Open globe injury in Hospital Serdang - an 8-year retrospective review

Introduction: Open globe injury may lead to devastating visual outcome. Urgent management and subsequent follow-up is important to maximise recovery. More data on open globe injury in Malaysia is needed to identify risk groups and prognostic factors. This study was carried out to investigate open globe injury, the socio-epidemic profile, clinical characteristics and outcome of the open globe injury in the Hospital Serdang, Malaysia. Methods: All patients managed for open globe injury to Hospital Serdang from January 2006 to December 2013 were included in this retrospective case review. Student’s T-test was used to determine difference between means and chi-square for categorical data. P value of less than 0.05 was regarded as statistically significant. Results: There were 155 patients managed for open globe injury with three of them had bilateral involvement. As such, there were 158 cases eligible for analysis in this study. The average age was 32.2 ± 16.5 years (mean ± standard deviation, SD). Male was at higher risk for open globe injury. Predictors for poor visual outcome were foreign nationality (p=0.047), lid laceration (0.008), type of injury (p=0.001), site of injury (p=0.008), RAPD (p<0.001), uveal prolapse (p<0.001), hyphaema (p=0.008), lens damage (p=0.010), vitreous loss (0.014), retinal detachment (p=0.011), intraocular foreign body (IOFB) (0.014) and poor presenting uncorrected visual acuity (UCVA) (p<0.001). Conclusions: Occupational injury was a main cause of open globe injury in Hospital Serdang. Although in general the visual outcome is good, effort should be put to prevent work-related injury

An 8-year retrospective review of microbial keratitis in a secondary referral centre in Malaysia

Introduction: Microbial keratitis (MK) is an important cause for corneal blindness and understanding its risk factors enable us to improve management and minimise its complications. Methods: In this retrospective case review, medical records of all patients treated for MK from 2006 to 2013 was analysed to know the socio-demography, preceding risk factors, clinical characteristics, causative organisms and final visual outcome. Results: A total of 174 patients (180 eyes) were included in this study. Identifiable ocular risk factors included contact lens (CL) usage (85, 47.2%), ocular trauma (50, 27.8%), ocular surface disease (21, 11.6%), steroid use (6, 3.3%) and immuno-compromy (19, 10.5%). Association factors for presenting uncorrected visual acuity (UCVA) were age group (p=0.013), size (p<0.001), location (p<0.001) and hypopyon (p<0.001). The predictors for final best spectacle-corrected visual acuity (BSCVA) were age group (p<0.001), nationality (p=0.020), occupation (p<0.001), CL use (p<0.001), ocular surface disease (p=0.048), size (p<0.001) and location (p<0.044), hospitalisation duration (p=0.002) and presenting UCVA (p<0.001). Conclusions: Contact lens was the most frequent predisposing risk factor for microbial keratitis, followed by ocular trauma. Understanding the association factors for presenting vision and predictors for final vision may help in the patients’ management and improve eventual outcome of microbial keratitis

Expression of beta defensin genes in frozen thawed and cultured immortalised human corneal epithelial cell line

Human beta defensins (hBD) are important host defense molecules at the ocular surface. In addition to their antimicrobial activities, hBD may also act as regulatory factors in recruiting and activating immune cells. Only hBD-1 – hBD-4 have been well characterised. To date, a complete profile of the beta defensin genes (DEFB) expression in immortalised human corneal epithelial cell line (HCE-2) has not been established. Therefore, this study is aimed to explore a spectrum of DEFB expression in HCE-2. Total RNAs were extracted from frozen thawed HCE-2 and cultured HCE-2 to ensure the gene expression were identical. The RNAs were reverse transcribed into cDNAs. The expression of 10 DEFB (DEFB1, DEFB4A, DEFB103, DEFB104, DEFB105, DEFB106, DEFB109, DEFB123, DEFB126 and DEFB127) were analysed using polymerase chain reaction (PCR) and gel electrophoresis. DEFB1 and DEFB103 were the only hBD mRNAs found constitutively expressed in frozen thawed HCE-2 and cultured HCE-2. It was also interesting to note that PCR enhancer was needed to amplify the genes in cultured HCE-2. Our findings suggest that corneal epithelium constantly produce hBD-1 and hBD-3, which presumably provide the baseline defense against infection. Further investigation on the expression of these genes when HCE-2 stimulated with proinflammatory cytokines would help in better understanding of the ocular surface defense mechanism

Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

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

Prevalence of dyslipidaemia in type 2 diabetes mellitus patients and its association to diabetic retinopathy in a Malaysian tertiary hospital

Background: Diabetic retinopathy (DR) is a microvascular complication of diabetes, which is a cause of visual impairment and blindness. Its development and progression have been linked to dyslipidaemia, although the link remains inconclusive. Aim: This study aimed to determine the prevalence of dyslipidaemia among type 2 diabetic patients with DR in a tertiary setting and to determine the association between dyslipidaemia and DR severity. Materials and methods: This was a cross sectional study using retrospective data of type 2 diabetic patients attending the opthalmology clinic of a tertiary centre from January 2007 to June 2014. Results of their fasting lipid profile and clinical data were retrieved from the hospital information system. Results: A total of 178 patient’s data were collected. 120 (n=67.4%) patients had non-proliferative diabetic retinopathy (NDPR) with moderate NPDR being the most prevalent. Dyslipidaemia was noted in 151 (84.8%) of the patients. Patients had a combination of more than one abnormality in the lipid profile with increased LDL-cholesterol being the main abnormality. Dyslipidaemia was however, not significantly associated with DR severity. Conclusion: Dyslipidaemia was highly prevalent in DR patients. The dyslipidaemia was however not associated with severity of DR

Efficient adsorption of organic pollutants phthalates and bisphenol A (BPA) utilizing magnetite functionalized covalent organic frameworks (MCOFs): A promising future material for industrial applications

The utilization of phthalates and bisphenol A (BPA) as the major component in plastic and its derivative industry has raised concerns among the public due to the harmful effects caused by these organic pollutants. These pollutants are found to exhibit unique physicochemical properties that allow the pollutants to have prolonged existence in the environment, thus causing damage to the environment. Since phthalates and bisphenol A are used in a variety of industrial applications, the industry must recover these compounds from its water before releasing the pollutants into the environment. As a result, these materials have a promising future in industrial applications. Therefore, the discovery of new quick and reliable abatement technologies is important to ensure that these organic pollutants can be detected and removed from the water sources. This review highlights the use of the adsorption method to remove phthalates and BPA from water sources by employing novel modified adsorbent magnetite functionalized covalent organic frameworks (MCOFs). MCOFs is a new class of porous materials that have demonstrated promising features in a variety of applications due to their adaptable structures, significant surface areas, configurable porosity, and customizable chemistry. The structural attributes, functional design strategies, and specialized for environmental applications before offering some closing thoughts and suggestions for further research were discussed in this paper in addition to developing an innovative solution for the industry to the accessibility for clean water

QoS Enabled Layered Based Clustering for Reactive Flooding in the Internet of Things

The Internet of Things has gained substantial attention over the last few years, because of connecting daily things in a wide range of application and domains. A large number of sensors require bandwidth and network resources to give-and-take queries among a heterogeneous IoT network. Network flooding is a key questioning strategy for successful exchange of queries. However, the risk of the original flooding is prone to unwanted and redundant network queries which may lead to heavy network traffic. Redundant, unwanted, and flooded queries are major causes of inefficient utilization of resources. IoT devices consume more energy and high computational time. More queries leads to consumption of more bandwidth, cost, and miserable QoS. Current existing approaches focused primarily on how to speed up the basic routing for IoT devices. However, solutions for flooding are not being addressed. In this paper, we propose a cluster-based flooding (CBF) as an interoperable solution for network and sensor layer devices which is also capable minimizing the energy consumption, cost, network flooding, identifying, and eliminating of redundant flooding queries using query control mechanisms. The proposed CBF divides the network into different clusters, local queries for information are proactively maintained by the intralayer cluster (IALC), while the interlayer cluster (IELC) is responsible for reactively obtain the routing queries to the destinations outside the cluster. CBF is a hybrid approach, having the potential to be more efficient against traditional schemes in term of query traffic generation. However, in the absence of appropriate redundant query detection and termination techniques, the CBF may generate more control traffic compared to the standard flooding techniques. In this research work, we used Cooja simulator to evaluate the performance of the proposed CBF. According to the simulation results the proposed technique has superiority in term of traffic delay, QoS/throughput, and energy consumption, under various performance metrics compared with traditional flooding and state of the art