Publications by authors named "Zamzuri Idris"

76 Publications

Commentary: Radiofrequency Ablation for Movement Disorders: Risk Factors for Intracerebral Hemorrhage, a Retrospective Analysis.

Oper Neurosurg (Hagerstown) 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia.

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http://dx.doi.org/10.1093/ons/opab190DOI Listing
June 2021

Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments.

Malays J Med Sci 2021 Apr 21;28(2):100-105. Epub 2021 Apr 21.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: This paper outlines a summary of examination technique to identify the range of movement of the cervical spine. Due to common difficulties in obtaining tools for cervical examination within the district, a standardised compilation of easy-to-replicate examination techniques are provided using different tools.

Methods: Bedside instruments that can be used includes a measuring tape, compass, goniometer, inclinometer and cervical range of motion (CROM) instrument.

Discussion: Cervical flexion-extension, lateral flexion and rotation will be assessed with bedside instruments. This would aid in increasing accuracy and precision of objective measurement while conducting clinical examination to determine the cervical range of motion.
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http://dx.doi.org/10.21315/mjms2021.28.2.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075604PMC
April 2021

Deep Tendon Reflex: The Tools and Techniques. What Surgical Neurology Residents Should Know.

Malays J Med Sci 2021 Apr 21;28(2):48-62. Epub 2021 Apr 21.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

The deep tendon reflex (DTR) is a key component of the neurological examination. However, interpretation of the results is a challenge since there is a lack of knowledge on the important features of reflex responses such as the amount of hammer force, the strength of contraction, duration of the contraction and relaxation. The tools used to elicit the reflexes also play a role in the quality of the reflex contraction. Furthermore, improper execution techniques during the DTR assessment may alter the findings and cloud the true assessment of the nervous system. Therefore, understanding the basic principles and the key features of DTR allows for better interpretation of the reflex responses. This paper discusses the brief history of reflexes, the development of the reflex hammer, and also the key features of a reflex response encompassing the amplitude of force needed to elicit a reflex response, the velocity of contraction, the strength of contraction, and the duration of contraction and relaxation phases. The final section encloses the techniques of eliciting DTR in the upper extremities, trunk, and lower extremities, and the interpretation of these reflexes.
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http://dx.doi.org/10.21315/mjms2021.28.2.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075597PMC
April 2021

Quantum and Electromagnetic Fields in Our Universe and Brain: A New Perspective to Comprehend Brain Function.

Brain Sci 2021 Apr 28;11(5). Epub 2021 Apr 28.

Department of Physics, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia.

The concept of wholeness or oneness refers to not only humans, but also all of creation. Similarly, consciousness may not wholly exist inside the human brain. One consciousness could permeate the whole universe as limitless energy; thus, human consciousness can be regarded as limited or partial in character. According to the limited consciousness concept, humans perceive projected waves or wave-vortices as a waveless item. Therefore, human limited consciousness collapses the wave function or energy of particles; accordingly, we are only able to perceive them as particles. With this "limited concept", the wave-vortex or wave movement comes into review, which also seems to have a limited concept, i.e., the limited projected wave concept. Notably, this wave-vortex seems to embrace photonic light, as well as electricity and anything in between them, which gives a sense of dimension to our brain. These elements of limited projected wave-vortex and limitless energy (consciousness) may coexist inside our brain as electric (directional pilot wave) and quantum (diffused oneness of waves) brainwaves, respectively, with both of them giving rise to one brain field. Abnormality in either the electrical or the quantum field or their fusion may lead to abnormal brain function.
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http://dx.doi.org/10.3390/brainsci11050558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146693PMC
April 2021

Prediction of outcomes in traumatic brain injury: the IMPACT and CRASH prognostic models in a single neurosurgical center, Malaysia.

J Neurosurg Sci 2021 Mar 11. Epub 2021 Mar 11.

Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia -

Background: Traumatic brain injury (TBI) has recently become a major concern for public health care and a socioeconomic burden internationally. Prognostic models are mathematical models developed from specific populations which are used to predict the mortality and unfavourable outcomes especially in trauma centres. Hence, we formulate a study to perform an external validation of the IMPACT and CRASH prognostic models; the CRASH model to predict 14-day mortality and 6-month unfavourable outcome and the IMPACT model to estimate 6-month mortality and unfavourable outcome in a single centre cohort of TBI patients in Malaysia.

Methods: All patients with traumatic brain injury (mild, moderate and severe) who were admitted to Hospital Queen Elizabeth from 1st November 2017 to 31st January 2019, were prospectively analysed through a data collection sheet. The discriminatory power of the models was assessed as area under the receiver operating characteristic curve and calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and Cox calibration regression analysis.

Results: We analyzed 281 patients with significant TBI treated in a single neurosurgical center in Malaysia over a 2-year period. The overall observed 14-day mortality was 9.6%, a 6-month unfavourable outcome of 23.5%, and a 6-month mortality of 13.2%. Overall, both the CRASH and IMPACT models showed good discrimination with AUCs ranging from 0.88 to 0.94 and both models calibrating satisfactorily H-L GoF p>0.05 and calibration slopes >1.0 although IMPACT seemed to be slightly more superior compared to the CRASH model.

Conclusions: The CRASH and IMPACT prognostic models displayed satisfactory overall performance in our cohort of TBI patients, but further investigations on factors contributing to TBI outcomes and continuous updating on both models remain crucial.
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http://dx.doi.org/10.23736/S0390-5616.21.05249-8DOI Listing
March 2021

A Clinical Test for a Newly Developed Direct Brain Cooling System for the Injured Brain and Pattern of Cortical Brainwaves in Cooling, Noncooling, and Dead Brain.

Ther Hypothermia Temp Manag 2021 Jan 29. Epub 2021 Jan 29.

Collaborative Microelectronic Design Excellence Center (CEDEC), Universiti Sains Malaysia, Bayan Lepas, Malaysia.

To ensure the direct delivery of therapeutic hypothermia at a selected constant temperature to the injured brain, a newly innovated direct brain cooling system was constructed. The practicality, effectiveness, and safety of this system were clinically tested in our initial series of 14 patients with severe head injuries. The patients were randomized into two groups: direct brain cooling at 32°C and the control group. All of them received intracranial pressure (ICP), focal brain oxygenation, brain temperature, and direct cortical brainwave monitoring. The direct brain cooling group did better in the Extended Glasgow Outcome Scale at the time of discharge and at 6 months after trauma. This could be owing to a trend in the monitored parameters; reduction in ICP, increment in cerebral perfusion pressure, optimal brain redox regulation, near-normal brain temperature, and lessening of epileptic-like brainwave activities are likely the reasons for better outcomes in the cooling group. Finally, this study depicts interesting cortical brainwaves during a transition time from being alive to dead. It is believed that the demonstrated cortical brainwaves follow the principles of quantum physics.
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http://dx.doi.org/10.1089/ther.2020.0033DOI Listing
January 2021

Accumulation of Mitochondrial DNA Microsatellite Instability in Malaysian Patients with Primary Central Nervous System Tumors.

Turk Neurosurg 2021 ;31(1):99-106

Sains Malaysia University, School of Medical Sciences, Health Campus, Department of Neurosciences, 16150 Kubang Kerian, Kelantan, Malaysia.

Aim: To determine the mitochondrial microsatellite instability (mtMSI) status in a series of Malaysian patients with brain tumors. Furthermore, we analyzed whether the mtMSI status is associated with the clinicopathological features of the patients.

Material And Methods: Forty fresh frozen tumor tissues along with blood samples of brain tumor patients were analyzed for mtMSI by PCR amplification of genomic DNAs, and the amplicons were directly sequenced in both directions using Sanger sequencing.

Results: Microsatellite analysis revealed that 20% (8 out of 40) of the tumors were mtMSI positive with a total of 8 mtMSI changes. All mtMSI markers were detected in D310 and D16184 of the D-loop region. Additionally, no significant association was observed between mtMSI status and clinicopathological features.

Conclusion: The variations, specifically the mtMSI, suggest that the mitochondrial DNA (mtDNA) can be targeted for genomic alteration in brain tumors. Therefore, the specific role of mtDNA alteration in brain tumor development and prognosis requires further investigation.
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http://dx.doi.org/10.5137/1019-5149.JTN.27893-20.4DOI Listing
March 2021

Commentary: Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network.

Oper Neurosurg (Hagerstown) 2021 03;20(4):E281-E283

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opaa473DOI Listing
March 2021

Commentary: Demonstration of Microsurgical Technique and Nuances for the Resection of a Midbrain Tectal Glioma via the Transcollicular Approach: 3-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 03;20(4):E308-E311

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opaa465DOI Listing
March 2021

Neurological Examination Techniques of Speech in for Adults: Simple Approach Practiced in Hospital Universiti Sains Malaysia.

Malays J Med Sci 2020 Dec 29;27(6):148-182. Epub 2020 Dec 29.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in . This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.
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http://dx.doi.org/10.21315/mjms2020.27.6.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785259PMC
December 2020

Examination Approach to the Dizzy and Swaying Patient.

Malays J Med Sci 2020 Dec 29;27(6):89-101. Epub 2020 Dec 29.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Background: Dizziness is a common presenting complaint among patients in Malaysia. It is a vague term which could be associated with vertigo, imbalance, ataxia or syncope. In order to deal with this overwhelming complaint, a detailed history-taking is essential in confirming aetiology of disease and this should be followed by a meticulous clinical examination. The purpose of the video manuscript it to provide a step-by-step approach to a dizzy and swaying patient, specially catered for Malaysian medical students and trainees.

Methods: A series of videos were shot, which involved the eye, ear, vestibular system, cerebellar, proprioceptive sense and gait examination. These videos, conducted in Universiti Sains Malaysia (USM) School of Medical Sciences, will be first in Malaysia and will highlight the proper technique and rapport with patients and essential points of each examination. There will be summary at the end of each examination on how to report findings which is a common weakness among students.

Conclusion: We hope that students and junior doctors could be apply these methods in their daily assessment of dizzy patients and ultimately, reach an accurate diagnosis.
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http://dx.doi.org/10.21315/mjms2020.27.6.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785257PMC
December 2020

Introduction of a newly created AW stereotactic frame: a phantom-based accuracy evaluation and an initial experience in clinical usage.

Br J Neurosurg 2020 Nov 16:1-8. Epub 2020 Nov 16.

Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Sarawak, Malaysia.

Background: A new stereotactic frame was created in 2015, based on a linear algorithm. It is called Albert Wong (AW) frame. A simple AW stereo-calculator was also designed based on Excel (Microscoft Corporation, Redmond, WA) programme for the frame.

Objective: The aim of this study is to test the accuracy of the AW frame by a direct head to head comparison with CRW frame (Integra Life Sciences, Plainsboro, NJ) on a phantom.

Methods: This is a prospective pilot cross-sectional phantom study with a total of 42 (21 for AW and 21 for CRW) laboratory testings performed in 2017 at our institute to compare the accuracies of both frames in a consecutive manner. A phantom (BL phantom) was newly created, where targets can be placed at different heights and positions on a platform attached under the frame for accuracy testing comparing between the AW and CRW frames.

Results: A comparable accuracy testing results were observed between the AW and CRW frames of 0.64 mm versus 1.07 mm respectively. Approval from the local ethics committee for a clinical trial was obtained. We report on three case illustrations who had the AW frame-based biopsies with definitive diagnoses and without any post-biopsy related complication.

Conclusion: AW frame successfully demonstrated a good accuracy of 0.64 mm in phantom testing using the BL phantom by a linear algorithmic calculation. The clinical trial with three patients demonstrated definitive diagnoses and safety with its use.
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http://dx.doi.org/10.1080/02688697.2020.1837728DOI Listing
November 2020

COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020.

Malays J Med Sci 2020 Oct 27;27(5):141-195. Epub 2020 Oct 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.
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http://dx.doi.org/10.21315/mjms2020.27.5.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605837PMC
October 2020

Examination Techniques of the First Cranial Nerve: What Neurosurgical Residents Should Know.

Malays J Med Sci 2020 Oct 27;27(5):124-129. Epub 2020 Oct 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Olfactory or smell dysfunction is often overlooked by clinicians despite being prevalent in the population. To date in Malaysia, there is no standard and reliable test to examine the function of olfaction. Tests used at developed countries such as the Sniffin' Sticks Test (SST), the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the University of Pennsylvania Smell Identification Test (UPSIT) and the Brief Smell Identification Test (B-SIT) are not readily available in this region and may be costly to procure. The first cranial nerve can be tested using commonly available materials to assess: i) the function of odour detection; ii) the odour discrimination; and iii) the odour identification. An abnormal odour detection threshold test generally indicates a peripheral olfactory problem while the odour discrimination and identification test attribute the problem to the cerebral cortex. An olfactory complaint should not be taken lightly and a proper olfactory function examination is important: i) to determine the legitimacy of a patient's complaint; ii) to monitor the progress of patient's olfactory function; iii) to establish insurance payout for disability; and iv) to characterise the specific nature of the problem. A video has been produced to demonstrate the examination techniques explained in this article.
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http://dx.doi.org/10.21315/mjms2020.27.5.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605834PMC
October 2020

The Neurological Exam of a Comatose Patient: An Essential Practical Guide.

Malays J Med Sci 2020 Oct 27;27(5):108-123. Epub 2020 Oct 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

A thorough examination of a comatose patient is essential given the spectrum of clinical diagnoses. The most immediate threat to patients is airway, breathing and circulation. All attending physician should employ a structured and focused approach in dealing with a comatose patient. It is important to recognise the urgent steps needed at the time to prevent further deterioration, followed by the final diagnosis of patient's neurologic status. Here we provide the essential practical guide to the neurological exam of a comatose patient that would assist to determine the aetiology, location and nature of the neurological lesion.
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http://dx.doi.org/10.21315/mjms2020.27.5.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605838PMC
October 2020

Disconnecting surgery at alveus and cornu ammonis of hippocampus, amygdala superficialis, and amygdala medial nuclei for epilepsy associated with attention deficit hyperactivity disorder.

Childs Nerv Syst 2021 05 19;37(5):1797-1802. Epub 2020 Sep 19.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

The neural basis for epilepsy and attention deficit hyperactivity disorder (ADHD) is currently incompletely known. We reported a young girl with both epilepsy and ADHD, who had a calcified lesion in the right basolateral amygdalo-hippocampal region extending to the ventral striatum. The child underwent disconnecting surgery and biopsy of the lesion. Fascinatingly, the child's behavior changed immediately after the surgery from inattentive and impulsive to nearly normal behavior experiencing no more breakthrough seizures since after 3 years of surgery. The Schaltenbrand Wahren Brain Atlas revealed alveus, cornu ammonis, amygdala superficialis, and medium as the disconnected region in this surgery.
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http://dx.doi.org/10.1007/s00381-020-04893-zDOI Listing
May 2021

Big Brain Data Initiative in Universiti Sains Malaysia: Challenges in Brain Mapping for Malaysia.

Malays J Med Sci 2020 Jul 19;27(4):1-8. Epub 2020 Aug 19.

Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Universiti Sains Malaysia has started the Big Brain Data Initiative project since the last two years as brain mapping techniques have proven to be important in understanding the molecular, cellular and functional mechanisms of the brain. This Big Brain Data Initiative can be a platform for neurophysicians and neurosurgeons, psychiatrists, psychologists, cognitive neuroscientists, neurotechnologists and other researchers to improve brain mapping techniques. Data collection from a cohort of multiracial population in Malaysia is important for present and future research and finding cure for neurological and mental illness. Malaysia is one of the participant of the Global Brain Consortium (GBC) supported by the World Health Organization. This project is a part of its contribution via the third GBC goal which is influencing the policy process within and between high-income countries and low- and middle-income countries, such as pathways for fair data-sharing of multi-modal imaging data, starting with electroencephalographic data.
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http://dx.doi.org/10.21315/mjms2020.27.4.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444831PMC
July 2020

Prevalence of mitochondrial DNA common deletion in patients with gliomas and meningiomas: A first report from a Malaysian study group.

J Chin Med Assoc 2020 Sep;83(9):838-844

Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.

Background: The 4977-bp common deletion (mtDNA) is a well-established mitochondrial genome alteration that has been described in various types of human cancers. However, to date, no studies on mtDNA in brain tumors have been reported. The present study aimed to determine mtDNA prevalence in common brain tumors, specifically, low- and high-grade gliomas (LGGs and HGGs), and meningiomas in Malaysian cases. Its correlation with clinicopathological parameters was also evaluated.

Methods: A total of 50 patients with pathologically confirmed brain tumors (13 LGGs, 20 HGGs, and 17 meningiomas) were enrolled in this study. mtDNA was detected by using polymerase chain reaction (PCR) technique and later confirmed via Sanger DNA sequencing.

Results: Overall, mtDNA was observed in 16 (32%) patients and it was significantly correlated with the type of tumor group and sex, being more common in the HGG group and in male patients.

Conclusion: The prevalence of mtDNA in Malaysian glioma and meningioma cases has been described for the first time and it was, indeed, comparable with previously published studies. This study provides initial insights into mtDNA in brain tumor and these findings can serve as new data for the global mitochondrial DNA mutations database.
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http://dx.doi.org/10.1097/JCMA.0000000000000401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478208PMC
September 2020

Detailed Anatomical Volumetric Study of Deep Nuclei of Brain and Other Structures Between Parkinson's Disease Patients Who Had Deep Brain Stimulation and Control Group.

Malays J Med Sci 2020 May 30;27(3):53-60. Epub 2020 Jun 30.

Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: Deep brain stimulation (DBS) was pioneered by Neuroscience team of Hospital Universiti Sains Malaysia (HUSM) nearly a decade ago to treat advanced medically refractory idiopathic Parkinson's disease (IPD) patients.

Objectives: Brain volume reduction occurs with age, especially in Parkinson plus syndrome or psychiatric disorders. We searched to define the degree of volume discrepancy in advanced IPD patients and correlate the anatomical volumetric changes to motor symptoms and cognitive function.

Methods: We determined the magnetic resonance imaging (MRI)-based volumetry of deep brain nuclei and brain structures of DBS-IPD group and matched controls.

Results: DBS-IPD group had significant deep nuclei atrophy and volume discrepancy, yet none had cognitive or psychobehavioural disturbances. Globus pallidus volume showed positive correlation to higher mental function.

Conclusion: The morphometric changes and clinical severity discrepancy in IPD may imply a more complex degenerative mechanism involving multiple neural pathways. Such alteration could be early changes before clinical manifestation.
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http://dx.doi.org/10.21315/mjms2020.27.3.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337947PMC
May 2020

Rare and Unique Case of Midline Anterior Arch of Atlas Non-formation Mimicking Jefferson Type 1 Fracture.

Cureus 2020 Feb 3;12(2):e6850. Epub 2020 Feb 3.

Neurosurgery, Universiti Sains Malaysia Health Campus, Kota Bharu, MYS.

Cervical spine injuries are rare occurrences in children, especially the congenital anomalies of the atlas vertebra. Any injury involving the craniovertebral junction such as Jefferson fracture, is a valid cause for alarm due to the complex nature of the craniovertebral junction and the morbidity associated with it. We report the case of a 10-year-old male, who had failure of fusion of anterior arch of atlas due to the failure of formation of the anterior midline synchondrosis, and this mimicked a Jefferson fracture. If it was not for the peculiar absence of any corresponding evidence to suggest spinal injury, we might have mistaken this extremely rare but benign anomaly for a Jefferson fracture and subjected the patient to needless surgical treatment. Hence, it is concluded that keen clinical acumen and clear understanding of the developmental anatomy of these patients may be necessary to adequately manage them.
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http://dx.doi.org/10.7759/cureus.6850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053688PMC
February 2020

Quantum Physics Perspective on Electromagnetic and Quantum Fields Inside the Brain.

Authors:
Zamzuri Idris

Malays J Med Sci 2020 Feb 27;27(1):1-5. Epub 2020 Feb 27.

Brain Behaviour Cluster and Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Brain energy is associated commonly with electrochemical type of energy. This energy is displayed in the form of electromagnetic waves or better known as brainwaves. This concept is a classical concept (Newtonian) in which the studied object, that is the brain is viewed as a large anatomical object with its functional brainwaves. Another concept which incorporates quantum principles in it can also be used to study the brain. This perspective viewing the brain as purely waves, including its anatomical substrate. Thus, there are two types of energy or field exist in our brain: electromagnetic and quantum fields. Electromagnetic field is thought as dominant energy in purely motor and sensory inputs to our brain, whilst quantum field or energy is perceived as more influential in brain cognitions. The reason for this notion lies in its features which is diffused, non-deterministic, varied, complex and oneness.
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http://dx.doi.org/10.21315/mjms2020.27.1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053547PMC
February 2020

Role of toll-like receptor 4 antagonist Lipopolysaccharide-Rhodobacter sphaeroides on acute stress-induced voluntary ethanol preference and drinking behaviour: In vivo Swiss Albino mouse model.

Eur Neuropsychopharmacol 2021 Apr 1;45:59-72. Epub 2020 Feb 1.

Integrated Neuroscience Program (INP), Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia; Department of Neurosciences, Brain and Behaviour Cluster, Universiti Sains Malaysia, Jalan Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia; Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston 77240, TX, USA. Electronic address:

The present study focused on investigating the effect of toll-like receptor 4 (TLR4) antagonist Lipopolysaccharide-Rhodobacter sphaeroides(LPS-RS) on acute, stress-induced voluntary ethanol preference and drinking behaviour, neuronal components activation, and gene expression associated with stress and addictive behaviour. This study involved the exposure of restraint stress and social isolation using Swiss Albino mice. Two-bottle choice ethanol preference analysis was used in the evaluation of voluntary ethanol seeking and drinking behaviour. Several behavioural assessments were carried out to assess fear and anxiety-like behaviour, neuromuscular ability, motor coordination and locomotion. Morphological and immunoreactivity analysis and gene expression analysis were done after the completion of behavioural assessments. TLR4 antagonist LPS-RS treated stressed-mice showed a significant decrease in ethanol drinking compared with stressed mice. Behavioural results showed that stress exposure induced fear and anxiety-like behaviour; however; no significant deficit was found on motor coordination, neuromuscular ability, locomotion and exploratory behaviour among groups. Morphological analysis showed no significant change in the prefrontal cortex and hippocampus among all groups, while immunoreactivity analysis showed higher expression of c-Fos in prefrontal cortex and hippocampus, higher TLR4 expression in the prefrontal cortex and glial fibrillary acidic protein (GFAP) in hippocampus among stressed-animals. Stressed-mice also showed significant increase in TLR4, Nuclear Factor-Kappa B (NF-kB), inducible nitric oxide synthase (iNOS), dopamine receptor D2 (DRD), cyclic adenosine monophosphate (cAMP) response element binding protein-1 (CREB-1) and opioid receptor MU-1 (OPRM-1) genes expression compared with control and LPS-RS treated stressed-mice. As a conclusion, the antagonism of TLR4 could provide therapeutic value in the treatment of stress-induced addiction.
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http://dx.doi.org/10.1016/j.euroneuro.2019.12.121DOI Listing
April 2021

Commentary: Temporoinsular Glioma Resection Under Awake Mapping: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 07;19(1):E55-E57

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opz390DOI Listing
July 2020

A Retrospective Study on the First Cerebrospinal Fluid Taken from External Ventricular Drainage Insertion in Meningitis Patients with Hydrocephalus.

Malays J Med Sci 2019 Sep 4;26(5):64-73. Epub 2019 Nov 4.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: Ventriculoperitoneal (VP) shunting is a permanent form of cerebrospinal fluid (CSF) diversion that can be performed for hydrocephalus. Sterility of the CSF is an important prerequisite for permanent shunt placement. It has been hypothesised that in early stage of meningitis, ventricular CSF remains sterile. A study is conducted on the first CSF sample taken from patients suspected to have meningitic hydrocephalus.

Method: A retrospective review case records of patients who had undergone external ventricular drainage (EVD) for suspected meningitic hydropcephalus in Hospital Sultanah Aminah Johor Bahru (HSAJB), Johor, Malaysia.

Results: Fifty-one cases were analysed. Mean age of patients was 37.27 years old, with 64.7% of them was male. Univariate analysis revealed that the main parameters to determine CSF sterility were CSF glucose (95% CI, 0.852, 10.290, = 0.001), CSF protein (CI 95%, 0.722, 14.898, < 0.001), CSF gram stain (95% CI, 16.437, 0.877, < 0.001 ) and CSF appearance ( 0.611, 6.362, = 0.012). Multivariate analysis had proven that gram stain was the main parameter in the CSF analysis (CI 95%, 16.437, 0.029, = 0.016). No significant differences in CSF results were observed from EVD and lumbar puncture.

Conclusion: The most significant parameter in CSF to determine infection was gram stain.
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http://dx.doi.org/10.21315/mjms2019.26.5.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839652PMC
September 2019

Anti-Cancer Properties of sp. Honey Via Induction of Apoptosis in Malignant Glioma Cells.

Malays J Med Sci 2019 Mar 30;26(2):30-39. Epub 2019 Apr 30.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: There has been increasing evidence showing that stingless bee honey exhibits anti-oxidant, anti-inflammatory and anti-cancer properties. Pharmacologically-active components in honey such as flavonoids and phenolic constituents are known to contribute to its medicinal benefits. To the best of our knowledge, this is the first study on evaluating anti-cancer effects of locally-produced Malaysian stingless bee honey from sp. on malignant glioma cells.

Methods: Proliferation and apoptosis studies of U-87 MG cells following stingless bee honey treatment were carried out using MTS assay and acridine orange/propidium iodide dual staining, respectively.

Results: Results demonstrated time and dose-dependent cytotoxicity using 0.625%, 1.25% and 10% stingless bee honey ( < 0.05). IC values were calculated using cells treated with 10% stingless bee honey. It was also observed that 10% stingless bee honey induced nuclear shrinkage, chromatin condensation and nucleus fragmentation, indicating that cellular changes were consistent with the apoptotic characteristics of the cells.

Conclusion: These data provide a good basis for further evaluation of the medicinal properties of stingless bee honey from sp. This source of honey may serve as a potential therapy for malignant glioma.
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http://dx.doi.org/10.21315/mjms2019.26.2.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687214PMC
March 2019

Patient-Specific Reconstruction Utilizing Computer Assisted Three-Dimensional Modelling for Partial Bone Flap Defect in Hybrid Cranioplasty.

J Craniofac Surg 2019 Nov-Dec;30(8):e720-e723

School of Dental Sciences, Universiti Sains Malaysia, Malaysia.

Purpose: Decompressive craniectomy is a life-saving procedure in the setting of malignant brain swelling. Patients who survive require cranioplasty for anatomical reconstruction and cerebral protection. Autologous cranioplasty remains the commonest practice nowadays, but partial bone flap defects are frequently encountered. The authors, therefore, seek to develop a new technique of reconstruction for cranioplasty candidate with partial bone flap defect utilizing computer-assisted 3D modeling and printing.

Methods: A prospective study was conducted to evaluate the outcome of a new reconstruction technique that produces patient-specific hybrid polymethyl methacrylate-autologous cranial implant. Computer-assisted 3D modeling and printing was utilized to produce patient-specific molds, which allowed real-time reconstruction of bone flap with partial defect intra-operatively.

Results: Outcome assessment for 11 patients at 6 weeks and 3 months post-operatively revealed satisfactory implant alignment with favorable cosmesis. The mean visual analog scale for cosmesis was 91. Mean implant size was 50cm, and the mean duration of intra-operative reconstruction was 30 minutes. All of them revealed improvement in quality of life following surgery as measured by the SF-36 score. Cost analysis revealed that this technique is more cost-effective compared to customized cranial prosthesis.

Conclusion: This new technique and approach produce hybrid autologous-alloplastic bone flap that resulted in satisfactory implant alignment and favorable cosmetic outcome with relatively low costs.
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http://dx.doi.org/10.1097/SCS.0000000000005713DOI Listing
February 2020

Cortical Modulation After Two Different Repetitive Transcranial Magnetic Stimulation Protocols in Similar Ischemic Stroke Patients.

Malays J Med Sci 2018 Mar 27;25(2):116-125. Epub 2018 Apr 27.

Department of Rehabilitation Medicine 2, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

Background: Stroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients.

Objectives: This pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects.

Methods: Eight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η ).

Result: The study observed large effect sizes (η > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants.

Conclusions: The partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.
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http://dx.doi.org/10.21315/mjms2018.25.2.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422591PMC
March 2018

Teleneurosurgery: Outcome of Mild Head Injury Patients Managed in Non-Neurosurgical Centre in the State of Johor.

Malays J Med Sci 2018 Mar 27;25(2):95-104. Epub 2018 Apr 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: With teleneurosurgery, more patients with head injury are managed in the primary hospital under the care of general surgical unit. Growing concerns regarding the safety and outcome of these patients are valid and need to be addressed.

Method: This study is to evaluate the outcome of patients with mild head injury which were managed in non-neurosurgical centres with the help of teleneurosurgery. The study recruits samples from five primary hospitals utilising teleneurosurgery for neurosurgical consultations in managing mild head injury cases in Johor state. Two main outcomes were noted; favourable and unfavourable, with a follow up review of the Glasgow Outcome Scale (GOS) at 3 and 6 months.

Results: Total of 359 samples were recruited with a total of 11 (3.06%) patients have an unfavourable. no significant difference in GOS at 3 and 6 months for patient in the unfavourable group ( = 0.368).

Conclusion: In this study we have found no significant factors affecting the outcome of mild head injury patients managed in non-neurosurgical centres in Johor state using the help of teleneurosurgery.
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http://dx.doi.org/10.21315/mjms2018.25.2.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422582PMC
March 2018

Incidence, Clinico-Radiological Features and Outcome of Skull Base versus Non-Skull Base Meningiomas Treated in Kuala Lumpur General Hospital: A Five-Year Experience.

Malays J Med Sci 2018 May 28;25(3):88-102. Epub 2018 Jun 28.

Centre for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Meningiomas are the most common intracranial tumours; they account for 13%-26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of all meningiomas and are one of the most difficult intracranial tumours to be managed surgically. This is due to the fact that it is difficult to approach the lesions which are also close to vital structures such as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia, local data on meningiomas is scarce.

Methods: This is a retrospective study consisting of 199 patients with meningiomas who have been operated at the Kuala Lumpur General Hospital from January 2010-December 2014. They were categorised into skull base and non-skull base groups. Demography, tumour characteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well as Cox hazard univariable and multivariable regressions for the possible predictors of survival were analysed.

Results: 97.5% of the patients ( = 194) had WHO grade I meningioma and only five patients had WHO grade II meningioma. There was a female predominance ( = 134; 67.3%), with a male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skull base meningiomas had poorer outcomes and discharge conditions ( = 23; 42.6% < 0.01), in addition to higher risk of incomplete resections ( = 34; 63% < 0.01). Multivariate cox hazard regressions showed that the skull base meningioma group had four times the risk of death of the non-skull base group.

Conclusions: Symptomatic meningiomas can be curative if the tumour is completely removed. Our study has revealed that skull base meningiomas which were operated locally had higher rates of incomplete resection and poorer surgical outcomes as compared to the non-skull base group. Patients with skull base meningiomas had four times the risk of death vis-à-vis non-skull base ones. More local studies are needed to look into skull base meningiomas for the improvement of its surgical outcomes.
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http://dx.doi.org/10.21315/mjms2018.25.3.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422556PMC
May 2018

Mitochondrial 10398A>G NADH-Dehydrogenase Subunit 3 of Complex I Is Frequently Altered in Intra-Axial Brain Tumors in Malaysia.

Brain Tumor Res Treat 2018 Apr;6(1):31-38

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia.

Background: Mitochondria are major cellular sources of reactive oxygen species (ROS) generation which can induce mitochondrial DNA damage and lead to carcinogenesis. The mitochondrial 10398A>G alteration in NADH-dehydrogenase subunit 3 (ND3) can severely impair complex I, a key component of ROS production in the mitochondrial electron transport chain. Alteration in ND3 10398A>G has been reported to be linked with diverse neurodegenerative disorders and cancers. The aim of this study was to find out the association of mitochondrial ND3 10398A>G alteration in brain tumor of Malaysian patients.

Methods: Brain tumor tissues and corresponding blood specimens were obtained from 45 patients. The ND3 10398A>G alteration at target codon 114 was detected using the PCR-RFLP analysis and later was confirmed by DNA sequencing.

Results: Twenty-six (57.8%) patients showed ND3 10398A>G mutation in their tumor specimens, in which 26.9% of these mutations were heterozygous mutations. ND3 10398A>G mutation was not significantly correlated with age, gender, and histological tumor grade, however was found more frequently in intra-axial than in extra-axial tumors (62.5% vs. 46.2%, p<0.01).

Conclusion: For the first time, we have been able to describe the occurrence of ND3 10398A>G mutations in a Malaysian brain tumor population. It can be concluded that mitochondrial ND3 10398A>G alteration is frequently present in brain tumors among Malaysian population and it shows an impact on the intra-axial tumors.
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http://dx.doi.org/10.14791/btrt.2018.6.e5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932297PMC
April 2018
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