-dried samples exhibited higher phenolic and flavonoid content than the aqueous extract, with values of 302.85 ± 0.03 mg GAE/g and 22.70 ± 0.02 mg QE/g compared with 226.8 ± 0.03 mg GAE/g and 15.38 ± 0.05 mg QE/g, respectively. This study showed that S. asper leaf extracts contain a number of health promoting bioactive compounds, such as phenolic compounds, and are potential sources of natural antioxidants.
Brain functional connectivity patterns for emotional state classification in Parkinson's disease patients without dementia

Yuvaraj R, Murugappan M, Acharya UR, Adeli H, Ibrahim NM, Mesquita E

Behav Brain Res, 2016 Feb 1;298(Pt B):248-60.
PMID: 26515932 DOI: 10.1016/j.bbr.2015.10.036

Successful emotional communication is crucial for social interactions and social relationships. Parkinson's Disease (PD) patients have shown deficits in emotional recognition abilities although the research findings are inconclusive. This paper presents an investigation of six emotions (happiness, sadness, fear, anger, surprise, and disgust) of twenty non-demented (Mini-Mental State Examination score >24) PD patients and twenty Healthy Controls (HCs) using Electroencephalogram (EEG)-based Brain Functional Connectivity (BFC) patterns. The functional connectivity index feature in EEG signals is computed using three different methods: Correlation (COR), Coherence (COH), and Phase Synchronization Index (PSI). Further, a new functional connectivity index feature is proposed using bispectral analysis. The experimental results indicate that the BFC change is significantly different among emotional states of PD patients compared with HC. Also, the emotional connectivity pattern classified using Support Vector Machine (SVM) classifier yielded the highest accuracy for the new bispectral functional connectivity index. The PD patients showed emotional impairments as demonstrated by a poor classification performance. This finding suggests that decrease in the functional connectivity indices during emotional stimulation in PD, indicating functional disconnections between cortical areas.
Voice therapy for Parkinson's disease via smartphone videoconference in Malaysia: A preliminary study

Chan MY, Chu SY, Ahmad K, Ibrahim NM

J Telemed Telecare, 2021 Apr;27(3):174-182.
PMID: 31431134 DOI: 10.1177/1357633X19870913

INTRODUCTION: Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson's disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia.
METHODS: Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire.
RESULTS: Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method.
DISCUSSION: Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.
Paradoxical worsening of chest radiographs secondary to immune reconstitution syndrome (IRIS) in a patient with advanced HIV infection and Rhodococcus pneumonia

Koh KC, Ibrahim NM, Ong SCL

Med J Malaysia, 2020 03;75(2):164-166.
PMID: 32281599

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.
Fulltext A rare extrapyramidal manifestation in a patient with primary central nervous system lymphoma

Tee TY, Khoo CS, Ibrahim NM, Osman SS

Neurol India, 2019 3 13;67(1):297-299.
PMID: 30860142 DOI: 10.4103/0028-3886.253620
Fulltext Spinocerebellar ataxias in Asia: Prevalence, phenotypes and management

van Prooije T, Ibrahim NM, Azmin S, van de Warrenburg B

Parkinsonism Relat Disord, 2021 11;92:112-118.
PMID: 34711523 DOI: 10.1016/j.parkreldis.2021.10.023

This paper reviews and summarizes three main aspects of spinocerebellar ataxias (SCA) in the Asian population. First, epidemiological studies were comprehensively reviewed. Overall, the most common subtypes include SCA1, SCA2, SCA3, and SCA6, but there are large differences in the relative prevalence of these and other SCA subtypes between Asian countries. Some subtypes such as SCA12 and SCA31 are rather specific to certain Asian populations. Second, we summarized distinctive phenotypic manifestations of SCA patients of Asian origin, for example a frequent co-occurrence of parkinsonism in some SCA subtypes. Lastly, we have conducted an exploratory survey study to map SCA-specific expertise, resources, and management in various Asian countries. This showed large differences in accessibility, genetic testing facilities, and treatment options between lower and higher income Asian countries. Currently, many Asian SCA patients remain without a final genetic diagnosis. Lack of prevalence data on SCA, lack of patient registries, and insufficient access to genetic testing facilities hamper a wider understanding of these diseases in several (particularly lower income) Asian countries.
Causes, factors, and complications associated with hospital admissions among patients with Parkinson's disease

Shaibdat NS, Ahmad N, Azmin S, Ibrahim NM

Front Neurol, 2023;14:1136858.
PMID: 36959822 DOI: 10.3389/fneur.2023.1136858

INTRODUCTION: Patients with Parkinson's disease (PD) are at a higher risk of hospital admissions compared to the general population. We studied the causes and factors associated with admissions among patients with PD over 6 years.
METHODS: We included all PD admissions between 1 January 2016 and 31 December 2021. Other causes of parkinsonism were excluded. Causes of admissions were divided into PD-related (direct or indirect) or non-PD-related. The type of admission was categorized into emergency or elective.
RESULTS: We identified 605 hospital admissions (259 patients with PD); 345 (57.0%) were PD-related and 260 (43%) were non-PD-related. Emergency PD admissions contributed to 50.4% of all admissions, most commonly from respiratory infection (23%). PD admissions in comparison to non-PD admissions were associated with worse disease severity (HY ≥ 3; p < 0.001), longer disease duration [8.71 (SD 6.23) vs. 6.60 (SD 5.39) years; p < 0.001], and longer hospital stay [7.70 (SD 5.89) vs. 6.42 (SD 7.63) days; p = 0.020]. Non-PD admissions were associated with more comorbidities (97.3%; p = 0.013). There were 124 (20.5%) complications and 31 deaths (5.1%). A total of 29 deaths were due to respiratory infection and 3 deaths were due to COVID-19 pneumonia. Emergency admission (PD- and non-PD-related; p = 0.001) and respiratory-related causes (p < 0.001) were predictors of unfavorable hospital admission outcomes (death and complications).
CONCLUSION: Respiratory infection was the leading cause of hospital admission and a significant independent predictor of unfavorable hospital admission outcomes (death and complications). PD-related admissions were associated with disease severity and led to more complications and longer hospital stays. Non-PD-related admissions were associated with comorbidities.
Optimal set of EEG features for emotional state classification and trajectory visualization in Parkinson's disease

Yuvaraj R, Murugappan M, Ibrahim NM, Sundaraj K, Omar MI, Mohamad K, et al.

Int J Psychophysiol, 2014 Dec;94(3):482-95.
PMID: 25109433 DOI: 10.1016/j.ijpsycho.2014.07.014

In addition to classic motor signs and symptoms, individuals with Parkinson's disease (PD) are characterized by emotional deficits. Ongoing brain activity can be recorded by electroencephalograph (EEG) to discover the links between emotional states and brain activity. This study utilized machine-learning algorithms to categorize emotional states in PD patients compared with healthy controls (HC) using EEG. Twenty non-demented PD patients and 20 healthy age-, gender-, and education level-matched controls viewed happiness, sadness, fear, anger, surprise, and disgust emotional stimuli while fourteen-channel EEG was being recorded. Multimodal stimulus (combination of audio and visual) was used to evoke the emotions. To classify the EEG-based emotional states and visualize the changes of emotional states over time, this paper compares four kinds of EEG features for emotional state classification and proposes an approach to track the trajectory of emotion changes with manifold learning. From the experimental results using our EEG data set, we found that (a) bispectrum feature is superior to other three kinds of features, namely power spectrum, wavelet packet and nonlinear dynamical analysis; (b) higher frequency bands (alpha, beta and gamma) play a more important role in emotion activities than lower frequency bands (delta and theta) in both groups and; (c) the trajectory of emotion changes can be visualized by reducing subject-independent features with manifold learning. This provides a promising way of implementing visualization of patient's emotional state in real time and leads to a practical system for noninvasive assessment of the emotional impairments associated with neurological disorders.
Inter-hemispheric EEG coherence analysis in Parkinson's disease: assessing brain activity during emotion processing

Yuvaraj R, Murugappan M, Ibrahim NM, Sundaraj K, Omar MI, Mohamad K, et al.

J Neural Transm (Vienna), 2015 Feb;122(2):237-52.
PMID: 24894699 DOI: 10.1007/s00702-014-1249-4

Parkinson's disease (PD) is not only characterized by its prominent motor symptoms but also associated with disturbances in cognitive and emotional functioning. The objective of the present study was to investigate the influence of emotion processing on inter-hemispheric electroencephalography (EEG) coherence in PD. Multimodal emotional stimuli (happiness, sadness, fear, anger, surprise, and disgust) were presented to 20 PD patients and 30 age-, education level-, and gender-matched healthy controls (HC) while EEG was recorded. Inter-hemispheric coherence was computed from seven homologous EEG electrode pairs (AF3-AF4, F7-F8, F3-F4, FC5-FC6, T7-T8, P7-P8, and O1-O2) for delta, theta, alpha, beta, and gamma frequency bands. In addition, subjective ratings were obtained for a representative of emotional stimuli. Interhemispherically, PD patients showed significantly lower coherence in theta, alpha, beta, and gamma frequency bands than HC during emotion processing. No significant changes were found in the delta frequency band coherence. We also found that PD patients were more impaired in recognizing negative emotions (sadness, fear, anger, and disgust) than relatively positive emotions (happiness and surprise). Behaviorally, PD patients did not show impairment in emotion recognition as measured by subjective ratings. These findings suggest that PD patients may have an impairment of inter-hemispheric functional connectivity (i.e., a decline in cortical connectivity) during emotion processing. This study may increase the awareness of EEG emotional response studies in clinical practice to uncover potential neurophysiologic abnormalities.
Emotion classification in Parkinson's disease by higher-order spectra and power spectrum features using EEG signals: a comparative study

Yuvaraj R, Murugappan M, Ibrahim NM, Omar MI, Sundaraj K, Mohamad K, et al.

J Integr Neurosci, 2014 Mar;13(1):89-120.
PMID: 24738541 DOI: 10.1142/S021963521450006X

Deficits in the ability to process emotions characterize several neuropsychiatric disorders and are traits of Parkinson's disease (PD), and there is need for a method of quantifying emotion, which is currently performed by clinical diagnosis. Electroencephalogram (EEG) signals, being an activity of central nervous system (CNS), can reflect the underlying true emotional state of a person. This study applied machine-learning algorithms to categorize EEG emotional states in PD patients that would classify six basic emotions (happiness and sadness, fear, anger, surprise and disgust) in comparison with healthy controls (HC). Emotional EEG data were recorded from 20 PD patients and 20 healthy age-, education level- and sex-matched controls using multimodal (audio-visual) stimuli. The use of nonlinear features motivated by the higher-order spectra (HOS) has been reported to be a promising approach to classify the emotional states. In this work, we made the comparative study of the performance of k-nearest neighbor (kNN) and support vector machine (SVM) classifiers using the features derived from HOS and from the power spectrum. Analysis of variance (ANOVA) showed that power spectrum and HOS based features were statistically significant among the six emotional states (p < 0.0001). Classification results shows that using the selected HOS based features instead of power spectrum based features provided comparatively better accuracy for all the six classes with an overall accuracy of 70.10% ± 2.83% and 77.29% ± 1.73% for PD patients and HC in beta (13-30 Hz) band using SVM classifier. Besides, PD patients achieved less accuracy in the processing of negative emotions (sadness, fear, anger and disgust) than in processing of positive emotions (happiness, surprise) compared with HC. These results demonstrate the effectiveness of applying machine learning techniques to the classification of emotional states in PD patients in a user independent manner using EEG signals. The accuracy of the system can be improved by investigating the other HOS based features. This study might lead to a practical system for noninvasive assessment of the emotional impairments associated with neurological disorders.
Emotion processing in Parkinson's disease: an EEG spectral power study

Yuvaraj R, Murugappan M, Omar MI, Ibrahim NM, Sundaraj K, Mohamad K, et al.

Int J Neurosci, 2014 Jul;124(7):491-502.
PMID: 24168328 DOI: 10.3109/00207454.2013.860527

Although an emotional deficit is a common finding in Parkinson's disease (PD), its neurobiological mechanism on emotion recognition is still unknown. This study examined the emotion processing deficits in PD patients using electroencephalogram (EEG) signals in response to multimodal stimuli.
Validation study of the Mini-Mental State Examination in a Malay-speaking elderly population in Malaysia

Ibrahim NM, Shohaimi S, Chong HT, Rahman AH, Razali R, Esther E, et al.

Dement Geriatr Cogn Disord, 2009;27(3):247-53.
PMID: 19246909 DOI: 10.1159/000203888

BACKGROUND/AIMS: In view of the differing sensitivity and specificity of the Mini-Mental State Examination (MMSE) in the non-English-speaking populations, we conducted the first validation study of the Malay version (M-MMSE) in Malaysia among 300 subjects (from the community and outpatient clinics).
METHODS: Three versions were used: M-MMSE-7 (serial 7), M-MMSE-3 (serial 3) and M-MMSE-S (spell 'dunia' backwards). Dementia was assessed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV. The optimal cutoff scores were obtained from the receiver operating characteristics curves.
RESULTS: Seventy-three patients (24.3%) had dementia and 227 (75.7%) were controls. Three hundred patients completed the M-MMSE-7, 160 the M-MMSE-3 and 145 the M-MMSE-S. All 3 versions were valid and reliable in the diagnosis of dementia. The optimal cutoff scores varied with each version and gender. In the control group, significant gender differences were observed in the patients with the lowest educational status. Increasing educational levels significantly improved the M-MMSE performance in both genders.
CONCLUSION: All 3 versions of the M-MMSE are valid and reliable as a screening tool for dementia in the Malaysian population, but at different cutoff scores. In those with the lowest educational background, gender-adjusted cutoff scores should be applied.
Study site: Community, neurology and dementia outpatient clinics, Perubatan Universiti Kebangsaan Malaysia (PPUKM), University Malaya Medical Centre (UMMC)
Fulltext A case of Hashimoto encephalopathy in a Malay woman with Graves disease

Ngiu CS, Ibrahim NM, Yahya WN, Tan HJ, Mustafa N, Basri H, et al.

BMJ Case Rep, 2009;2009.
PMID: 21709844 DOI: 10.1136/bcr.01.2009.1501

Hashimoto encephalopathy (HE) is a poorly recognised steroid-responsive encephalopathy, with prominent neuropsychiatric features. Diagnosis is often difficult due to its heterogeneous clinical presentation, especially since the thyroid status or anti-thyroid antibody titres may not be related to the disease state. Here, the case of a 23-year-old Malay woman with Graves disease who presented with progressive encephalopathy diagnosed as HE is presented. She responded dramatically to high dose intravenous and then oral corticosteroid. A month after the initiation of treatment, she regained full independency.
Fulltext Anti-GABAB Receptor Encephalitis Presenting with Atypical Corticobasal Syndrome in a Patient with Parkinson's Disease

Abdullah NS, Jan TH, Remli R, Mukari SAM, Ibrahim NM

J Mov Disord, 2020 Sep;13(3):235-237.
PMID: 32894902 DOI: 10.14802/jmd.20011
Knowledge and practice of burn first aid among parents of under-age children

Halil MF, Ibrahim NM, Ahmad ZNBS, Che Hasan MK

Enferm Clin, 2021 04;31 Suppl 2:S100-S104.
PMID: 33849139 DOI: 10.1016/j.enfcli.2020.09.008

The objective of this study is to assess the level of knowledge and practice of burn first aid management among parents. A cross-sectional study was conducted among parents of under-age children in the Taman Desa Darul Naim area of Pasir Tumbuh, in Kelantan, Malaysia, using an adapted survey from Davies et al. Out of 80 respondents, 46.3% showed minimal knowledge of burn first aid, 47.5% had moderate knowledge, and 6.3% extensive knowledge. There was a significant relationship between the demographic data and the knowledge of burn first aid for gender (p=0.02), but no significant relationship between the level of knowledge and level of education (p=0.29) or age (p=0.09). The findings indicate that the level of knowledge of burn first aid is limited. Education for parents of under-age children, including demonstrations of burn first aid, is needed to promote safe action and prevent further injury in the community.
Fulltext Clinical and genetic profile in index patients with spinocerebellar ataxia type 3 in Indonesia: case report

Aminah S, Huda F, Gamayani U, Pusparini I, Mochyadin MFA, Sribudiani Y, et al.

Heliyon, 2021 Jul;7(7):e07519.
PMID: 34345727 DOI: 10.1016/j.heliyon.2021.e07519

Spinocerebellar ataxia (SCA) is an autosomal dominant hereditary disease with progressive course, and no causal therapy. Diagnostics are still challenging, due to facility and protocols, and so as in Indonesia. As a national referral center, Dr. Hasan Sadikin Central General Hospital has received a lot of patients from all over Indonesia, particularly from Western Java. Study related to SCA (including clinical and genetic profile) is still limited in Indonesia. We identified index patients from three families with ataxia, hence intend to determine their clinical and genetic pattern. The hereditary pattern is autosomal dominant. Scale for the assessment and rating of ataxia (SARA) shows mild and moderate ataxia. Inventory of non-ataxia signs (INAS) scores of the patients were 3, 5 and 6. Montreal cognitive assessment-Indonesian version (MOCA-INA) shows only one patient has mild cognitive impairment, despite young age. Barthel index shows 1 subject has moderate dependency. Mutation in Ataxin3 polyQ repeats shows pathologically long CAG repeats, 72,10; 72,10; and 72,23 respectively in mutant and wild type allele. We diagnosed the index patients with spinocerebellar ataxia type 3. This study is the first case series study in Indonesia. The hereditary pattern is clearly shown as an autosomal dominant ataxia. The clinical and genetic profile was varied, and the symptom is progressive and deteriorates overtime, including wide based gait, speech problem, motor and sensor complaint, and cognitive decline complaint. Despite the same polyQ stretch length, the onset and clinical characteristics of patients are diverse.

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