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Fulltext Brain activation due to various visual stimuli: a pilot study using fixed-effects analysis on healthy participants. [Pengaktifan otak yang disebabkan oleh stimulus penglihatan pelbagai: satu kajian rintis menggunakan analisis kesan malar ke atas subjek sihat]

Nasaruddin, N.H., Yusoff, A.N., Sharanjeet Kaur, Nasrudin, N.F., Muda, S.

Jurnal Sains Kesihatan Malaysia, 2015;13(1):57-68.
MyJurnal

Ocular abnormalities have apparent effects on brain activation. However, neuroimaging data about the ocular characteristics of healthy participants are still lacking to be compared with data for patients with ocular pathology. The objective of this multiple participants’ functional magnetic resonance imaging (fMRI) studies was to investigate the brain activation characteristics of healthy participants when they view stimuli of various shapes, pattern and size. During the fMRI scans, the participants view the growing ring, rotating wedge, flipping hour glass/bow tie, quadrant arc and full checker board stimuli. All stimuli have elements of black-and-white checkerboard pattern. Statistical parametric mapping (SPM) was used in generating brain activation via fixed-effects (FFX) and conjunction analyses. The stimuli of various shapes, pattern and size produce different brain activation with more activation concentrated in the left hemisphere. These results are supported by the conjunction analysis which indicated that the left pre-central, post-central, superior temporal and occipital gyrus as well as the left cingulate cortices were involved when the participants viewed each given stimulus. Differential activation analysis showed activation with high specificity in the occipital region due to the stimuli of various shapes, pattern and size. The activation in the right middle temporal gyrus was found to be significantly higher in response to moving stimuli as compared to stationary stimuli. This confi rms the involvement of the right middle temporal gyrus in the observation of movements. The black-and-white checkerboard stimuli of various shapes, pattern and size, stationary and moving was found to 1) activate visual as well as other cortices in temporal and parietal lobes, 2) cause asymmetry in brain function and 3) exhibit functional integration characteristics in several brain areas.
Keywords: fMRI; SPM; visual stimulus; occipital gyrus; middle temporal gyrus
Fulltext Fatal mediastinal biopsy: How interventional radiology saves the day

Yaacob Y, Muda S, Zakaria R

Ann Thorac Med, 2012 Apr;7(2):107-9.
PMID: 22558017 DOI: 10.4103/1817-1737.94534

This was a case of a 35-year-old man with mediastinal mass requiring computed tomography (CT)-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA (n-Butyl cyanoacrylate) was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome.
Influence of beta-cyclodextrin and chitosan in the formulation of a colon-specific drug delivery system

Rehman K, Amin MC, Muda S

Drug Res (Stuttg), 2013 Dec;63(12):657-62.
PMID: 23842943 DOI: 10.1055/s-0033-1349129

The increase in diseases of the colon underscores the need to develop cost-effective site-directed therapies. We formulated a polysaccharide-based matrix system that could release ibuprofen under conditions simulating those in the colon by employing a wet granulation method. Tablets were prepared in a series of formulations containing a polysaccharide (beta-cyclodextrin and chitosan) matrix system along with ethylcellulose. We characterized physicochemical properties and performed an in vitro drug release assay in the absence and presence of digestive enzymes to assess the ability of the polysaccharides to function as a protective barrier against the upper gastrointestinal environment. Fourier transform infrared spectroscopy studies revealed no chemical interaction between ibuprofen and polysaccharides; however, spectrum analysis suggested the formation of an inclusion complex of beta-cyclodextrin with ibuprofen. The formulations contained 50% ethylcellulose and 50% beta-cyclodextrins (1:1) were proven to be the better formulation that slowly released the drug until 24 h (101.04 ± 0.65% maximum drug release in which 83.08 ± 0.89% drug was released in colonic medium) showed better drug release profiles than the formulations containing chitosan. We conclude that a beta-cyclodextrin drug carrier system may represent an effective approach for treatment of diseases of the colon.
Fulltext Percutaneous catheter-based rheolytic thrombectomy for massive pulmonary embolism: a case report

Nguyen D, Yaacob Y, Muda S, Mohamed Z

Malays J Med Sci, 2013 Mar;20(2):70-5.
PMID: 23983581 MyJurnal

Pulmonary thromboembolism is a life-threatening cardiovascular condition. The mortality rate is high in its current management. Besides supportive treatments, systemic thrombolysis and surgical thrombectomy play important roles in the comprehensive management of pulmonary embolism (PE). The percutaneous catheter-based rheolytic thrombectomy is a promising alternative for management of massive pulmonary emboli, particularly, when patients have contraindication with systemic thrombolysis or are not suitable for surgery. We present the case of a 36-year-old Somalian man who came to our center for a total knee replacement (TKR). Three days after TKR, he developed sudden shortness of breath and decreased oxygen saturation. Computed tomography of pulmonary arteriogram showed extensive thrombi within the main pulmonary trunk, right and left pulmonary arteries, bilateral ascending and bilateral descending pulmonary arteries in keeping with massive PE. Because the patient was contraindicated for systemic thrombolysis, percutaneous, catheter-based rheolytic thrombectomy was chosen as the alternative treatment. His clinical symptoms improved immediately post-treatment. In conclusion, catheter-based rheolytic thrombectomy can serve as an alternative treatment for massive PE with a good clinical outcome.
Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre's-Like Syndrome

Nguyen D, Yaacob Y, Hamid H, Muda S

Malays J Med Sci, 2013 Oct;20(5):70-8.
PMID: 24643401

Lemierre's syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
Fulltext Multiple sclerosis in malaysia: demographics, clinical features, and neuroimaging characteristics

Viswanathan S, Rose N, Masita A, Dhaliwal JS, Puvanarajah SD, Rafia MH, et al.

Mult Scler Int, 2013;2013:614716.
PMID: 24455266 DOI: 10.1155/2013/614716

Background. Multiple sclerosis (MS) is an uncommon disease in multiracial Malaysia. Diagnosing patients with idiopathic inflammatory demyelinating diseases has been greatly aided by the evolution in diagnostic criterion, the identification of new biomarkers, and improved accessibility to neuroimaging in the country. Objectives. To investigate the spectrum of multiple sclerosis in Malaysia. Methods. Retrospective analysis with longitudinal follow-up of patients referred to a single tertiary medical center with neurology services in Malaysia. Results. Out of 245 patients with idiopathic inflammatory demyelinating disease, 104 patients had multiple sclerosis. Female to male ratio was 5 : 1. Mean age at onset was 28.6 ± 9.9 years. The Malays were the predominant racial group affected followed by the Chinese, Indians, and other indigenous groups. Subgroup analysis revealed more Chinese having neuromyelitis optica and its spectrum disorders rather than multiple sclerosis. Positive family history was reported in 5%. Optic neuritis and myelitis were the commonest presentations at onset of disease, and relapsing remitting course was the commonest disease pattern observed. Oligoclonal band positivity was 57.6%. At disease onset, 61.5% and 66.4% fulfilled the 2005 and 2010 McDonald's criteria for dissemination in space. Mean cord lesion length was 1.86 ± 1.65 vertebral segments in the relapsing remitting group as opposed to 6.25 ± 5.18 vertebral segments in patients with neuromyelitis optica and its spectrum disorders. Conclusion. The spectrum of multiple sclerosis in Malaysia has changed over the years. Further advancement in diagnostic criteria will no doubt continue to contribute to the evolution of this disease here.
Fulltext Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

Yaacob Y, Nguyen DV, Mohamed Z, Ralib AR, Zakaria R, Muda S

Indian J Radiol Imaging, 2013 Apr;23(2):121-5.
PMID: 24082475 DOI: 10.4103/0971-3026.116543

To report our early experience in image-guided chemoport insertions by interventional radiologists.
Fulltext The frequency of anti-aquaporin-4 Ig g antibody in neuromyelitis optica and its spectrum disorders at a single tertiary referral center in malaysia

Viswanathan S, Arip M, Mustafa N, Dhaliwal JS, Rose N, Muda S, et al.

Mult Scler Int, 2014;2014:568254.
PMID: 25548676 DOI: 10.1155/2014/568254

Background. In the past the occurrence of neuromyelitis optica in Malaysia was thought to be uncommon and the frequency of anti-aquaporin-4 Ig G antibody was unknown. Objective. To evaluate the frequency of anti-aquaporin-4 Ig G antibody (Anti-AQP4 antibody) amongst patients with neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) and the differences between the seropositive and seronegative groups. Methods. Retrospectively, 96 patients with NMO/high risk syndromes for NMOSD (HRS-NMOSD) were identified out of 266 patients with idiopathic inflammatory demyelinating disease from a single center hospital based registry. Anti-AQP4 seropositivity was found in 38/48 (79.2%) with NMO, 12/21 (57.1%) with brain involvement at high risk for NMOSD, 12/15 (80%) with transverse myelitis (i.e., 11/15 with relapsing transverse myelitis and one with monophasic transverse myelitis), and 3/7 (42.8%) with relapsing optic neuritis. Sixty-five out of 96 patients, that is, 67.7%, with NMO/HRS for NMOSD were seropositive. Seropositivity was significantly associated with female gender, a higher number of mean relapses, that is, 5.15 ± 4.42 versus 2.10 ± 1.68, longer length of spinal cord lesions, that is, 6.6 ± 4.9 versus 2.9 ± 2.5, vertebral bodies, higher EDSS, 4.5 ± 2.4 versus 2.4 ± 2.6, presence of paroxysmal tonic spasms, and blindness (unilateral/bilateral); P < 0.001. Longitudinally extensive cord lesions (contiguous or linear), presence of lesions in the cervical and thoracic regions, and involvement of the central gray matter or holocord regions on axial scans, were also significantly associated with seropositivity; P < 0.001. Conclusion. NMO and HRS for NMOSD are present in larger numbers than previously thought in Malaysia. More than 2/3rds are seropositive. Seropositive and seronegative NMO/NMOSD have differences that are useful in clinical practice.
Fulltext Fine sand facilitates egg extrusion and improves reproductive output in female mud crab genus Scylla

Fazhan H, Waiho K, Shu-Chien AC, Wang Y, Ikhwanuddin M, Abualreesh MH, et al.

PeerJ, 2022;10:e13961.
PMID: 36032946 DOI: 10.7717/peerj.13961

Mud crabs (genus Scylla) are gaining attention as potential aquaculture species due to their lucrative market price and high demand. One of the essential components of mud crab culture is broodstock quality. The optimisation of mud crab broodstock culture currently focused on its nutritional aspects and common rearing parameters, including stocking density and temperature. The use of sandy substrate to induce egg extrusion in female Scylla broodstock is common; however, its optimisation has never been conducted. This study investigated (1) the substrate association of two Scylla species (S. olivacea, S. paramamosain) during broodstock conditioning until egg extrusion when the choices of fine (66.99 ± 14.48 μm) and coarse (656.17 ± 38.13 μm) sands were given; (2) the female reproductive output when S. olivacea females were individually exposed to either fine sand, coarse sand, or no sand treatments. Females, spawners and non-spawners, of S. olivacea and S. paramamosain were associated with fine sand and none was observed to bury in the coarse sand tray. The occurrence of egg extrusion was not significantly different between species but moderately associated with the duration of visits (stayed in sand for 1 d, 2 d, ≥3 d). The final incubation period in the sand tray was more than 2 days in all cases, except for one female S. paramamosain (buried in the sand for 1 day prior to egg extrusion). When no choice was available, the highest percentage (58.3%) of females extruded eggs in fine sand treatment, followed by coarse sand treatment (33.3%), and no sand treatment (8.3%). Sand type influenced the weight of egg clutch, total egg number, fecundity, and clutch size. These results suggest that fine sand (<70 μm) substrate should be incorporated into Scylla broodstock rearing to maximise female reproductive output.
Fulltext Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services

Al Hashmi AM, Shuaib A, Imam Y, Amr D, Humaidan H, Al Nidawi F, et al.

Front Neurol, 2022;13:1016376.
PMID: 36408502 DOI: 10.3389/fneur.2022.1016376

Background: Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa.
Objective: Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke.
Method: Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022.
Results: The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250-1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15-75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH.
Conclusion: This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.