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Fulltext Baseline Specimens of Erosion and Abrasion Studies

Ishak H, Field J, German M

Eur J Dent, 2021 May;15(2):369-378.
PMID: 33368070 DOI: 10.1055/s-0040-1721235

The difficulty in obtaining human teeth that are caries-free that have similar environmental exposure, e.g., diet intake and water fluoridation has lead researchers to opt for bovine teeth as a substitute for erosion studies. Bovine mandibular incisors are readily available at abattoirs and often originate from the same region and are likely to consume similar dietary intake. The bovine teeth for erosion or abrasion studies usually undergo specimen preparation to produce a "flat surface" baseline specimen. Among other terms used to define baseline specimens for erosion and abrasion studies include phrases like "optically flat" and "flat and smooth surface." However, these terms might have no quantitative value as it does not justify the actual surface characteristics of the prepared flattened surface. In dentistry, roughness average (Ra) is the most commonly used parameter when reporting the roughness of specimens Reporting Ra alone might not be sufficient as it does not provide information regarding the surface texture as there is no distinction between valleys and peaks, nor does it provide information about the core structure of a material unlike the bearing area curve. The incorporation of Ra and BAP values in baseline specimens has the potential in predicting the wear or lubricating potential of these specimens. Furthermore, standardization of baseline specimens by acknowledging its surface roughness values ensures comparability of erosion and abrasion studies as different specimen preparation technique might influence the outcome or results of research.
Fulltext Effect of ageing towards location and visibility of mental foramen on panoramic radiographs

Ngeow WC, Dionysius DD, Ishak H, Nambiar P

Singapore Dent J, 2010 Jun;31(1):15-9.
PMID: 23739252 DOI: 10.1016/S0377-5291(12)70004-4

Mental foramen is an opening of the mental canal onto the lateral surface of the mandible. In this pilot radiographical study, in Malay population the effects of ageing towards the location and visibility of the mental foramen were determined. Most of the mental foramina were found to be located inferior to the apex of the second premolar. Non-visibility of the foramen was greatly increased in patients aged 50 years and above (Pearson Chi-square; p = 0.00). This finding may provide a guide to dental surgeries in Malay patients of different age groups.
A radiographic study on the visualization of the anterior loop in dentate subjects of different age groups

Ngeow WC, Dionysius DD, Ishak H, Nambiar P

J Oral Sci, 2009 Jun;51(2):231-7.
PMID: 19550091

The anterior loop is defined as where the mental neurovascular bundle crosses anterior to the mental foramen then doubles back to exit the mental foramen. It cannot be seen clinically but can be detected in 11-60% of panoramic radiographs. As this anatomical structure is important in determining the placement position of endosseous implants in the mandibular premolar region, a pilot study was undertaken to determine its visibility on dental panoramic radiographs in dentate subjects of various age groups. One or more anterior loops were visible in 39 (40.2%) radiographs encompassing 66 sites (34.4%). Interestingly, anterior loops were most commonly observed bilaterally, followed by on the right side of the mandible only. An anterior loop on the left side only was observed in just 1 radiograph. Visibility of anterior loops reduced as the age of subjects increased. More than half (58.1%) of subjects aged 20-29 years exhibited at least one anterior loop; this gradually reduced to only 15 percent of subjects aged 50 and older. There was no association between visualization of the anterior loop and subject gender.
Endogenous endophthalmitis: a 9-year retrospective study at a tertiary referral hospital in Malaysia

Muda R, Vayavari V, Subbiah D, Ishak H, Adnan A, Mohamed SO

J Ophthalmic Inflamm Infect, 2018 Oct 11;8(1):14.
PMID: 30306361 DOI: 10.1186/s12348-018-0158-3

BACKGROUND: The objective of this study was to determine the clinical presentation, systemic risk factors, source of infective microorganism, treatment outcomes, and prognostic indicators of endogenous endophthalmitis at a main tertiary referral hospital for uveitis in Malaysia. A retrospective review of medical records of 120 patients (143 eyes) with endogenous endophthalmitis over a period of 9 years between January 2007 and December 2015 was undertaken.
RESULTS: Identifiable systemic risk factors were present in 79.2%, with the majority related to diabetes mellitus (60.0%). The most common source of bacteremia was urinary tract infection (17.5%). A positive culture from ocular fluid or other body fluids was obtained in 82 patients (68.9%), and the blood was the highest source among all culture-positive results (42.0%). Gram-negative organisms accounted 42 cases (50.6%) of which Klebsiella pneumonia was the most common organism isolated (32.5%). Sixty-nine eyes (48.6%) were managed medically, and 73 eyes (51.4%) underwent vitrectomy. Final visual acuity of counting fingers (CF) or better was achieved in 100 eyes (73.0%). Presenting visual acuity of CF or better was significantly associated with a better final acuity of CF or better (p = 0.001).
CONCLUSIONS: The visual prognosis of endogenous endophthalmitis is often poor, leading to blindness. As expected, gram-negative organisms specifically Klebsiella pneumonia were the most common organisms isolated. Urinary tract infection was the main source of infection. Poor presenting visual acuity was significantly associated with grave visual outcomes. A high index of suspicion, early diagnosis, and treatment are crucial to salvage useful vision.
Tuberculous pleural effusion in a patient with sympathetic ophthalmia on immunosuppression: a case report

Thiagarajan D, Teh DAL, Ahmad Tarmidzi NA, Ishak H, Abu Bakar Z, Bastion MC

Trop Dis Travel Med Vaccines, 2021;7:27.
PMID: 34667620 DOI: 10.1186/s40794-021-00153-3

Background: Tuberculous pleural effusion (TPE) is paucibacillary, making its diagnosis difficult based on laboratory investigations alone. We present a case of a patient with a TPE who was initially misdiagnosed to have azathioprine-induced lung injury. The diagnosis of TPE was arrived at with the help of clinical assessment, laboratory and radiological investigations.
Case presentation: A 25-year-old chronic smoker with sympathetic ophthalmia on long-term immunosuppression, latent tuberculosis infection and a significant family history of tuberculosis presented with a three-week history of productive cough, low-grade fever, night sweats and weight loss. Examination of the lungs showed reduced breath sounds at the right lower zone. Chest x-ray showed minimal right pleural effusion with a small area of right upper lobe consolidation. The pleural fluid was exudative with predominant mononuclear leukocytes. Direct smears of sputum and pleural fluid; polymerase chain reaction of pleural fluid; and sputum, pleural fluid and blood cultures were negative for M. tuberculosis (MTB) and other organisms. As he did not respond to a course of broad-spectrum antibiotics, he was then treated as a case of azathioprine-induced lung injury. However, his condition did not improve despite the cessation of azathioprine. A contrast-enhanced computed tomography of the thorax showed right upper lobe consolidation with tree-in-bud changes, bilateral lung atelectasis, subpleural nodule, mild right pleural effusion and mediastinal lymphadenopathy. Bronchoalveolar lavage was negative for malignant cells and microorganisms including, MTB. However, no pleural biopsy was done. He was empirically treated with anti-tubercular therapy for 9 months duration and showed complete recovery.
Conclusion: A high index of suspicion for TPE is required in individuals with immunosuppression living in regions endemic to tuberculosis. Targeted investigations and sound clinical judgement allow early diagnosis and prompt treatment initiation to prevent morbidity and mortality.
Fulltext Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

Ngah NF, Muhamad NA, Mohamed SO, Abdul Aziz RA, Ma'amor NH, Ahmad Tarmidzi NA, et al.

Int J Ophthalmol, 2023;16(5):712-720.
PMID: 37206185 DOI: 10.18240/ijo.2023.05.07

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.
METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it.
RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created.
CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.