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Fulltext Diagnosing pediatric intussusception through bedside ultrasound by novice emergency department sonographers: a case report

Farah, N. A., Ismail, M. S.

Medicine & Health, 2017;12(2):321-328.
MyJurnal

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound
Contactless respiration rate measurement using optical method and empirical mode decomposition

Gan KB, Yahyavi ES, Ismail MS

Technol Health Care, 2016 Sep 14;24(5):761-8.
PMID: 27163300 DOI: 10.3233/THC-161161

BACKGROUND: At the emergency triage center, assessment of the present of the danger signs and measurement of vital signs are measured according to the guidelines. The respiration rate is still posing a challenge to the doctor as it is impractical to use conventional devices. Attaching measurement devices to the patient will induce artificial measurements (self-awareness stress effects) besides being time-consuming. Currently, the medical officers visually count the number of times the chest movement in a minute, sometimes poses cultural challenges especially for female patients.
OBJECTIVE: The main objective of this paper is to develop a robust algorithm to extract respiration rate using the contactless displacement sensor.
METHODS: In this study, chest movements were used as an indicative of inspiration and expiration to measure respiratory rate using the contactless displacement sensor. The contactless optical signals were recorded from 32 healthy subjects in four different controlled breathing conditions: rest, coughing, talking and hand movement to obtain the motion artifacts that the patients may have in the emergency department. The Empirical mode decomposition (EMD) algorithm was used to derive continuous RR signal from the contactless optical signal.
RESULTS: The analysis showed that there is a good correlation (0.9702) with RMSE of 0.33 breaths per minutes between the contact respiration rate and contactless respiration rate using empirical mode decomposition method.
CONCLUSION: It can be concluded that the empirical mode decomposition method can extract the respiration rate of the contactless optical signal from chest movement.
Fulltext Patient attendance at a major accident and emergency department: are public emergency services being abused?

Azhar AA, Ismail MS, Ham FL

Med J Malaysia, 2000 Jun;55(2):164-8.
PMID: 19839143

A total of 37,152 patients attended the Accident & Emergency (A&E) Department of Hospital Universiti Kebangsaan Malaysia (HUKM) from 1st January to 31st December 1998. Attendance during early hours (midnight to 0659 hrs.) constituted only 10.4% (3853 cases) whereas that for three other time periods of 0700-1159 hrs., 1200-1759 hrs., and 1800-2359 hrs. was 29.4% (10,927 cases), 30.8% (11,448 cases), and 29.4% (10,924 cases) respectively. Two hundred and fifty-one patients were direct admissions from other hospitals into our hospital wards and they attended the A&E department for registration purposes only. Of the remaining 36,901 that were triaged, 196 (0.5%) were resuscitation cases [Triage 1], 3648 (9.9%) were emergency cases [Triage 21, 18,935 (51.3%) were urgent cases [Triage 3], and 14,122 (38.3%) were non-urgent cases [Triage 4]. Despite fluctuations in monthly patient attendance, the proportions of patients according to time of attendance, age group, gender and triage categories remained similar throughout. As majority of patients attended during convenient hours (89.6% from 0700-2359 hrs.) and a high proportion of patients (38.3%) belonged to the non-urgent Triage category, we feel that public emergency services are possibly being abused.
Secondary triage classification using an ensemble random forest technique

Azeez D, Gan KB, Mohd Ali MA, Ismail MS

Technol Health Care, 2015;23(4):419-28.
PMID: 25791174 DOI: 10.3233/THC-150907

BACKGROUND: Triage of patients in the emergency department is a complex task based on several uncertainties and ambiguous information. Triage must be implemented within two to five minutes to avoid potential fatality and increased waiting time.
OBJECTIVE: An intelligent triage system has been proposed for use in a triage environment to reduce human error.
METHODS: This system was developed based on the objective primary triage scale (OPTS) that is currently used in the Universiti Kebangsaan Malaysia Medical Center. Both primary and secondary triage models are required to develop this system. The primary triage model has been reported previously; this work focused on secondary triage modelling using an ensemble random forest technique. The randomized resampling method was proposed to balance the data unbalance prior to model development.
RESULTS: The results showed that the 300% resampling gave a low out-of-bag error of 0.02 compared to 0.37 without pre-processing. This model has a sensitivity and specificity of 0.98 and 0.89, respectively, for the unseen data.
CONCLUSION: With this combination, the random forest reduces the variance, and the randomized resembling reduces the bias, leading to the reduced out-of-bag error.
KEYWORDS: Decision support system; emergency department; random forest; randomized resampling
Severe complications induced by experimental bacterial superinfection of orf lesions

Zamri-Saad M, Roshidah I, al-Ajeeli KS, Ismail MS, Kamarzaman A

Trop Anim Health Prod, 1993 May;25(2):85-8.
PMID: 8236484

Twelve goats about 3 months of age were divided into 4 equal groups. Goats in Groups 1 and 2 were infected with orf virus followed by Corynebacterium pyogenes infection of Groups 1 and 3, 3 days after the first appearance of orf lesions. Goats in Group 4 were uninfected controls. Complicated orf lesions which consisted of wet suppurative scabs around the entire lips were observed in goats in Group 1. The lesions persisted for 24 days but were most severe from days 8 to 13. Goats in Group 2 developed lesions typical of orf virus infection that lasted 10 days, while goats in Group 3 developed small nodules of about 1 cm diameter, 48 hours following the introduction of C. pyogenes, which persisted for only 6 days. No lesion was observed in goats in Group 4. Two goats in Group 1 with complicated orf died after 16 and 22 days respectively.
Fulltext Endometriosis of the appendix presenting as acute appendicitis

Khoo JJ, Ismail MS, Tiu CC

Singapore Med J, 2004 Sep;45(9):435-6.
PMID: 15334288

While endometriosis is fairly common, endometriosis of the appendix is a very rare occurrence. Correct pre-operative diagnosis is uncommon and definitive diagnosis is established by histology of the appendix. We present a case of endometriosis of the appendix that manifested as acute appendicitis in a 40-year-old woman.
Perception of quality of life amongst end stage renal failure patients undergoing haemodialysis

Ho SE, Ho CC, Norshazwani N, Teoh KH, Ismail MS, Jaafar MZ, et al.

Clin Ter, 2013;164(6):499-505.
PMID: 24424213 DOI: 10.7417/CT.2013.1627

AIMS: The objective of the study was to examine the quality of life amongst the end stage renal disease (ESRD) haemodialysis patients in Malaysia.
MATERIALS AND METHODS: A cross sectional descriptive study was conducted on 72 ESRD patients at a Dialysis Centre in Malaysia. The modified KDQOL-SF™ subscales, kidney disease-targeted scale and 36 item health survey scale questionnaires were used.
RESULTS: The overall health rating was 66.73 ± 11.670 indicating good quality of life. There was no significant difference between quality of life for the different domains according to gender (p >0.05). However, there were significant differences between quality of life in the domain of burden of kidney disease. Physical functioning deteriorated significantly with age (p=0.012) while social functioning was lowest in the 50-65 years age group (p=0.037). Those who had no morbidities had significantly better scores on the effects of kidney (p=0.036), burden of kidney disease (p=0.011) and physical functioning (p=0.025).
CONCLUSIONS: Patients undergoing haemodialysis have been found to have good quality of life despite having ESRD. It is therefore of paramount importance to constantly monitor the standard of care for these patients to enable them to live their life to the fullest.
Cardiopulmonary bypass in surgery for complex-combined vascular malformation of the lower limb: case report

Ismail MS, Sharaf I, Thambidorai CR, Zainal A, Somasundaram S, Adeeb S, et al.

Pediatr Surg Int, 2005 May;21(5):392-5.
PMID: 15806424

A 16-year-old boy was referred with features of Parkes Weber syndrome (PWS) involving the right lower limb. He had presented at birth with cutaneous vascular malformations (VM) in the right thigh and at the age of 7 years developed congestive cardiac failure, which was controlled with drugs. He received alpha interferon and steroids during this period without any benefit. He defaulted follow-up and at 12 years of age presented with further enlargement of the VM in the right thigh and leg with skin and soft tissue thickening. At this stage, embolization and subsequent excision of the VM were tried, but the surgery was abandoned because of massive hemorrhage. Over the next 4 years, the boy became totally bedridden because of massive increase in the size of the limb, repeated hemorrhages, and secondary infection of the VM. Right hip disarticulation was considered the best option to improve his quality of life. To prevent uncontrollable hemorrhage during surgery, the disarticulation was done under cardiopulmonary bypass with low circulatory flow. Postoperatively, the patient required intensive care nursing for a week. He is presently ambulatory with crutches. Cardiopulmonary bypass with low flow has been used for treating posttraumatic arteriovenous malformations. However, its use in surgery for PWS has not been reported earlier.
The effect of feed-based vaccination on tilapia farm endemic for streptococcosis

Ismail MS, Syafiq MR, Siti-Zahrah A, Fahmi S, Shahidan H, Hanan Y, et al.

Fish Shellfish Immunol, 2017 Jan;60:21-24.
PMID: 27864157 DOI: 10.1016/j.fsi.2016.11.040

A tilapia farm experiencing endemic streptococcosis was selected to study the effect of vaccination with a feed-based vaccine on naturally ocurring streptococcosis. A total of 9000 red tilapia, Oreochromis niloticus × Oreochromis mossambicus of 100 ± 20 g were divided into 9 cages. Fish of Group 1 in cages 1, 2 and 3 were not vaccinated. Group 2 in cages 4, 5 and 6 were vaccinated on days 0 and 14 (single booster) while Group 3 in cages 7, 8 and 9 were vaccinated on days 0, 14 and 42 (double booster). Vaccination was done by oral administration of the feed-based bacterin vaccine at 4% bodyweight. Samples of serum for antibody study and the brain, eyes and kidney for bacterial isolation were collected at 14-day intervals. The study was carried out during the critical months between April and June. Following vaccination and booster, there was significant (p
Feed-based vaccination regime against streptococcosis in red tilapia, Oreochromis niloticus x Oreochromis mossambicus

Ismail MS, Siti-Zahrah A, Syafiq MR, Amal MN, Firdaus-Nawi M, Zamri-Saad M

BMC Vet Res, 2016;12(1):194.
PMID: 27608936 DOI: 10.1186/s12917-016-0834-1

Streptococcosis is an important disease of tilapia throughout the world. In Malaysia, streptococcosis outbreak was commonly reported during the 3-month period of high water temperature between April and July. This study describes the duration of protection following single and double booster dose regimes against streptococcosis in tilapia using a feed-based vaccine containing formalin-killed Streptococcus agalactiae. A total of 510 tilapias of 120 ± 10 g were selected and divided into 3 groups. Fish of Group 1 were vaccinated at weeks 0 and 2 (single booster group) while fish of Group 2 were vaccinated at weeks 0, 2 and 6 (double booster group) with a feed-based vaccine against streptococcosis. Fish of Group 3 was not vaccinated. Serum samples were collected weekly to determine the antibody level while samples of eye, brain and kidney were collected for bacterial isolation. At week 10, all fish were challenged with live S. agalactiae and the survival rate was determined.
Stimulation of the bronchus-associated lymphoid tissue of goats and its effect on in vitro colonization by Pasteurella haemolytica

Effendy AW, Zamri-Saad M, Maswati MA, Ismail MS, Jamil SM

Vet Res Commun, 1998 Apr;22(3):147-53.
PMID: 9618886

Twenty goats of about 7 months of age were divided into five groups. The goats in groups 1 and 2 were exposed once, using an intranasal spray to 2 ml of an inoculum containing 10(6) colony-forming units/ml of living or dead Pasteurella haemolytica A2, respectively. The goats in groups 3 and 4 were similarly exposed twice at a 2-week interval. Group 5 was the untreated control. The number and size of the bronchus-associated lymphoid tissue (BALT) in goats exposed twice to either living or dead organisms were significantly (p < 0.05) increased compared with those exposed once and with the unexposed control. In vitro colonization by living P. haemolytica A2 onto the lung tissue in which the BALT had been stimulated by two exposures of either living or dead organisms was significantly (p < 0.05) reduced. The study indicates that stimulation of the respiratory mucosal immunity may prevent P. haemolytica A2 infection.
Fulltext Comparison of fracture patterns between rural and urban populations in a developing country

Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG

Singapore Med J, 2010 Sep;51(9):702-8.
PMID: 20938610

The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.
Study on advanced life support devices in the ambulances for emergency cases in Klang Valley, Malaysia

Ismail MS, Hasinah AB, Syaiful MN, Murshidah HB, Thong TJ, Zairi Z, et al.

Clin Ter, 2012;163(2):115-22.
PMID: 22555825

In an effort to improve pre-hospital care, the authors assessed the availability and utility of ambulance devices. The study aimed to identify commonly used devices for managing emergency cases in Klang Valley of Malaysia.
Drone versus ambulance for blood products transportation: an economic evaluation study

Zailani MA, Azma RZ, Aniza I, Rahana AR, Ismail MS, Shahnaz IS, et al.

BMC Health Serv Res, 2021 Dec 05;21(1):1308.
PMID: 34863156 DOI: 10.1186/s12913-021-07321-3

BACKGROUND: Medical transportation is an essential step in health care services, and includes ground, air and water transportation. Among the important uses of medical transportation is the delivery of blood products in the event of a clinical emergency. Drone technology is the latest technological advancement that may revolutionize medical transportation globally. Nonetheless, its economic evaluation is scant and insufficient, whilst its cost-effectiveness remains controversial. The aim of this study was to compare the cost-effectiveness of drone transportation versus the ambulance.
METHODS: The setting of the study was within a developing nation. An economic evaluation study of drone versus ambulance for emergency blood products transportation between the Sabah Women and Children Hospital (SWACH) and the Queen Elizabeth II Hospital (QEH2) on Borneo Island was conducted using the Cost-Effectiveness Analysis (CEA) technique. The total cost of each mode of transportation was calculated using the Activity Based Costing (ABC) method. Travel time was used as a denominator to estimate the Incremental Cost Effectiveness Ratio (ICER).
RESULTS: For one clinical emergency in SWACH, a round trip of blood products transportation from SWACH to QEH2 costs RM1,266.02 (USD307.09) when using the ambulance, while the drone costs RM1,313.28 (USD319.36). The travel time for the drone was much shorter (18 min) compared to the ambulance (34 min). The Cost-Effectiveness Ratio (CER) of ambulance transportation was RM37.23 (USD9.05) per minute whilst the CER of drone transportation was RM72.96 (USD17.74) per minute. The ICER of drone versus ambulance was - 2.95, implying an increase of RM2.95 in cost for every minute saved using a drone instead of an ambulance.
CONCLUSION: Although drone transportation of blood products costs more per minute compared to the ambulance, the significantly shorter transport time of the drone offset its cost. Thus, we believe there is good economic potential for drone usage for blood products transportation in developing nations particularly if the drone price decreases and its operational lifespan increases. Our limitation of a non-clinical denominator used in this study leads to the recommendation for use of clinical outcomes in future studies.

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