MyMedR

Fulltext Coronary artery bypass graft (CABG) surgery: current University Hospital (K.L.) experience

Ghani SA

Med J Malaysia, 1991 Mar;46(1):21-7.

A personal series of 163 patients who underwent coronary artery bypass surgery (CABG) in the University Hospital, Kuala Lumpur between March 1988 and December 1990 were reviewed retrospectively to determine factors affecting hospital morbidity and mortality. One hundred and thirty eight were elective cases while 25 patients underwent emergency CABG surgery. Of these, 15 patients had recent myocardial infarction, with unstable haemodynamics or post infarct angina; six had failed angioplasty procedures and four patients immediately following coronary angiogram. The elective hospital mortality rate was 2.2% (three cases) and there were two deaths in the emergency group. Pre-operatively 20 patients (13%) had very poor left ventricular function of less than 30% ejection fraction. Significant improvement in ejection fraction was observed following surgery. The follow-up periods were between three months to three years. Ninety eight percent of patients showed improvement in their functional status (NYHA classification) in relation to angina and exercise performance.

Florid diabetic retinopathy in a young patient

Ahmad SS, Ghani SA

J Ophthalmic Vis Res, 2012 Jan;7(1):84-7.

PMID: 22737392

Kearns-Sayre syndrome: An unusual ophthalmic presentation

Ahmad SS, Ghani SA

Oman J Ophthalmol, 2012 May;5(2):115-7.

PMID: 22993469

Kearns-Sayre syndrome (KSS) belongs to the group of neuromuscular disorders known as mitochondrial encephalomyopathies. It has characteristic syndromal features, which include: chronic progressive external ophthalmoplegia, bilateral atypical pigmentary retinopathy, and cardiac conduction abnormalities. So far, only a single case has been reported where a patient with KSS had a normal retina. Herein, we report this extremely rare variant of KSS, which not only presented later than the normal age of presentation, but also had minimal pigmentary retinopathy.

Fulltext Pigmentary Glaucoma with Retinochoroidal Pigmentation

Ahmad SS, Ghani SA

J Ophthalmic Vis Res, 2016 5 20;11(1):120-3.

PMID: 27195097 DOI: 10.4103/2008-322X.180710

Fractured tracheostomy tube in the tracheobronchial tree

Ming CC, Ghani SA

J Laryngol Otol, 1989 Mar;103(3):335-6.

PMID: 2703781

A fractured tracheostomy tube is a rare complication; cases have been reported in the past, usually associated with prolonged usage in patients with chronic airway obstruction. We present here a fracture occurring in a new tube, and also describe a method for retrieving the tube from the tracheobronchial tree.

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents

Chew-Ean T, Ghani SA, Shatriah I

Med J Malaysia, 2020 09;75(5):531-537.

PMID: 32918422

INTRODUCTION: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians.

METHODS: A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery.

RESULTS: Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05).

CONCLUSION: Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery.

Fulltext A case of choroidal melanocytoma mimicking a choroidal melanoma

Ahmad SS, Lad L, Ghani SA

Saudi J Ophthalmol, 2015 Jul-Sep;29(3):242-5.

PMID: 26155089 DOI: 10.1016/j.sjopt.2015.02.002

A 17-year-old young girl was seen by us with complaints of progressive, painless decreasing vision in one eye for the last 4 years. No other supporting history could be elucidated. On examination, a large choroidal mass was found. Since the features were suggestive of malignant melanoma of the choroid, an enucleation of the eye was performed. Subsequently, histopathological examination of the enucleated eye revealed findings consistent with melanocytoma of the choroid. This case is unique in that the patient was of relatively young age and the tumor was huge compared to previous such reports.

Bilateral optic perineuritis and left abducens nerve palsy in a toddler

Chew-Ean T, Othman K, Ghani SA, Shatriah I

Can J Ophthalmol, 2018 10;53(5):e211-e212.

PMID: 30340747 DOI: 10.1016/j.jcjo.2017.11.011

Fulltext A case of bilateral, spontaneous absorption of lenses

Ahmad SS, Rahim AA, Ghani SA

Digit J Ophthalmol, 2011;17(1):3-5.

PMID: 23362385 DOI: 10.5693/djo.02.2011.01.002

Spontaneous absorption of lenses or cataracts is rare. We report a case of bilateral spontaneous lens absorption in a 36-year-old woman for which no cause could be determined despite extensive laboratory testing.

Fulltext Investigation of a PAX6 gene mutation in a Malaysian family with congenital aniridia

Lee PC, Lam HH, Ghani SA, Subrayan V, Chua KH

Genet. Mol. Res., 2014;13(2):3553-9.

PMID: 24737507 DOI: 10.4238/2014.March.24.15

Mutations in the PAX6 gene that cause aniridia have been identified in various ethnicities but not in the Malaysian population. Therefore, the objective of this study was to investigate the PAX6 mutation in a Malaysian family with congenital aniridia. In this study, a complete ophthalmic examination was performed on a Dusun ethnic family with aniridia. Genomic DNA was extracted from the peripheral blood of the subjects and screened for the PAX6 gene mutation using polymerase chain reaction amplification high-resolution melting curve analysis (PCR-HRM) followed by confirmation via direct DNA sequencing. A heterozygous G deletion (c.857delG) in exon 7 causing a frame shift in PAX6 was identified in all affected family members. Genotype-phenotype correlation analysis revealed congenital cataract and all affected family members showed a similar spectrum of aniridia with no phenotypic variability but with differences in severity that were age-dependent. In summary, by using a PCR-HRM approach, this study is the first to report a PAX6 mutation in a Malaysian family. This mutation is the cause of the aniridia spectra observed in this family and of congenital cataract.

Fulltext Cut-it-out technique for ocular fish-hook injury

Ahmad SS, Seng CW, Ghani SA, Lee JF

J Emerg Trauma Shock, 2013 Oct;6(4):293-5.

PMID: 24339666 DOI: 10.4103/0974-2700.120384

An 11-year-old boy was involved in an injury with a fish-hook to his eye. The hook had impaled itself to the cornea and deeper structures. There was associated corneal edema and hyphema, making visualization difficult. In this case, we performed the unusual "cut-it-out" technique to remove the hook from the eye.

Cobalt(II) selective membrane electrode based on palladium(II) dichloro acetylthiophene fenchone azine

Isa IM, Mustafar S, Ahmad M, Hashim N, Ghani SA

Talanta, 2011 Dec 15;87:230-4.

PMID: 22099672 DOI: 10.1016/j.talanta.2011.10.002

A new cobalt(II) ion selective electrode based on palladium(II) dichloro acetylthiophene fenchone azine(I) has been developed. The best membrane composition is found to be 10:60:10:21.1 (I)/PVC/NaTPB/DOP (w/w). The electrode exhibits a Nerstian response in the range of 1.0 × 10(-1)-1.0 × 10(-6)M with a detection limit and slope of 8.0 × 10(-7)M and 29.6 ± 0.2 mV per decade respectively. The response time is within the range of 20-25s and can be used for a period of up to 4 months. The electrode developed reveals good selectivity for cobalt(II) and could be used in pH range of 3-7. The electrode has been successfully used in the determination of cobalt(II) in water samples.

Fulltext Study on ABO and RhD blood grouping: Comparison between conventional tile method and a new solid phase method (InTec Blood Grouping Test Kit)

Yousuf R, Abdul Ghani SA, Abdul Khalid N, Leong CF

Malays J Pathol, 2018 Apr;40(1):27-32.

PMID: 29704381 MyJurnal

INTRODUCTION: 'InTec Blood Grouping Test kit' using solid-phase technology is a new method which may be used at outdoor blood donation site or at bed side as an alternative to the conventional tile method in view of its stability at room temperature and fulfilled the criteria as point of care test. This study aimed to compare the efficiency of this solid phase method (InTec Blood Grouping Test Kit) with the conventional tile method in determining the ABO and RhD blood group of healthy donors.

METHODS: A total of 760 voluntary donors who attended the Blood Bank, Penang Hospital or offsite blood donation campaigns from April to May 2014 were recruited. The ABO and RhD blood groups were determined by the conventional tile method and the solid phase method, in which the tube method was used as the gold standard.

RESULTS: For ABO blood grouping, the tile method has shown 100% concordance results with the gold standard tube method, whereas the solid-phase method only showed concordance result for 754/760 samples (99.2%). Therefore, for ABO grouping, tile method has 100% sensitivity and specificity while the solid phase method has slightly lower sensitivity of 97.7% but both with good specificity of 100%. For RhD grouping, both the tile and solid phase methods have grouped one RhD positive specimen as negative each, thus giving the sensitivity and specificity of 99.9% and 100% for both methods respectively.

CONCLUSION: The 'InTec Blood Grouping Test Kit' is suitable for offsite usage because of its simplicity and user friendliness. However, further improvement in adding the internal quality control may increase the test sensitivity and validity of the test results.

A rare case of methicillin resistant Staphylococcus aureus (MRSA) cerebral abscess secondary to conjunctivitis

Gan YK, Azmi AZ, Ghani SA, Samsudin A

Med J Malaysia, 2017 06;72(3):197-198.

PMID: 28733571 MyJurnal

This case report discusses the rare association of cerebral abscess related to conjunctivitis in an otherwise healthy child. A 6 year old boy presented with conjunctivitis was treated with topical antibiotics and resolved after a week. Conjunctival swab cultures grew MRSA. A month later he developed status epileptics and CT scans revealed a large cerebral abscess. He was treated with intravenous antibiotics which covered for MRSA, along with an incision and drainage for the cerebral abscess. Pus cultures grew MRSA. The patient recovered well with no disturbance in visual acuity or visual field. On post-operative follow ups, he had no other neurological deficit apart from a slight limp.

Fulltext The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement

Hadizie D, Kor YS, Ghani SA, Mohamed-Saat MA

Malays Orthop J, 2022 Nov;16(3):24-29.

PMID: 36589367 DOI: 10.5704/MOJ.2211.005

INTRODUCTION: The primary aim of open fracture management is to prevent fracture-related infection by early antibiotic administration, debridement and wound coverage. However, the timing of the initial debridement is still controversial, and 6 to 24 hours is commonly advocated. Studies have yet to provide substantial evidence regarding the best time for surgical debridement. Thus, this study was conducted to compare the incidence of fracture-related infection at different time intervals of initial debridement of the open tibia fracture.

MATERIALS AND METHODS: A total of 91 patients with grade I, II and IIIa open tibia fractures were recruited from 2016 to 2018, and their data were obtained from the consensus book and medical records. Participants were divided into four groups based on the time of initial debridement: (1) less than 6 hours, (2) 6 to less than 12 hours, (3) 12 to less than 24 hours, and (4) 24 hours and more. Fracture-related infection was determined by using Metsemakers confirmative criteria. Association between time and infection were determine by Binary Logistic Regression analysis by remerged the group into three; (1) less than 12 hours, (2) 12 to less than 24 hours and (3) 24 hours and more. The collected information was analysed using SPSS version 24 and Microsoft Excel 2010.

RESULTS: The mean age of the participants was 31.9 years old, with male predominant (n=80, 87.0%). Most participants had delayed initial debridement of more than 24 hours and predominantly Gustilo-Anderson type IIIa (n=47). A total of 8 fractures complicated with infection (8.7%), majority in grade IIIa and debridement performed within 12 to less than 24 hours. Binary logistic regression showed increased odds of infection with a delayed wound debridement both in clinical presentation and positive culture, but the association was not statistically significant. The commonest organism isolated was Pseudomonas aeruginosa.

CONCLUSION: Comparing to different time interval, initial wound debridement of more than 24 hours did not have strong association with increasing infection rate. However, even though statistically not significant, the odds of infection was increase with increasing time of initial wound debridement of an open tibia fracture, thus it should be performed early.

Fulltext 5-year-old girl with left upper eyelid swelling

Ahmad SS, Ghani SA, Peng KS, Sellamuthu P

Digit J Ophthalmol, 2012;18(4):15-7.

PMID: 23847451 DOI: 10.5693/djo.03.2012.05.001

Fulltext Bilateral persistent pupillary membranes associated with cataract

Ahmad SS, Binson C, Lung CK, Ghani SA

Digit J Ophthalmol, 2011;17(4):62-5.

PMID: 23362401 DOI: 10.5693/djo.02.2011.10.001

Exuberant persistent pupillary membranes (PPM) are rare in adult eyes. We report the case of a 53-year-old man diagnosed with bilateral, profuse, persistent pupillary membranes and unilateral cataract.

A review of hydroxyapatite-based coating techniques: Sol-gel and electrochemical depositions on biocompatible metals

Asri RI, Harun WS, Hassan MA, Ghani SA, Buyong Z

J Mech Behav Biomed Mater, 2016 Apr;57:95-108.

PMID: 26707027 DOI: 10.1016/j.jmbbm.2015.11.031

New promising techniques for depositing biocompatible hydroxyapatite-based coatings on biocompatible metal substrates for biomedical applications have continuously been exploited for more than two decades. Currently, various experimental deposition processes have been employed. In this review, the two most frequently used deposition processes will be discussed: a sol-gel dip coating and an electrochemical deposition. This study deliberates the surface morphologies and chemical composition, mechanical performance and biological responses of sol-gel dip coating as well as the electrochemical deposition for two different sample conditions, with and without coating. The review shows that sol-gel dip coatings and electrochemical deposition were able to obtain the uniform and homogeneous coating thickness and high adherent biocompatible coatings even in complex shapes. It has been accepted that both coating techniques improve bone strength and initial osseointegration rate. The main advantages and limitations of those techniques of hydroxyapatite-based coatings are presented. Furthermore, the most significant challenges and critical issues are also highlighted.

Fulltext The Values of Receptor Activator Nuclear Kappa-B Ligand Expression in Stage III Giant Cell Tumor of the Bone

Ghani SA, Wan Ismail WF, Md Salleh MS, Yahaya S, Syahrul Fitri ZM

Indian J Orthop, 2018 2 9;52(1):31-34.

PMID: 29416167 DOI: 10.4103/ortho.IJOrtho_153_17

Background: Giant cell tumor (GCT) of bone is a benign locally aggressive primary bone tumor which is risky for local recurrences and pulmonary metastasis. Till date, there are still many uncertainties in predicting the aggressiveness of GCT. We aim to investigate whether receptor activator nuclear kappa-B ligand (RANKL) expression may determine the prognosis of the lesion.

Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.

Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.

Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.

Fulltext Cytomegalovirus retinitis associated with high CD4 counts and DHEA abuse

Keat GY, Ahmad SS, Subramaniam S, Ghani SA, Samsudin A

Indian J Sex Transm Dis AIDS, 2020 06 18;41(1):119-122.

PMID: 33062999 DOI: 10.4103/ijstd.IJSTD_90_15

The most frequent ocular manifestation of acquired immunodeficiency syndrome (AIDS) is cytomegalovirus retinitis (CMVR). This infection is reportedly inversely proportional to the CD4 counts. Usually CMVR develops once the CD4 counts fall below 50/mm3. Our case report documents an AIDS patient who developed CMVR despite CD4 counts being persistently >200/mm3. The patient was self-administering dehydroepiandrosterone, high dose Vitamin C, testosterone and hydrocortisone. This case report describes a unique case of pharmacologically induced elevated CD4 counts, which however, did not prevent the development of CMVR in the patient.

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