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Fulltext Modified subtotal cholecystectomy: a procedure for the difficult gall bladder

Khan TF

Med J Malaysia, 1992 Mar;47(1):65-8.
PMID: 1387453

Modified subtotal cholecystectomy involves removal of the gall bladder after circumferential division of the neck. Either the impacted stone or the surgeons finger was used as a guide to identify the neck. The stump cavity in the neck is obliterated with interrupted sutures to prevent recurrent stone formation. Indications for this procedure are obscure anatomy, due either to the severe inflammation in acute cholecystitis or dense adhesions in the small fibrosed gall bladder. The decision to perform modified subtotal cholecystectomy is taken during the operation. Forty three patients (14%) underwent this procedure during the period between August 85 and April 90. Out of 289 cholecystectomies performed seven were emergency and thirty-six were early cholecystectomies. With the increasing trend towards urgent and early cholecystectomy in acute cholecystitis the author has found this to be a safe and definitive procedure.
Mechanical, bioadhesive strength and biological evaluations of chitosan films for wound dressing

Peh K, Khan T, Ch'ng H

J Pharm Pharm Sci, 2000 Sep-Dec;3(3):303-11.
PMID: 11177648

To investigate the suitability of chitosan films prepared using two different solvents, acetic acid (Chitosan-AA) and lactic acid (Chitosan-LA), for wound dressing, in comparison with a commercial preparation, Omiderm.
Fulltext Diagnosis and management of blunt pancreatic trauma: a case report with review of the literature

Khan TF, Zahari A

Med J Malaysia, 1993 Jun;48(2):244-7.
PMID: 8350806

Details of a young logger who sustained a clean prevertebral transection of the pancreas to the left of the superior mesenteric vessels and a crush injury in segments 2 and 3 of the liver are presented. CT scan was not done but ultrasound scan revealed free intraperitoneal fluid and no comment was made about the pancreas. The pancreatic injury was discovered at laparotomy carried out 24 hours after admission and treated by resection.
Spectrum of cholangitis in a rural setting in North-eastern Peninsular Malaysia

Khan TF, Raj SM, Visvanathan R

Trop Doct, 1993 Jul;23(3):117-8.
PMID: 8356738
Recurrent pyogenic cholangitis: 'sump syndrome' following choledochoduodenostomy

Khan TF, Sherazi ZA, Muniandy S, Mumtaz M

Trop Doct, 1997 Jan;27(1):51-2.
PMID: 9030026

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the 'sump syndrome', developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.
Comparison and Evaluation of Different Seed Extracts of Trachyspermum ammi for Immunomodulatory Effect on Cell-Mediated Immunity through Delayed-Type Hypersensitivity Assay Skin Thickness Method

Siddiqui MJ, Aslam A, Khan T

J Pharm Bioallied Sci, 2019 3 25;11(1):43-48.
PMID: 30906139 DOI: 10.4103/jpbs.JPBS_174_18

Objective: The aim and objective of this study was to find the immunostimulant and immunomodulatory effect of T. ammi seed extracts.
Methods: Seeds of T. ammi were extracted using three different solvents n-hexane, chloroform, and methanol by using soxhlet apparatus. To assess the immunomodulatory effect, delayed-type hypersensitivity (DTH) assay method was used and by the DTH assay, the effect of T. ammi on the skin thickness of rats was estimated. To find the exact dose for administration, acute toxicity test was performed using crude methanolic extract at a dose of 400, 800, 1600, and 3200mg/kg. After acute toxicity test, 500mg/kg dose was determined as safe for therapeutic effect and immunomodulatory effect was evaluated at this dose. Dose of 500mg/kg was administered to Wistar rats daily for 14 days and skin thickness of rats was measured at 24, 48, and 72h.
Results: Results were obtained from six groups of rats, which were positive control group, negative control group, and the groups receiving the test drugs. Standard drug was the combination of sodium selenite, vitamin E, and sodium chloride and it showed more positive results as compared to that of test drug. Furthermore, among the three extracts, methanol extract showed more effectiveness on skin thickness.
Conclusion: There was a meaningful difference was observed between the skin thickness of rats which shows that T. ammi have good immunomodulatory as well as immunostimulant activity.
Seroprevalence of low avidity anti-Toxoplasma IgG in pregnant women and its relationship with their age and contact with cats

Khan K, Khan W, Khan T, Naaz G, Naheda A, Aqeel S

Trop Biomed, 2020 Dec 01;37(4):1038-1049.
PMID: 33612756 DOI: 10.47665/tb.37.4.1038

Toxoplasma gondii is a protozoan parasite that can infect all mammals, serving as intermediate hosts. The cause of congenital toxoplasmosis is transplacental transmission of the parasite to the foetus, resulting in wide range of manifestations from mild chorioretinitis to miscarriage. Its frequency can be reduced by early screening of pregnant women which is based mainly on tests for anti-Toxoplasma antibodies. We collected serum samples of 594 pregnant women (subjects) after taking their consent over a period of two years (2016-2018) and analyzed them for anti-Toxoplasma IgG by ELISA. The positive samples were then analyzed for IgG avidity test which could differentiate between recent and past infections. The seroprevalence was also correlated with the age of the subjects and their contact with cats. 162 subjects were found positive out of which only three showed a recent infection. After following up until delivery, one of them delivered a baby who had jaundice and was diagnosed with anti-Toxoplasma IgM at birth. The foetus of the second subject died in-utero, while the third woman delivered a normal baby after being given spiramycin when diagnosed with toxoplasmosis in the first trimester. It was found that most of the positive subjects had frequent contact with cats. Invasion of the parasite during third trimester resulted in death in-utero and jaundice. Most common cause of pregnancy wastage during our study was spontaneous abortions while pregnancy loss due to congenital anomalies was rare.
Fulltext Patient-physician Communication Barrier: A Pilot Study Evaluating Patient Experiences

Khan T, Hassali M, Al-Haddad M

J Young Pharm, 2011 Jul;3(3):250-5.
PMID: 21897668 DOI: 10.4103/0975-1483.83778

This study aims to identify the patient-physician communication barriers in the primary healthcare setting in Pulau Penang, Malaysia. A cross-sectional study was designed to attain the objectives of the study. A self-developed 17-item study tool was used to explore respondent's perception about the barriers they have faced while communicating with physician. The reliability scale was applied and internal consistency of the study tool was estimated on the basis of Cronbach's alpha (α = 0.58). The data analysis was conducted using statistical package for social sciences students SPSS 13(®). Chi Square test was used to test the difference between proportions. A total of n = 69 patients responded to this survey. A higher participation was seen by the male respondents, 39 (56.5%). About 52 (76.5%) of the respondents were satisfied with the information provided by the physician. In an effort to identify the patient-physician barriers, a poor understanding among the patients and physician was revealed. 16 (23.5%) respondents disclosed lack of satisfaction from the information provided to them. Overall, it is seen that lack of physician-patient understanding was the main reason that result hindrance in the affective communication. Moreover, there is a possibility that a low level of health literacy among the patients and inability of the physician to affectively listen to patients may be the other factors that result in a deficient communication.
Fulltext General Public Expectation from the Communication Process with their Healthcare Providers

Hassali M, Shafie A, Khan T

J Young Pharm, 2012 Jul;4(3):193-8.
PMID: 23112539 DOI: 10.4103/0975-1483.100028

The current study aimed to explore the public views and expectation about a successful communication process between the healthcare providers/physicians and patients in Penang Island, Malaysia. A cross-sectional study was conducted in Penang Island using a 14-item questionnaire. Statistical Package for Social Sciences (SPSS) software version 15.0(®) were used to analyze the collected data. A nonparametric statistics was applied; the Chi-square test was applied to measure the association among the variables. P-values less than 0.05 were considered statistically significant. A total of N (500) respondents have shown willingness to participate in the study with a response rate of 83.3%. The majority 319 (63.9%) have disclosed to communicate with their healthcare providers in the Malay language and about 401 (80.4%) of the respondents were found satisfied with the information provided by the physician. It was a common expectation by the most of the sample to focus more on the patient history before prescribing any medicine. Moreover, about 60.0% of the respondents expected that the healthcare providers must show patience to the patient's queries. The level of satisfaction with the information shared by the healthcare providers was higher among the respondents with a higher education level. Furthermore, patients with higher level of education expect that physician shouldwell understand their views and medical history to prescribe a better therapeutic regimen.
Fulltext Anomalous pancreatico-biliary junction--a non-dilated biliary system and gallbladder carcinoma

Toufeeq Khan TF, Hayat FZ, Muniandy S

Singapore Med J, 1998 Jan;39(1):25-6.
PMID: 9557100

Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.
Fulltext Bilio-enteric anastomoses: results in benign and malignant conditions

Toufeeq Khan TF, Lwin M, Ulah S, Zahari A, Mokti I

Singapore Med J, 1993 Dec;34(6):545-50.
PMID: 8153721

Twenty bilio-enteric anastomoses were performed or managed from May 1990 to December 1992. Recurrent pyogenic cholangitis (RPC) and pancreatic cancer were the commonest conditions which required drainage procedures. Roux-en-Y hepatico-jejunostomy (RHJ) was performed in 9 patients, 4 for RPC, one for pancreatic cancer, another for a cholangiocarcinoma, 2 following excision of choledochal cyst and one hepatico-jejunostomy was part of a Whipple reconstruction. Roux-en-Y side to side choledocho-jejunostomy (CDJ) was performed in one patient. Choledocho-duodenostomy (CDD) was performed in 6, 4 for obstructive jaundice due to choledocholithiasis, one for RPC and one in a choledochal cyst. One patient operated elsewhere presented with complications after a CDD. Palliative cholecysto-jejunostomy (CYJ) was carried out in 4 patients with pancreatic malignancy. All benign conditions were treated by hepatico-jejunostomy and choledocho-duodenostomy, while three patients with malignant conditions were treated by hepatico-jejunostomy. Permanent subcutaneous access loops were provided when recurrent problems were anticipated, 4 in RPC and one after subtotal resection of a cholangiocarcinoma. Based on this study, we found Roux-en-Y hepatico-jejunostomy a versatile drainage procedure, which was useful in both benign and malignant diseases.
Fulltext Agenesis of the gall bladder with duplication cysts of the hepatic flexure--a case report and literature review

Toufeeq Khan TF, Baqai FU

Singapore Med J, 1993 Apr;34(2):181-2.
PMID: 8266167

A 24-year-old lady with recurrent upper abdominal pain, underwent surgery for cholelithiasis based on imaging diagnosis by ultrasound scanning. At laparotomy, the gall bladder could not be found either in its normal or ectopic locations. The diagnosis of agenesis of the gall bladder was confirmed by operative cholangiography. Duplication cysts of the hepatic flexure were discovered in the position normally occupied by the gall bladder. The stony hard faeces in the cysts were probably interpreted as gallstones on ultrasound. This rare condition is discussed and the importance of intraoperative cholangiography is stressed.
Fulltext Ascarid worms causing recurrent cholangitis in a patient with an obstructing ampullary tumour

Khan TF, Zahari A, Sherazi ZA, Visvanathan R

Singapore Med J, 1993 Oct;34(5):462-3.
PMID: 8153702

This is a report of a 57-year-old Malay lady who presented with recurrent episodes of cholangitis and septicaemia. A dilated biliary tree caused by a stenosing periampullary tumour was found to contain adult round worms. A pancreatico-duodenectomy was performed following biliary decompression. Ascarid worms are a rare cause of cholangitis in malignant biliary obstruction.
A Pilot Study Evaluating the Stigma and Public Perception about the Causes of Depression and Schizophrenia

Khan T, Hassali M, Tahir H, Khan A

Iran J Public Health, 2011;40(1):50-6.
PMID: 23113054

To evaluate public perceptions towards the causes of depression and schizophrenia and identifications of factors resulting stigma towards mental ill.
Gall bladder tumour, choledochal cyst and an anomalous pancreatico-biliary junction

Toufeeq Khan TF, Sherazi ZA, Tan YY

HPB Surg, 1995 Jun;8(3):185-6.
PMID: 7547622

This report highlights the association of a tumour in an acalculous gall bladder with an anomalous pancreatico-biliary junction (PBJ) and a type IVa choledochal cyst. Cholecystectomy and Rouxen-Y hepatico-jejunostomy (RHJ) was performed after division of the common bile duct (CBD) and excision of the dilated segment. The details of the case are presented and the role of an abnormal PBJ in gall bladder carcinogenesis is discussed.
Multifocal mucus secreting papillary adenocarcinoma of the bile duct causing obstructive jaundice

Khan TF, Sherazi ZA, Alias NA, Mahmood Z

Ann Acad Med Singap, 1993 Mar;22(2):251-3.
PMID: 8363342

We present a 64-year-old Malay lady who had undergone a choledochoduodenostomy (CDD) two years ago for obstructive jaundice. She was admitted with jaundice and underwent ultrasonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangio pancreatography (ERCP) and computed tomographic (CT) scanning of the liver and biliary tree. All the investigations confirmed a type IVa choledochal cyst. At operation, the grossly dilated biliary system was packed with a thick mucoid material and the mucosa of the bile ducts was visibly abnormal with scattered nodules. This mucoid material had caused occlusion of the entire biliary tree resulting in obstructive jaundice. To the best of our knowledge, this is probably the first report of obstructive jaundice caused by thick mucus. The peculiar management problems of this case and the risk of malignant change in choledochal cysts are discussed.
Fulltext Mirizzi syndrome--a report of 3 cases with a review of the present classifications

Khan TF, Muniandy S, Hayat FZ, Sherazi ZA, Nawaz MH

Singapore Med J, 1999 Mar;40(3):171-3.
PMID: 10402897

We report three cases of Mirizzi syndrome, two with external compression of the common hepatic duct and another with cystobiliary fistula. All patients presented with jaundice. The diagnosis was suggested by ultrasonography and confirmed by endoscopic retrograde cholangiography (ERC). All three had the stones removed surgically, one through a choledochotomy, another through an opening in the gall bladder and the third at the time of subtotal cholecystectomy. We would like to propose a simple classification of Mirizzi syndrome, based on surgical procedures necessary for the correction of the pathological anatomy. If it involves the removal of calculi with some form of cholecystectomy, we consider it as Type I, whereas Type II involves the construction of a hepaticojejunostomy apart from the removal of calculi.
Fulltext A secure and dependable trust assessment (SDTS) scheme for industrial communication networks

Khan T, Singh K, Ahmad K, Ahmad KAB

Sci Rep, 2023 Feb 02;13(1):1910.
PMID: 36732583 DOI: 10.1038/s41598-023-28721-x

Due to tamper-resistant sensor nodes and wireless media, Industrial Wireless Sensor Networks (WSNs) are susceptible to various security threats that severely affect industrial/business applications. The survival of sensor networks is highly dependent on the flourishing collaboration of sensor nodes. Trust management schemes seem to be realistic and promising techniques to improve security as well as cooperation (dependability) among sensor nodes by estimating the trust level (score) of individual sensor nodes. This research paper presents a well-organized and motivating secure, dependable trust assessment (SDTS) scheme for industrial WSNs to cope with unexpected behavior such as an on-off attack, bad-mouthing attack, garnished attack, etc., by employing robust trust evaluation components based on success ratio and node misbehaviour. SDTS incorporates an interesting trust evaluation function in which the trust range can be adjusted in accordance with the application requirement. SDTS include direct communication trust, indirect communication trust, data trust, and misbehavior-based trust to defend the multiple internal attacks. SDTS works according to the behavior of nodes, i.e., whether the sensor nodes are interacting frequently or not. Moreover, abnormal attenuation and dynamic slide lengths are incorporated in the proposed model (SDTS) to deal with various natural calamities and internal attacks. SDTS is compared against three recent state-of-the-art methods and found efficient in terms of ease of trust assessment, false-positive rate (2.5%), false-negative rate (2%), attack detection rate (90%), detection accuracy (91%), average energy consumption (0.40 J), and throughput (108 Kbps) under the load of 500 sensor nodes with 50% malicious nodes. Investigational results exhibit the potency of the proposed scheme.
Genotoxicity assessment of raw and treated water samples using Allium cepa assay: evidence from Perak River, Malaysia

Malakahmad A, Manan TSBA, Sivapalan S, Khan T

Environ Sci Pollut Res Int, 2018 Feb;25(6):5421-5436.
PMID: 29209979 DOI: 10.1007/s11356-017-0721-8

Allium cepa assay was carried out in this study to evaluate genotoxic effects of raw and treated water samples from Perak River in Perak state, Malaysia. Samples were collected from three surface water treatment plants along the river, namely WTPP, WTPS, and WTPK. Initially, triplicates of equal size Allium cepa (onions) bulbs, 25-30 mm in diameter and average weight of 20 g, were set up in distilled water for 24 h at 20 ± 2 °C and protected from direct sunlight, to let the roots to grow. After germination of roots (0.5-1.0 cm in length), bulbs were transferred to collected water samples each for a 96-h period of exposure. The root physical deformations were observed. Genotoxicity quantification was based on mitotic index and genotoxicity level. Statistical analysis using cross-correlation function for replicates from treated water showed that root length has inverse correlation with mitotic indices (r = - 0.969) and frequencies of cell aberrations (r = - 0.976) at lag 1. Mitotic indices and cell aberrations of replicates from raw water have shown positive correlation at lag 1 (r = 0.946). Genotoxicity levels obtained were 23.4 ± 1.98 (WTPP), 26.68 ± 0.34 (WTPS), and 30.4 ± 1.13 (WTPK) for treated water and 17.8 ± 0.18 (WTPP), 37.15 ± 0.17 (WTPS), and 47.2 ± 0.48 (WTPK) for raw water. The observed cell aberrations were adherence, chromosome delay, C-metaphase, chromosome loss, chromosome bridge, chromosome breaks, binucleated cell, mini cell, and lobulated nuclei. The morphogenetic deformations obtained were likely due to genotoxic substances presence in collected water samples. Thus, water treatment in Malaysia does not remove genotoxic compounds.
Assessment of Euphorbia retusa and Pulicaria undulata activity against Leishmania major and Toxoplasma gondii

Khan TA, Al Nasr IS, Mujawah AH, Koko WS

Trop Biomed, 2021 Mar 01;38(1):135-141.
PMID: 33797536 DOI: 10.47665/tb.38.1.023

Leishmaniasis and toxoplasmosis are parasitic protozoal diseases that pose serious health concerns, especially for immunocompromised people. Leishmania major and Toxoplasma gondii are endemic in Saudi Arabia and are particularly common in the Qassim Region. The present work was conducted to evaluate the in vitro antileishmanial and antitoxoplasmal activity of methanolic extracts and phytochemical fractions from two plants, Euphorpia retusa and Pulicaria undulata, which are ethnobotanical agents used to treat parasitic infection. Whole E. retusa and P. undulata plants were extracted with methanol and fractionated using petroleum ether, chloroform, ethyl acetate, n-butanol, and water and then were tested in vitro against L. major promastigote and the amastigote stages of T. gondii; the cytotoxicity of the extracts was tested against Vero cell line. The methanolic extracts of E. retusa and P. undulata exhibited promising antitoxoplasmal activity against T. gondii with EC50 values 5.6 and 12.7 μg mL-1, respectively. The chloroform fraction of P. undulata was the most potent, exhibiting an EC50 of 1.4 μg mL-1 and SI value of 12.1. It was also the most active fraction against both L. major promastigotes and amastigotes, exhibiting an EC50 of 3.9 and 3.8 μg mL-1 and SI values 4.4 and 4.5, respectively. The chloroform fraction from P. undulata is a very good candidate for the isolation of active antitoxoplasmal and antileishmanial ingredients; therefore, further phytochemical analysis for active compound isolation is highly recommended.

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