MyMedR

MRI of optic tract lesions: review and correlation with visual field defects

Fadzli F, Ramli N, Ramli NM

Clin Radiol, 2013 Oct;68(10):e538-51.

PMID: 23932674 DOI: 10.1016/j.crad.2013.05.104

Visual field defects are a conglomerate of patterns of visual impairment derived from diseases affecting the optic nerve as it extends from the globe to the visual cortex. They are complex signs requiring perimetry or visual confrontation for delineation and are associated with diverse aetiologies. This review considers the chiasmatic and post-chiasmatic causes of visual disturbances, with an emphasis on magnetic resonance imaging (MRI) techniques. Newer MRI sequences are considered, such as diffusion-tensor imaging. MRI images are correlated with perimetric findings in order to demonstrate localization of lesions in the visual pathway. This may serve as a valuable reference tool to clinicians and radiologists in the early diagnostic process of differentiating causes of various visual field defects in daily practice.

Fulltext Radiology Loading and Coverage Hours in Malaysia

Fadzli F, Ramli NM

Korean J Radiol, 2024 Apr 11.

PMID: 38627877 DOI: 10.3348/kjr.2024.0111

Structured Imaging Approach for Viral Encephalitis

Ramli NM, Bae YJ

Neuroimaging Clin N Am, 2023 Feb;33(1):43-56.

PMID: 36404046 DOI: 10.1016/j.nic.2022.07.002

MR imaging is essential in diagnosing viral encephalitis. Clinical features, cerebrospinal fluid analysis and pathogen confirmation by polymerase chain reaction can be supported by assessing imaging features. MR imaging patterns with typical locations can identify pathogens such as temporal lobe for herpes simplex virus type 1; bilateral thalami for Japanese encephalitis and influenza virus ; and brainstem for enterovirus and rabies. In this article, we have reviewed representative viral encephalitis and its MR imaging patterns. In addition, we also presented acute viral encephalitis without typical MR imaging patterns, such as dengue and varicella-zoster virus encephalitis.

A viable secondary intra-abdominal pregnancy resulting from rupture of uterine scar: role of MRI

Teng HC, Kumar G, Ramli NM

Br J Radiol, 2007 Jul;80(955):e134-6.

PMID: 17704308

Pre-natal diagnosis of intra-abdominal pregnancy is difficult. Ultrasound has been the frontline modality to date; however, it gives a diagnostic error of 50-90% and its use is disappointing. In recent years, MRI has emerged as an appealing imaging modality. With its good soft tissue contrast and non-ionizing property, it acts as a means of definitive non-invasive assessment before surgical intervention when ultrasound is inconclusive.

Diagnostic challenge: Diffuse large B-cell lymphoma masquerading as orbital cellulitis

Wen LY, Mohamad NF, Ramli NM

Trop Doct, 2023 Jan;53(1):97-99.

PMID: 36380613 DOI: 10.1177/00494755221137628

We report a clinical case of orbital lymphoma masquerading as orbital cellulitis. Orbital lymphoma and lymphoma of the orbital adnexa are relatively rare types of lymphoma. They represent the malignant end of a spectrum of lymphoproliferative lesions that occur in the orbit, conjunctiva and eyelid. Diffuse large B-cell lymphomas (DLBCL) with variable clinical presentations have a relatively poor prognosis with rapid visual loss. Therefore, thorough evaluation and assessment with a multi-specialty effort are warranted for earlier diagnosis and initiation of treatment to save life and prevent sight loss.

Fulltext The Growing Problem of Radiologist Shortage: Malaysia's Perspective

Ramli NM, Mohd Zain NR

Korean J Radiol, 2023 Oct;24(10):936-937.

PMID: 37793663 DOI: 10.3348/kjr.2023.0742

Differentiating multiple-system atrophy from Parkinson's disease

Ramli N, Nair SR, Ramli NM, Lim SY

Clin Radiol, 2015 May;70(5):555-64.

PMID: 25752581 DOI: 10.1016/j.crad.2015.01.005

The purpose of this review is to illustrate the differentiating features of multiple-system atrophy from Parkinson's disease at MRI. The various MRI sequences helpful in the differentiation will be discussed, including newer methods, such as diffusion tensor imaging, MR spectroscopy, and nuclear imaging.

Fulltext Central pontine and extrapontine myelinolysis: Diffusion weighted imaging and diffusion tensor imaging on follow-up

Nair SR, Ramli NM, Rahmat K, Mei-Ling ST

Neurol India, 2012 Jul-Aug;60(4):426-8.

PMID: 22954982 DOI: 10.4103/0028-3886.100712

Neonatal post-hemorrhagic hydrocephalus resulting in foraminal septae-radiological technique and surgical implications

Fadzli F, Ramli NM, Rahmat K, Ganesan D

Childs Nerv Syst, 2013 Jan;29(1):159-62.

PMID: 22996826 DOI: 10.1007/s00381-012-1923-5

Intraventricular haemorrhage is the most common cause of hydrocephalus in a pre-term baby and may require surgical intervention depending on severity.

Fulltext Ocular Tuberculosis Initially Presenting as Central Retinal Vein Occlusion

Mahyudin M, Choo MM, Ramli NM, Omar SS

Case Rep Ophthalmol, 2010 Aug 02;1(1):30-35.

PMID: 21116342

A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.

Periodic lateralized epileptiform discharges (PLEDs) in cerebral lupus correlated with white-matter lesions in brain MRI and reduced cerebral blood flow in SPECT

Aye SM, Lim KS, Ramli NM, Tan CT

Lupus, 2013 Apr;22(5):510-4.

PMID: 23358870 DOI: 10.1177/0961203312474705

This is a case report on an uncommon correlation between periodic lateralized epileptiform discharges (PLEDs) and white-matter lesions in cerebral lupus, and with a reduced cerebral blood flow (CBF) in single-photon emission computed tomography (SPECT). A 47-year-old woman with a long-term history of systemic lupus erythematosus (SLE) presented with a seizure followed by frontal lobe dysfunction clinically. An electroencephalogram (EEG) showed bilateral independent PLEDs in the frontal region. A magnetic resonance image of the brain showed white-matter changes in the frontal periventricular region. Cerebral angiogram did not reveal any evidence of vasculitis. A cerebral SPECT with tracer injected during the EEG showing PLEDs showed a reduction in CBF in the frontal regions. Clinical recovery was observed with intravenous immunoglobulin. This case shows that PLEDs can be seen with white-matter changes in SLE.

Glaucoma severity affects diffusion tensor imaging (DTI) parameters of the optic nerve and optic radiation

Sidek S, Ramli N, Rahmat K, Ramli NM, Abdulrahman F, Tan LK

Eur J Radiol, 2014 Aug;83(8):1437-41.

PMID: 24908588 DOI: 10.1016/j.ejrad.2014.05.014

To evaluate whether MR diffusion tensor imaging (DTI) of the optic nerve and optic radiation in glaucoma patients provides parameters to discriminate between mild and severe glaucoma and to determine whether DTI derived indices correlate with retinal nerve fibre layer (RNFL) thickness.

In vivo proton magnetic resonance spectroscopy (1H-MRS) evaluation of the metabolite concentration of optic radiation in primary open angle glaucoma

Sidek S, Ramli N, Rahmat K, Ramli NM, Abdulrahman F, Kuo TL

Eur Radiol, 2016 Dec;26(12):4404-4412.

PMID: 26943134

OBJECTIVE: To compare the metabolite concentration of optic radiation in glaucoma patients with that of healthy subjects using Proton Magnetic Resonance Spectroscopy (1H-MRS).

METHODS: 1H-MRS utilising the Single-Voxel Spectroscopy (SVS) technique was performed using a 3.0Tesla MRI on 45 optic radiations (15 from healthy subjects, 15 from mild glaucoma patients, and 15 from severe glaucoma patients). A standardised Volume of Interest (VOI) of 20 × 20 × 20 mm was placed in the region of optic radiation. Mild and severe glaucoma patients were categorised based on the Hodapp-Parrish-Anderson (HPA) classification. Mean and multiple group comparisons for metabolite concentration and metabolite concentration ratio between glaucoma grades and healthy subjects were obtained using one-way ANOVA.

RESULTS: The metabolite concentration and metabolite concentration ratio between the optic radiations of glaucoma patients and healthy subjects did not demonstrate any significant difference (p > 0.05).

CONCLUSION: Our findings show no significant alteration of metabolite concentration associated with neurodegeneration that could be measured by single-voxel 1H-MRS in optic radiation among glaucoma patients.

KEY POINTS: • Glaucoma disease has a neurodegenerative component. • Metabolite changes have been observed in the neurodegenerative process in the brain. • Using SVS, no metabolite changes in optic radiation were attributed to glaucoma.

Fulltext Integration of Algae to Improve Nitrogenous Waste Management in Recirculating Aquaculture Systems: A Review

Ramli NM, Verreth JAJ, Yusoff FM, Nurulhuda K, Nagao N, Verdegem MCJ

Front Bioeng Biotechnol, 2020;8:1004.

PMID: 33015002 DOI: 10.3389/fbioe.2020.01004

This review investigates the performance and the feasibility of the integration of an algal reactor in recirculating aquaculture systems (RAS). The number of studies related to this topic is limited, despite the apparent benefit of algae that can assimilate part of the inorganic waste in RAS. We identified two major challenges related to algal integration in RAS: first, the practical feasibility for improving nitrogen removal performance by algae in RAS; second, the economic feasibility of integrating an algal reactor in RAS. The main factors that determine high algal nitrogen removal rates are light and hydraulic retention time (HRT). Besides these factors, nitrogen-loading rates and RAS configuration could be important to ensure algal performance in nitrogen removal. Since nitrogen removal rate by algae is determined by HRT, this will affect the size (area or volume) of the algal reactor due to the time required for nutrient uptake by algae and large surface area needed to capture enough light. Constraints related to design, space, light capture, and reactor management could incur additional cost for aquaculture production. However, the increased purification of RAS wastewater could reduce the cost of water discharge in places where this is subject to levees. We believe that an improved understanding of how to manage the algal reactor and technological advancement of culturing algae, such as improved algal reactor design and low-cost artificial light, will increase the practical and economic feasibility of algal integration in RAS, thus improving the potential of mass cultivation of algae in RAS.

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Ramli NM, Sidek S, Rahman FA, Peyman M, Zahari M, Rahmat K, et al.

Graefes Arch Clin Exp Ophthalmol, 2014 Jun;252(6):995-1000.

PMID: 24770532 DOI: 10.1007/s00417-014-2622-6

PURPOSE: To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

METHODS: In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp-Anderson-Parish classification. Pearson's correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

RESULTS: Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70 ± 46.28 mm(3); 167.40 ± 45.36 mm(3)) than in the mild glaucoma group (264.03 ± 78.53 mm(3); 264.76 ± 78.88 mm(3)) and the control group (297.80 ± 71.45 mm(3); 296.56 ± 71.02 mm(3)). Moderate correlation was observed between: RNFL thickness and ON volume (r = 0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r = 0.60, p

Fulltext Bilateral pulmonary sequestrations mimicking advanced lung malignancy

Poh ME, Ng WL, Liam CK, Ramli NM, Hashim S

J Thorac Dis, 2018 Sep;10(9):E710-E713.

PMID: 30416823 DOI: 10.21037/jtd.2018.09.12

Salivary trace elements in relation to dental caries in a group of multi-ethnic schoolchildren in Shah Alam, Malaysia

Hussein AS, Ghasheer HF, Ramli NM, Schroth RJ, Abu-Hassan MI

Eur J Paediatr Dent, 2013 Jun;14(2):113-8.

PMID: 23758460

AIM: To assess the salivary levels of Copper (Cu), Zinc (Zn), Manganese (Mn) and Iron (Fe) obtained from children of different ethnic backgrounds in Shah Alam, Malaysia and investigate the possible relationships with caries.

MATERIALS AND METHODS: One hundred and twenty primary school children were included. They were divided into caries and caries-free groups. Unstimulated whole saliva was collected from each participant using spitting method. The salivary elements were measured using an Atomic Absorption Spectrophotometer. Descriptive statistics, bivariate and Pearson's correlation analysis were performed.

RESULTS: Salivary Cu and Zn levels were significantly higher in children with dental caries compared to those caries-free (p < 0.05). Moreover, these elements had a positive correlation with dental caries (Cu: r=0.698, p<0.001; Zn: r=0.181, p<0.05). No significant variations in Mn and Fe were observed between caries and caries-free group (p>0.05). Additionally, there were significant differences in salivary Zn and Fe among different age groups (p<0.05) and highly significant differences in salivary Cu, Mn and Fe among different ethnic groups (p<0.001). However, all elements exhibited no significant differences between males and females.

CONCLUSION: The salivary Cu and Zn levels showed significant differences between caries and caries-free groups. The findings also revealed significant variations in the levels of salivary Cu, Mn and Fe among different ethnic groups and salivary Zn and Fe among different age groups.

Optic canal characteristics in pediatric syndromic craniosynostosis

Hariri F, Farhana NA, Abdullah NA, Ibrahim N, Ramli NM, Mohd Abdullah AA, et al.

J Craniomaxillofac Surg, 2021 Dec;49(12):1175-1181.

PMID: 34247917 DOI: 10.1016/j.jcms.2021.06.017

The aim of this study was to compare optic canal parameters of syndromic craniosynostosis patients with those of normal patients to visit the possibility of optic nerve impingement as a cause of visual impairment. Computed tomography scan images were processed using the Materialise Interactive Medical Image Control System (MIMICS) Research 21.0 software (Materialise NV, Leuven, Belgium). Eleven optic canal parameters were measured: 1) height of optic canal on the cranial side, 2) height of optic canal on the orbital side 3) length of the medial wall of the optic canal, 4) length of the lateral canal wall of the optic canal, 5) diameter of the optic canal at five points (Q1-Q4 and mid canal), and 6) area and perimeter of optic canal. These measurements were obtained for both the right and left optic canals. The study sample comprised four Crouzon syndrome, five Apert syndrome, and three Pfeiffer syndrome patients. The age of these syndromic craniosynostosis patients ranged from 2 to 63 months. The height of the optic canal on the orbital side (p = 0.041), diameter of the mid canal (p = 0.040), and diameter between the mid-canal and the cranial opening (Q3) (p = 0.079) for syndromic craniosynostosis patients were statistically narrower compared with those of normal patients when a significance level of 0.1 was considered. Scatter plots for the ages of patients versus the above parameters gave three separated clusters that suggested the arresting of optic canal development with age. The findings from this study demonstrated a narrowing of the optic canal in syndromic craniosynostosis patients, and indicate that optic canal anatomical characteristics may have an association with visual impairment among pediatric syndromic craniosynostosis patients.

Fulltext Spectrum of imaging findings of papillary breast disease: A radiopathological review in a tertiary center

Fadzli F, Rahmat K, Ramli MT, Rozalli FI, Hooi TK, Fadzli AN, et al.

Medicine (Baltimore), 2021 Apr 23;100(16):e25297.

PMID: 33879660 DOI: 10.1097/MD.0000000000025297

To evaluate the clinical and imaging findings of papillary breast neoplasm and review the pathologic correlation at a tertiary center.Retrospective study of patients diagnosed with benign and malignant papillary lesions between 2008 to 2018. 147 patients were identified with histology diagnosis of papillary lesions. The clinical, imaging, and pathological characteristics were reviewed.Patient cohort included 147 women diagnosed with papillary lesions (mean age at diagnosis 53.8 years) and were divided into 3 histology groups (benign, atypical, and malignant). Common clinical presentations were breast lump (n = 60) and nipple discharge (n = 29), 48 patients were asymptomatic.Only 37 were detected as a mass lesion on mammogram. The presence of mass lesion on mammogram was the most common feature in all 3 papillary lesion groups, and with the presence of asymmetric density, were the 2 mammographic features significantly associated (P

Fulltext Antihypercholesterolemic and antiatherosclerotic potencies of Pandanus tectorius fruits via increasing scavenger receptor-B1 genes expression and inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity

Andriani Y, Chaudhry GE, Oksal E, Pangestika I, Ramli NM, Mohamad H, et al.

J Adv Pharm Technol Res, 2020 3 11;11(1):30-35.

PMID: 32154156 DOI: 10.4103/japtr.JAPTR_164_19

Atherosclerosis is a leading cause of death worldwide. The adverse side effects of currently available drugs urge to find more effective and safe remedial agents. Alternative candidates from natural resources are of great consequence in the emerging of new drugs. Pandanus tectorius (Pandanaceae) was traditionally used in Ayurvedic medicine to cure certain diseases. Thus, the current study conducted to elucidate the potency of P. tectorius fruit as antiatherosclerosis and antihypercholesterolemia agents through the regulation of high density lipoprotein (HDL) receptor (scavenger receptor [SR]-B1) gene expression and 3-hydroxy-3-methylglutaryl coenzyme A reductase reductase (HMGCR) in vitro, respectively. The P. tectorius fruit was noncytotoxic against the HepG2 cell line confirmed by 3-(4,5-dimethylthiazol-2-yl) 2,5-diphenyl tetrazolium bromide assay. The P. tectorius fruit successfully upregulates the SR-B1 gene expression and downregulate the HMGCR. Moreover, anin vivo study showed that P. tectorius has good activity on the upregulation of HDL and subsequently downregulation of total cholesterol level. Moreover, P. tectorius fruit did not show any increase in toxicity biomarkers serum glutamic oxaloacetic transaminase and serum glutamate pyruvate transaminase in vivo. These results found that P. tectorius fruits have potency as the preventive agent for hypercholesterolemia and atherosclerosis via SR-B1 and HMGCR mechanisms of action.

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