Displaying publications 1 - 20 of 83 in total

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  1. Gliricidia (Gliricidia sepium) Green manures as a potential source of N for maize production in the tropics
    Bah AR, Rahman ZA
    ScientificWorldJournal, 2001 Nov 22;1 Suppl 2:90-5.
    PMID: 12805783
    Use of cheap, N-rich, and environmentally benign legume green manures to correct N deficiency in infertile soils is a very attractive option in the humid tropics. Understanding the influence of management and climate on their effectiveness, and quantifying their contribution to crop productivity, is therefore crucial for technology adoption and adaptation. Mineral N buildup and the contribution to N uptake in maize were studied in an Ultisol amended with fresh Gliricidia leaves. Net mineral N accumulation was compared in mulched and incorporated treatments in a field incubation study. The 15 N isotope dilution technique was used to quantify N supplied to maize by Gliricidia leaves in an alley cropping. Mineral N accumulation was slow, but was much greater after incorporation than after mulching. Also, N buildup was always higher in the topsoil (0 to 10 cm) than in the subsoil (10 to 20 cm). More NO3-N was leached than NH4-N, and the effect was greater in the incorporated treatment. Surface-applied Gliricidia leaves significantly increased N uptake by maize, and supplied >30% of the total N in the stover and >20% of that in the corn grain, even in the presence of hedgerows. Thus Gliricidia leaf mulch has immense potential to improve productivity in tropical soils.
  2. Hypernasality in singing among children with cleft palate: a preliminary study
    Peter S, Abdul Rahman ZA, Pillai S
    Int J Oral Maxillofac Surg, 2019 Oct;48(10):1317-1322.
    PMID: 31014926 DOI: 10.1016/j.ijom.2019.03.896
    The aim of this study was to document differences in hypernasality during speaking and singing among children with cleft palate and to compare nasality score ratings of trained and untrained listeners. Twenty subjects with cleft palate aged between 7 and 12 years participated in this study. Audio recordings were made of the children reading a passage and singing a common local song, both in the Malay language. The degree of hypernasality was judged through perceptual assessment. Three trained listeners (a speech therapist, a classical singer, and a linguistic expert - all academicians) and two untrained listeners (a cleft volunteer worker and a national high school teacher) assessed the recordings using a visual analogue scale (VAS). Inter-rater and intra-rater reliability for hypernasality in both speaking and singing were verified using the intra-class correlation coefficient (ICC). A significant reduction in hypernasality was observed during singing as compared to speaking, indicating that hypernasality reduces when a child with cleft palate sings. The act of singing significantly reduces hypernasality. The outcome of this study suggests that children with cleft palate would benefit from singing exercises to ultimately reduce hypernasality. However, future research is needed to objectively measure nasality in singing compared to speaking.
  3. Fulltext An audit of sputum smear negative pulmonary tuberculosis cases in Kinta district, Perak, in 2011
    Subashini A, Lau KM, Habibur Rahman ZA
    Malays Fam Physician, 2012;7(2-3):31-4.
    PMID: 25606253 MyJurnal
    58 cases of sputum smear negative pulmonary tuberculosis (PTB) were reported to Kinta Health Department between January and June 2011. It was found that 47 cases (81%) were sputum smear negative cases. Six cases (10.3%) were actually sputum smear positive but were wrongly reported as smear negative. Five cases (8.6%) were misdiagnosed as tuberculosis. Majority of these patients (82.7%) sought consultation and treatment after two weeks of having cough. Only 6.9% sought treatment for cough that was less than two weeks old. Accurate diagnosis of PTB is crucial and the Perak State Health Department needs to quickly adopt steps to improve the situation.
  4. Effect of interactions on the nutrient status of a tropical soil treated with green manures and inorganic phosphate fertilizers
    Bah AR, Rahman ZA, Hussin A
    ScientificWorldJournal, 2004 Jun 08;4:393-414.
    PMID: 15252691
    Integrated nutrient management systems using plant residues and inorganic P fertilizers have high potential for increasing crop production and ensuring sustainability in the tropics, but their adoption requires in-depth understanding of nutrient dynamics in such systems. This was examined in a highly weathered tropical soil treated with green manures (GMs) and P fertilizers in two experiments conducted in the laboratory and glasshouse. The treatments were factorial combinations of the GMs (Calopogonium caeruleum, Gliricidia sepium, and Imperata cylindrica) and P fertilizers (phosphate rocks [PRs] from North Carolina, China, and Algeria, and triple superphosphate) replicated thrice. Olsen P, mineral N, pH, and exchangeable K, Ca, and Mg were monitored in a laboratory incubation study for 16 months. The change in soil P fractions and available P was also determined at the end of the study. Phosphorus available from the amendments was quantified at monthly intervals for 5 months by 33P-32P double isotopic labeling in the glasshouse using Setaria sphacelata as test crop. The GMs were labeled with 33P to determine their contribution to P taken up by Setaria, while that from the P fertilizers was indirectly measured by labeling the soil with 32P. The P fertilizers hardly changed Olsen P and exchangeable cations during 16 months of incubation. The legume GMs and legume GM+P did not change Olsen P, lowered exchangeable Ca, and increased exchangeable K about threefold (4.5 cmol[+]kg(-1) soil) in the first 4 months, even as large amounts of NH4-N accumulated (approximately 1000 mg kg soil(-1)) and soil pH increased to more than 6.5. Afterwards, Olsen P and exchangeable Ca and Mg increased (threefold) as NH4+-N and soil pH declined. The legume GMs also augmented reversibly sorbed P in Al-P and Fe-P fractions resulting in high residual effect in the soil, while fertilizer-P was irreversibly retained. The GMs increased PR-P utilization by 40 to over 80%, mobilized soil P, and markedly enhanced uptake of N, K, Ca, and Mg. Thus GMs+PRs is an appropriate combination for correcting nutrient deficiencies in tropical soils.
  5. Fabrication of a three-dimensional temporomandibular joint model for arthrocentesis and arthroscopy simulation
    Foo QC, Hariri F, Abdul Rahman ZA
    Int J Oral Maxillofac Surg, 2021 Aug;50(8):1095-1099.
    PMID: 33422383 DOI: 10.1016/j.ijom.2020.12.007
    Arthrocentesis and arthroscopy are relatively safe treatments for arthrogenic temporomandibular disorders. Hands-on training in both procedures is essential for surgeons to become competent. In this study, a three-dimensional (3D) temporomandibular joint (TMJ) prototype was developed at a relatively low cost, and arthrocentesis and arthroscopy were performed successfully on the model. Despite its limitations, this model is a viable adjunct to TMJ surgical training and can be fabricated easily by any training centre with a 3D printer.
  6. A Novel Technique Using Customized Headgear for Fixation of Rigid External Distraction Device in an Infant With Crouzon Syndrome
    Hariri F, Rahman ZA, Mahdah S, Mathaneswaran V, Ganesan D
    J Craniofac Surg, 2015 Nov;26(8):e740-4.
    PMID: 26594993 DOI: 10.1097/SCS.0000000000002174
    Rigid external distraction device is often indicated for superior midfacial advancement in pediatric syndromic craniosynostosis patients. Even though the technique is proven reliable to treat the functional issues related to the craniofacial deformity, major complications associated with its fixation, such as intracranial pin perforation and migration have been reported. We report a novel technique of using a customized headgear to prevent intracranial pin perforation over a very thin temporal bone region in an 8-month-old infant with Crouzon syndrome who underwent monobloc Le Fort III distraction osteogenesis using a combination of bilateral internal and a rigid external distraction device. The customized headgear provides a protective platform at the temporal region thus preventing intracranial pin perforation and allows stable fixation during the early phase of consolidation period to prevent central component relapse. The headgear can be used short term when rigid external distractor is indicated in infant patient but requires close monitoring because of risks of skin necrosis and temporal region indentation.
  7. Fulltext Involvement of nitrogen on flavonoids, glutathione, anthocyanin, ascorbic acid and antioxidant activities of Malaysian medicinal plant Labisia pumila Blume (Kacip Fatimah)
    Ibrahim MH, Jaafar HZ, Rahmat A, Rahman ZA
    Int J Mol Sci, 2012;13(1):393-408.
    PMID: 22312260 DOI: 10.3390/ijms13010393
    A split plot 3 by 4 experiment was designed to characterize the relationship between production of gluthatione (GSH), oxidized gluthatione (GSSG), total flavonoid, anthocyanin, ascorbic acid and antioxidant activities (FRAP and DPPH) in three varieties of Labisia pumila Blume, namely the varieties alata, pumila and lanceolata, under four levels of nitrogen fertilization (0, 90, 180 and 270 kg N/ha) for 15 weeks. The treatment effects were solely contributed by nitrogen application; there was neither varietal nor interaction effects observed. As the nitrogen levels decreased from 270 to 0 kg N/ha, the production of GSH and GSSG, anthocyanin, total flavonoid and ascorbic acid increased steadily. At the highest nitrogen treatment level, L. pumila exhibited significantly lower antioxidant activities (DPPH and FRAP) than those exposed to limited nitrogen growing conditions. Significant positive correlation was obtained between antioxidant activities (DPPH and FRAP), total flavonoid, GSH, GSSG, anthocyanin and ascorbic acid suggesting that an increase in the antioxidative activities in L. pumila under low nitrogen fertilization could be attributed to higher contents of these compounds. From this observation, it could be concluded that in order to avoid negative effects on the quality of L. pumila, it is advisable to avoid excessive application of nitrogen fertilizer when cultivating the herb for its medicinal use.
  8. Fulltext Effects of nitrogen fertilization on synthesis of primary and secondary metabolites in three varieties of Kacip Fatimah (Labisia pumila Blume)
    Ibrahim MH, Jaafar HZ, Rahmat A, Rahman ZA
    Int J Mol Sci, 2011;12(8):5238-54.
    PMID: 21954355 DOI: 10.3390/ijms12085238
    A split plot 3 by 4 experiment was designed to examine the impact of 15-week variable levels of nitrogen fertilization (0, 90, 180 and 270 kg N/ha) on the characteristics of total flavonoids (TF), total phenolics (TP), total non structurable carbohydrate (TNC), net assimilation rate, leaf chlorophyll content, carbon to nitrogen ratio (C/N), phenyl alanine lyase activity (PAL) and protein content, and their relationships, in three varieties of Labisia pumila Blume (alata, pumila and lanceolata). The treatment effects were solely contributed by nitrogen application; there was neither varietal nor interaction effect observed. As nitrogen levels increased from 0 to 270 kg N/ha, the production of TNC was found to decrease steadily. Production of TF and TP reached their peaks under 0 followed by 90, 180 and 270 kg N/ha treatment. However, net assimilation rate was enhanced as nitrogen fertilization increased from 0 to 270 kg N/ha. The increase in production of TP and TF under low nitrogen levels (0 and 90 kg N/ha) was found to be correlated with enhanced PAL activity. The enhancement in PAL activity was followed by reduction in production of soluble protein under low nitrogen fertilization indicating more availability of amino acid phenyl alanine (phe) under low nitrogen content that stimulate the production of carbon based secondary metabolites (CBSM). The latter was manifested by high C/N ratio in L. pumila plants.
  9. Fulltext The relationship between phenolics and flavonoids production with total non structural carbohydrate and photosynthetic rate in Labisia pumila Benth. under high CO2 and nitrogen fertilization
    Ibrahim MH, Jaafar HZ, Rahmat A, Rahman ZA
    Molecules, 2010 Dec 29;16(1):162-74.
    PMID: 21191319 DOI: 10.3390/molecules16010162
    A factorial split plot 4 × 3 experiment was designed to examine and characterize the relationship among production of secondary metabolites (total phenolics, TP; total flavonoids, TF), carbohydrate content and photosynthesis of three varieties of the Malaysian medicinal herb Labisia pumila Benth. namely the varieties alata, pumila and lanceolata under CO(2) enrichment (1,200 µmol mol(-1)) combined with four levels of nitrogen fertilization (0, 90, 180 and 270 kg N ha(-1)). No varietal differences were observed, however, as the levels of nitrogen increased from 0 to 270 kg N ha(-1), the production of TP and TF decreased in the order leaves>roots>stems. The production of TP and TF was related to increased total non structural carbohydrate (TNC), where the increase in starch content was larger than that in sugar concentration. Nevertheless, the regression analysis exhibited a higher influence of soluble sugar concentration (r(2) = 0.88) than starch on TP and TF biosynthesis. Photosynthesis, on the other hand, displayed a significant negative relationship with TP and TF production (r(2) = -0.87). A decrease in photosynthetic rate with increasing secondary metabolites might be due to an increase in the shikimic acid pathway that results in enhanced production of TP and TF. Chlorophyll content exhibited very significant negative relationships with total soluble sugar, starch and total non structural carbohydrate.
  10. Effect of acute exercise on the levels of salivary cortisol, tumor necrosis factor-alpha and nitric oxide
    Rahman ZA, Abdullah N, Singh R, Sosroseno W
    J Oral Sci, 2010 Mar;52(1):133-6.
    PMID: 20339244
    The aim of the present study was to assess the levels of salivary cortisol, tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) before, during and after acute exercise. Acute exercise was induced using a standard treadmill test with Bruce protocol in ten physically active male participants. Unstimulated saliva was collected before, during and after exercise. The levels of salivary cortisol and TNF-alpha were assessed by enzyme immunoassays. Salivary NO was determined by the Griess reagent. The results showed that both salivary cortisol and TNF-alpha increased and peaked at 14 min during exercise and then decreased. The levels of NO were increased up to 1 h after exercise and subsequently lowered after 24 h. The results of the present study suggest that acute exercise may induce high levels of salivary cortisol, TNF-alpha and NO.
  11. Brief communication genotyping of Burkholderia pseudomallei revealed high genetic variability among isolates from a single population group
    Zueter AM, Rahman ZA, Yean CY, Harun A
    Int J Mol Epidemiol Genet, 2015;6(1):41-7.
    PMID: 26417404
    Burkholderia pseudomallei is a soil dwelling Gram-negative bacteria predominates in Southeast Asia zone and the tropical part of Australia. Genetic diversity has been explored among various populations and environments worldwide. To date, little data is available on MLST profiling of clinical B. pseudomallei isolates in peninsular Malaysia. In this brief report, thirteen culture positive B. pseudomallei cases collected from a single population of Terengganu state in the Western Peninsular Malaysia and were confirmed by In-house TTS1-PCR. Isolates were subjected for multi-locus sequence typing (MLST) to explore their genotypic diversity and to investigate for possible clonal clustering of a certain sequence type. Patient's clinical information was examined to investigate for clinical correlation among the different genotypes. In spite of small sample set, MLST results indicated predictive results; considerable genotypic diversity, predominance and novelty among B. pseudomallei collected over a single geographically-located population in Malaysia. Massive genotypic heterogeneity was observed; 8 different sequence types with predominance of sequence type 54 and discovery of two novel sequence types. However, no clear pathogenomic or organ tropism clonal relationships were predicted.
  12. Spontaneous sublingual hematoma as a complication of severe hypertension: first report of a case
    Prepageran N, Raman R, Ismail SM, Rahman ZA
    Ear Nose Throat J, 2002 Aug;81(8):576-8.
    PMID: 12199178
    We describe what we believe is the first reported case of a sublingual hematoma secondary to severe hypertension. The patient, a 77-year-old woman, experienced a spontaneous hematoma of the floor of the mouth, tongue, and sublingual space that eventually caused an airway obstruction. We performed an emergency tracheostomy under local anesthesia and then evacuated the hematoma through an incision along the floor of the mouth. The patient recovered uneventfully.
  13. Fulltext Crouzon syndrome: Genetic and intervention review
    Al-Namnam NM, Hariri F, Thong MK, Rahman ZA
    J Oral Biol Craniofac Res, 2018 08 29;9(1):37-39.
    PMID: 30202723 DOI: 10.1016/j.jobcr.2018.08.007
    Crouzon syndrome exhibits considerable phenotypic heterogeneity, in the aetiology of which genetics play an important role. FGFR2 mediates extracellular signals into cells and the mutations in the FGFR2 gene cause this syndrome occurrence. Activated FGFs/FGFR2 signaling disrupts the balance of differentiation, cell proliferation, and apoptosis via its downstream signal pathways. However, very little is known about the cellular and molecular factors leading to severity of this phenotype. Revealing the molecular pathology of craniosynostosis will be a great value for genetic counselling, diagnosis, prognosis and early intervention programs. This mini-review summarizes the fundamental and recent scientific literature on genetic disorder of Crouzon syndrome and presents a graduated strategy for the genetic approach, diagnosis and the management of this complex craniofacial defect.
  14. Fulltext Multilocus sequence types of clinical Burkholderia pseudomallei isolates from peninsular Malaysia and their associations with disease outcomes
    Zueter AR, Rahman ZA, Abumarzouq M, Harun A
    BMC Infect Dis, 2018 01 02;18(1):5.
    PMID: 29291714 DOI: 10.1186/s12879-017-2912-9
    BACKGROUND: Previous studies on the Burkholderia pseudomallei genetic diversity among clinical isolates from melioidosis-endemic areas have identified genetic factors contributing to differential virulence. Although it has been ruled out in Australian and Thai B. pseudomallei populations, it remains unclear whether B. pseudomallei sequence types (STs) correlate with disease in Malaysian patients with melioidosis.

    METHODS: In this study, multi-locus sequence typing (MLST) was performed on clinical B. pseudomallei isolates collected from Kelantan state of Malaysia, patients' clinical data were reviewed and then genotype-risk correlations were investigated.

    RESULTS: Genotyping of 83 B. pseudomallei isolates revealed 32 different STs, of which 13(40%) were novel. The frequencies of the STs among the 83 isolates ranged from 1 to 12 observations, and ST54, ST371 and ST289 were predominant. All non-novel STs reported in this study have also been identified in other Asian countries. Based on the MLST data analysis, the phylogenetic tree showed clustering of the STs with each other, as well as with the STs from Southeast Asia and China. No evidence for associations between any of B. pseudomallei STs and clinical melioidosis presentation was detected. In addition, the bacterial genotype clusters in relation with each clinical outcome were statistically insignificant, and no risk estimate was reported. This study has expanded the data for B. pseudomallei on MLST database map and provided insights into the molecular epidemiology of melioidosis in Peninsular Malaysia.

    CONCLUSION: This study concurs with previous reports concluding that infecting strain type plays no role in determining disease presentation.

  15. Site suitability analysis for sanitary landfills using geospatial methods in a part of southern Peninsular Malaysia
    Arshad S, Lihan T, Rahman ZA, Idris WMR
    Environ Sci Pollut Res Int, 2023 Sep;30(41):93760-93778.
    PMID: 37516702 DOI: 10.1007/s11356-023-28764-7
    Globally, around 1.3 billion tonnes of waste are generated annually, and solid waste management has thus become a major concern worldwide. There are projections of a 70% increase in waste generation from 2016 to 2050 owing to urbanization and the rapid growth of the global population. Estimates indicate that around 38,200 tonnes of waste are generated per day in Malaysia, and this volume of waste is significantly shortening the planned life spans of operating sanitary landfills in the country. Batu Pahat is a district in the state of Johor, Malaysia, with a relatively large population of 495,000 and with no record of an operational sanitary landfill. This study was conducted to identify and classify the most suitable sites for sanitary landfill developments in southern Peninsular Malaysia by means of the Analytical Hierarchy Process (AHP), which is recognized as a competent technique for multicriteria decision-making. The resulting landfill site suitability index map established 33.88 km2 of area coverage as very highly suitable for landfill development, while 353.86 km2 of area coverage was classified as unsuitable. Sites 1-6 were identified as the most suitable for landfill activities. Sites 1-5 are situated in agricultural land areas, while site 6 is in a forested land area; this implies public participation and the adoption of compensatory measures in the event of landfill development in these areas, given their socioeconomic importance. The six suitable sites are all at least 2000 m from rivers: 2000-3000 m for sites 1, 3, and 5 and > 3000 m for sites 2, 4, and 6. The six sites are all > 3000 m from fault zones and > 1000 m from flood-prone areas, meaning that occurrences such as fault movements and flooding will have minimal impact on the operational activities of landfills at these sites. The selection of sites 1-6 as very suitable for landfill development was associated with an overall accuracy rating of 93.33% and kappa coefficient score of 0.92 based on accuracy assessment analysis of all sites. This study will guide the actions of policymakers, city planners, and local authorities toward sustainable and environment-friendly landfill development and operation in Batu Pahat and other districts in the state of Johor.
  16. Fulltext A systematic review and meta-analysis of intraarterial chemotherapy for non muscle invasive bladder cancer: Promising alternative therapy in high tuberculosis burden countries
    Rahman ZA, Hidayatullah F, Lim J, Hakim L
    Arch Ital Urol Androl, 2024 Feb 16;96(1):12154.
    PMID: 38363237 DOI: 10.4081/aiua.2024.12154
    INTRODUCTION: Local therapies for high risk non-muscle-invasive bladder cancer (NMIBC) such as intravesical chemotherapy (IVC) have shown a high rate of progression and recurrence. Intravesical Bacillus Calmette-Guérin (BCG) for local therapies has been shown to reduce progression and recurrence in patient with NMIBC. However, its potential role is limited in high burden countries for tuberculosis (TB) due to its low specificity that can cause wrong diagnosis or false positive in patients with clinically diagnosed tuberculosis. BCG vaccine that has to be given for most people in tuberculosis endemic countries will induce trained immunity that could reduce the effectivity of intravesical BCG for NMIBC. Moreover, intravesical BCG is contraindicated in patient with or previous tuberculosis. The potential clinical benefit of intraarterial chemotherapy (IAC) in delaying the recurrence and progression of high-risk NMIBC have been investigated with promising results. We aimed to conduct a meta-analysis to evaluate the potential anti-tumor effect of IAC in NMIBC.

    METHODS: We conducted a comprehensive search of published articles in Cochrane Library, Pubmed, and Science-Direct to identify relevant randomized controlled trials (RCTs) and observational studies comparing IAC alone or combined with IVC versus IVC/BCG alone in NMIBC. The protocol of preferred reporting items for systematic review and meta-analysis (PRISMA) was applied to this study.

    RESULTS: Four RCTs and 4 cohort observational studies were eligible in this study and 5 studies were included in meta-analysis. The risk ratio of tumor recurrence was reduced by 35% (RR = 0.65; 95% CI 0.49-0.87; p = 0.004) in IAC plus IVC, while recurrence-free survival (RFS) was prolonged by 45% (HR: 0.55; 95% CI, 0.44-0.69; p < 0.001). The risk of tumor progression was reduced by 45% (RR = 0.55; 95% CI 0.41-0.75; p = 0.002) and tumor progression-free survival (PFS) was also prolonged by 53% (HR: 0.47; 95% CI, 0.34-0.65; p<0.001). Some RCT's had high or unclear risk of bias, meanwhile 4 included cohort studies had overall low risk of bias, therefore the pooled results need to be interpreted cautiously. Subgroup analysis revealed that the heterogeneity outcome of tumour recurrence might be attributed to the difference in NMIBC stages and grades.

    CONCLUSIONS: The IAC alone or combined with IVC following bladder tumor resection may lower the risk of tumor recurrence and progression. These findings highlight the importance of further multi institutional randomized controlled trials with bigger sample size using a standardized IAC protocol to validate the current results.

  17. Fulltext A Combination of Trimethoprim-sulfamethoxazole and Ceftazidime Showed Good In Vitro Activity against Stenotrophomonas maltophilia
    Ismail N, Zam Z, Hassan SA, Rahman ZA
    Malays J Med Sci, 2017 Mar;24(2):21-27.
    PMID: 28894400 DOI: 10.21315/mjms2017.24.2.3
    BACKGROUND: Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates.

    METHODS: This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations.

    RESULTS: In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect.

    CONCLUSION: TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.

  18. Fulltext Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia
    Hamzan NI, Yean CY, Rahman RA, Hasan H, Rahman ZA
    Emerg Health Threats J, 2015;8:26011.
    PMID: 25765342 DOI: 10.3402/ehtj.v8.26011
    Background : Antibiotic resistance among Enterobacteriaceae posts a great challenge to the health care service. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is attracting significant attention due to its rapid and global dissemination. The infection is associated with significant morbidity and mortality, thus creating challenges for infection control and managing teams to curb the infection. In Southeast Asia, there have been limited reports and subsequent research regarding CRKP infections. Thus, the study was conducted to characterize CRKP that has been isolated in our setting. Methods : A total of 321 K. pneumoniae were included in the study. Each isolate went through an identification process using an automated identification system. Phenotypic characterization was determined using disk diffusion, modified Hodge test, Epsilometer test, and inhibitor combined disk test. Further detection of carbapenemase genes was carried out using polymerase chain reaction and confirmed by gene sequence analysis. Results : All together, 13 isolates (4.05%) were CRKP and the majority of them were resistant to tested antibiotics except colistin and tigercycline. Among seven different carbapenemase genes studied (blaKPC, bla IMP, bla SME, bla NDM, bla IMI, bla VIM, and bla OXA), only two, bla IMP4 (1.87%) and bla NDM1 (2.18%), were detected in our setting. Conclusion : Evidence suggests that the prevalence of CRKP in our setting is low, and knowledge of Carbapenem-resistant Enterobacteriaceae and CRKP has improved and become available among clinicians.
  19. Neurosurgical endoscopic training via a realistic 3-dimensional model with pathology
    Waran V, Narayanan V, Karuppiah R, Thambynayagam HC, Muthusamy KA, Rahman ZA, et al.
    Simul Healthc, 2015 Feb;10(1):43-8.
    PMID: 25514588 DOI: 10.1097/SIH.0000000000000060
    Training in intraventricular endoscopy is particularly challenging because the volume of cases is relatively small and the techniques involved are unlike those usually used in conventional neurosurgery. Present training models are inadequate for various reasons. Using 3-dimensional (3D) printing techniques, models with pathology can be created using actual patient's imaging data. This technical article introduces a new training model based on a patient with hydrocephalus secondary to a pineal tumour, enabling the models to be used to simulate third ventriculostomies and pineal biopsies.
  20. Endoscopic skull base training using 3D printed models with pre-existing pathology
    Narayanan V, Narayanan P, Rajagopalan R, Karuppiah R, Rahman ZA, Wormald PJ, et al.
    Eur Arch Otorhinolaryngol, 2015 Mar;272(3):753-7.
    PMID: 25294050 DOI: 10.1007/s00405-014-3300-3
    Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.
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