The CO2 laser has been actively used clinically for soft tissue surgery. The advantages have been widely acknowledged. In implant related tissue surgery, the use .6f CO2 laser has been debated on whether the heat generated during the procedure would be detrimental to the bone thus losing the implants through disosseointegration. In this preliminary work, CO2 laser was used to perform a simulated gingivectomy of tissue surrounding plasma coated titanium implants. The purpose was to observe the pattern of heat generated at different levels of the implant body. The safe power range and standard precaution was also identified. The results suggested that power output between 6 Watt to 8 Watt in repeated pulsed mode with duration of 5 seconds is considered safe. With this mode the operator
MeSH terms: Bone and Bones; Gingivectomy; Hot Temperature; Titanium; Dental Implants; Lasers, Gas
Gestational Diabetes Mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. This review provides an overview into the morbidity associated with GDM as well as the current methods of screening, diagnosis and management with the aim of early recognition and prevention of complications to both the mother and foetus.
In direct age-adjustment, a common age-structured population is used as standard. This population may actually exist (e.g., United States population, 1999) or may be fictitious (e.g., two populations may be combined to create a standard). In indirect age-adjustment, a common set of age-specific rates is applied to the populations whose rates are to be standardized. The simplest and most useful form of indirect adjustment is the standardized mortality ratio (SMR) (5).
Familial defective apolipoprotein B-100 (FDB) is an autosomal dominant genetic disorder associated with hypercholesterolaemia and premature coronary heart disease. FDB is caused by mutations in and around the codon 3500 of the apolipoprotein B (apo B) gene. Apo B R3500Q mutation is the first apo B mutation known to be associated with FDB and it is the most frequently reported apo B mutation in several different populations. The objective of the present study was to determine the association of apo B R3500Q mutation with elevated plasma cholesterol concentration in Kelantanese population in which both hypercholesterolaemia and coronary heart disease are common. Sixty-two Malay subjects with hyperlipidaemia, attending the lipid clinic at Hospital Universiti Sains Malaysia, Kelantan, were selected for this study. The DNA samples were analysed for the presence of apo B R3500Q mutation by polymerase chain reaction-based restriction fragment analysis method using mutagenic primers. This mutation was not detected in the subjects selected for this study. Apo B R3500Q mutation does not appear to be a common cause of hypercholesterolaemia in Kelantanese Malays.
The objective of the study was to determine the prevalence of H. pylori in functional dyspepsia among the three main races in Malaysia. Gastric antral biopsies from 233 (98 males, 135 females; age range: 17-75 years, mean age 39.5 years) patients attending the Universiti Kebangsaan Malaysia (UKM) gastroenterology clinic were assessed for the presence of H. pylori by culture and histology. About a third of the cases (79 of 233 (34%); 34 males, 45 females; mean age 42.6 yrs) were positive for H. pylori. The presence of H. pylori was always associated with antral gastritis. Malay patients were least likely to be positive for H. pylori (10 of 88 (11.4%); 5 males, 5 females; mean age 35.7 yrs) compared to the Chinese (43 of 95 (45%); 19 males; 24 females; mean age 40.2 yrs) and Indian patients (23 of 41 (56%); 10 males, 13 females; mean age 48.1 yrs). We found that H. pylori were most common among Chinese followed by Indians. However, the relative risk for the Indians was 8.58 and 6.29 for the Chinese compared to Malays. We conclude that the prevalence of H. pylori in patients with functional dyspepsia differs considerably with respect to ethnic groups.
Experience of acute medical, surgical conditions, and clinical procedures of undergraduate students were assessed via a questionnaire survey during the final week of the 1993/1998 programme at the School of Medical Sciences, Univestiti Sains Malaysia. Individual performances were assessed by a scoring system. One hundred and twenty four students responded, (response rate 97%). More than 90% had seen myocardial infarction, cerebrovascular accident, pneumonia, respiratory distress, gastroenteritis, coma, and snake bite. Less than 33% had witnessed acute psychosis, diabetic ketoacidosis, acute hepatic failure, status epilepticus, near drowning, hypertensive encephalopathy, acute haemolysis or child abuse.Acute surgical/obstetrics cases, seen by >90% students, included fracture of long bones, head injury, acute abdominal pain, malpresentation and foetal distress. Less than 33% had observed epistaxis, sudden loss of vision, peritonitis or burns. Among operations only herniorrhaphy, Caesarian section, internal fixation of fracture and cataract extraction were seen by >80% students. The main deficits in clinical procedures are in rectal and vaginal examinations, urine collection and microscopic examinations. The performance of individual students, assessed by a scoring system, showed 15 students had unacceptably low scores (<149/230, 50%), 37 had good scores (>181.4/230, 70%) and 5 had superior scores (197.6/230, 80%).
Nosocomial infection is a common problem in the Neonatal Intensive Care Unit (NICU) and a knowledge of the pattern of nosocomial infection will contribute greatly to the intensification of infection control measures and the development of antibiotic policies in the NICU. This study aims to compare the incidence and clinical characteristics of neonates with nosocomial infection in NICU of both Kuala Terengganu Hospital (HKT) and Universiti Sains Malaysia Hospital (HUSM). Neonates who had both clinical signs of sepsis and positive blood cultures, 48 hours after admission to NICU, from 1(st) January to 31(st) December 1998, in both hospitals were retrospectively studied. Among neonates admitted to NICU, 30 (5.4%) in HKT and 65 (3.6%) in HUSM had nosocomial infection (p = 0.07). The mean duration of hospitalisation was shorter (HUSM 37 days, HKT 49 days; p = 0.02), and the number of neonates with predisposing factors for infection is higher (HUSM 100%, HKT 73.3%; p < 0.001) in HUSM compared with HKT. There were no differences in gestation, mean age of onset of infection and mortality between both hospitals. The most common organism isolated from the blood in HKT was Klebsiella pneumoniae (33.3%), and in HUSM Klebsiella aerogenes (24.6%). Half of Klebsiella pneumoniae isolates were resistant to cephalosporins and aminoglycosides in HKT and a similar number of Klebsiella aerogenes isolates were resistant to piperacillin and aminoglycosides in HUSM. In conclusion nosocomial infection is a common problem in both hospitals. Except for more frequent predisposing factors for infection in HUSM, and a longer duration of hospital stay among neonates in HKT, the clinical characteristics of neonates with nosocomial infection in both hospitals were similar.
Absorbed dose to water was measured with ionisation chambers NE 2561 (#267), NE 2581 (#334), NE 2571 (#1028), using the IAEA standard water phantom. The ionisation chamber was inserted in the water phantom at a reference depth dependent on the type of the radiation quality used. Three radiation qualities were used namely 1.25 MeV gamma ray, 6 MV x-rays and 10 MV x-rays. The values of the absorbed dose to water were determined by the N(K)- and N(X)- based methods, i.e with the use of IAEA, HPA, NACP, AAPM, NCRP and ICRU protocols. The aim of this study was to make an intercomparison of the results, by taking the IAEA protocol as a standard. The largest deviation contributed by any of these protocols was recorded for each quality. It was found that AAPM, NCRP and ICRU protocols contributed 0.94% for 1.25 MeV gamma ray, NACP contributed 2.12% for the 6 MV x-rays, and NACP contributed 2.35% for 10 MV x-rays. Since the acceptable limit of deviation set by the IAEA for this absorbed dose work is ± 3%, it is clear that the overall deviations obtained were all satisfactory.
Short course hypo-fractionated radiotherapy is a standard regime for the palliation of stage IV head and neck cancers. However few patients respond favorably and require further radiotherapy in curative intent. We have used split-course radiotherapy technique to find out this conversion rate from palliative to curative intent. This was a prospective study conducted from November 1998 to October 1999; twenty-six (26) patients with stage IV head & neck cancers were treated with a hypofractionated regime of radiotherapy. A tumor dose of 30 Gy in 10 fractions [time dose fraction (TDF) 62] over 2 weeks was delivered using a 6 MV linear accelerator. A conventional 2 field or 3 field technique was used. Patients were assessed for the regression of tumor on fifth day, tenth day of radiotherapy and 4 weeks after the completion of radiotherapy. Patients showing complete response and good partial response were allowed to receive further radiotherapy of 30 Gy in 15 fractions [TDF 49]. There were 21 males and 5 females in the study with a median age of 44 years (range 19-77 years). All patients completed the initial regime. Complete responses were observed among 14 patients (54%); partial response in 6 patients (23%), and no response was seen among 6 patients (23%). Sixteen patients (61%) were suitable for radical radiotherapy after phase-I course of the above schedule. Seventeen patients (65%) showed an improvement in the general well being with a better quality of life. One year actuarial survival was (76%), with a median survival time of 12 months. Split-course technique is a useful radiotherapy treatment in stage IV head and neck cancers to distinguish between the subset of patients who would require curative treatment and who would not.
MeSH terms: Adult; Aged; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Palliative Care; Particle Accelerators; Prospective Studies; Quality of Life; Dose Fractionation; Young Adult
11Beta-hydroxysteroid dehydrogenase (11beta-HSD) Type I enzyme is found in testis and liver. In Leydig cell cultures, 11beta-HSD activity is reported to be primarily oxidative while another report concluded that is primarily reductive. Hepatic 11beta-HSD preferentially catalyzes reduction and the reaction direction is unaffected by the external factors. Recent analysis of testicular 11beta-HSD revealed two kinetically distinct components. In the present study, various steroid hormones or glycyrrhizic acid (GCA), given for 1 week, or thyroxine given for 5 weeks to normal intact rats had different effects on the 11beta-HSD oxidative activity in testis and liver. Deoxycorticosterone, dexamethasone, progesterone, thyroxine, and clomiphene citrate increased testicular 11beta-HSD oxidative activity, but decreased hepatic enzyme activity except for deoxycorticosterone (unchanged). Corticosterone and testosterone decreased 11beta-HSD oxidative activity in testis but not that of liver (which was unchanged). Estradiol, GCA and adrenalectomy lowered oxidative activity of 11beta-HSD in testis and liver, but the degrees of reduction were different. The in vivo effects of glucocorticoids too were different, even in the same organ. Dexamethasone, a pure glucocorticoid, has greater affinity for glucocorticoid receptors (GR) than corticosterone. The direct effects of dexamethasone via GR in increasing testicular 11beta-HSD oxidative activity may override its indirect effects. Possibly, the reverse occurs with corticosterone treatment, as it has both glucocorticoid and mineralocorticoid effects. Because both organs have Type I isoenzyme, the difference in 11beta-HSD oxidative activities of these two organs could be attributable to the presence of an additional isozyme in testis or differences in tissue-specific regulatory mechanisms.
Priapism, an uncommon urological emergency, is commonly drug-induced. We present a previously unreported case of a young man with priapism probably related to Ecstasy.
Recent studies have shown that good glycaemic control can prevent the development of diabetic complications in type 1 and type 2 diabetes. We wished to observe the glycaemic control in patients from different centres in Peninsular Malaysia and the factors that determine it. We recruited 926 patients with diabetes diagnosed before age 40 years from seven different centres, with proportionate representation from the three main ethnic groups. Clinical history and physical examination were done and blood taken for HbA1c and fasting glucose. The overall glycaemic control was poor with geometric mean HbA1c of 8.6% whilst 61.1% of the patients had HbA1c greater than 8%. Glycaemic control in patients with type 2 diabetes varied between various centres and ethnic groups, with the best control obtained in Chinese patients. Significant predictors of HbA1c in both type 1 and type 2 diabetes include access to nurse educators, ethnic background and WHR. In type 2 diabetes, use of insulin was a significant predictor, while in type 1 diabetes, household income was a significant predictor. Socioeconomic status did not have a significant effect in type 2 diabetes. There were no significant differences in the glycaemic control in patients with different educational status. In conclusion, glycaemic control in big hospitals in Malaysia was poor, and was closely related to the availability of diabetes care facilities and ethnic group, rather than socioeconomic status.
MeSH terms: Adult; Demography; Developing Countries; Diabetes Mellitus, Type 1/epidemiology*; Diabetes Mellitus, Type 1/therapy*; Diabetes Mellitus, Type 2/epidemiology*; Diabetes Mellitus, Type 2/therapy*; Female; Health Services Accessibility; Humans; Hyperglycemia/epidemiology; Hyperglycemia/therapy; Malaysia/epidemiology; Male; Social Class; Linear Models
A neonate with umbilical evagination of the bladder (UEB) and omphalocele minor (OM) is reported. The findings in this case support the origin of the urachus from the upper end of the cloaca rather than the allantois. The frequent occurrence of OM with urachal anomalies, including UEB, suggests an embryological association between the two conditions.
Medical students are usually drawn from the best of students, but it is not unusual to see these brilliant students fail their exams or even dismissed from medical school because of poor academic performance. Information overload has been recognized as one of the major contributing factors to this problem. The situation is expected to get worse, with the ever-present technology-induced exponential growth in information. In discussing this issue, the authors echo the concerns of several experts regarding the content overload of medical school curricula, particularly in pharmacology. It is the increasing awareness of this problem that led the Association of American Medical Colleges and the General Medical Council of Britain to promote the concept of a core curriculum for each of the principal disciplines in medicine. Several medical schools have adopted the concept and also the problem-based learning approach, which focuses on ameliorating the complex problems associated with information growth in medical education. Based on the authors' experience as medical students, medical practitioners, and pharmacology teachers, they discuss the factors that contribute to information overload, from psychological and nonpsychological perspectives. Issues such as the design and structure of the curriculum, the quality of training and effectiveness of the teachers (clinically qualified vs. nonclinically qualified teachers), and the psychological preparedness of the students are discussed. The authors make suggestions for improvement.
In accordance with detection of a few phospholipase A2 (PLA2) isozyme genes by Southern blot analysis, only two cDNAs, named NnkPLA-I , and NnkPLA-II, encoding group I PLA2s, NnkPLA-I and NnkPLA-II, respectively, were isolated from the venom gland cDNA library of Elapinae Naja naja kaouthia of Malaysia. NnkPLA-I and NnkPLA-II showed four amino acid substitutions, all of which were brought about by single nucleotide substitution. No existence of clones encoding CM-II and CM-III, PLA2 isozymes which had been isolated from the venom of N. naja kaouthia of Thailand, in Malaysian N. naja kaouthia venom gland cDNA library was verified by dot blot hybridization analysis with particular probes. NnkPLA-I and NnkPLA-II differed from CM-II and CM-III with four and two amino acid substitutions, respectively, suggesting that their molecular evolution is regional. The comparison of NnkPLA-I, NnkPLA-II and cDNAs encoding other group I snake venom gland PLA2s indicated that the 5'- and 3'-untranslated regions are more conserved than the mature protein-coding region and that the number of nucleotide substitutions per nonsynonymous site is almost equal to that per synonymous site in the protein-coding region, suggesting that accelerated evolution has occurred in group I venom gland PLA2s possibly to acquire new physiological functions.
There is remarkably little known about the incidence of melioidosis outside a few countries (Thailand, Australia, Singapore and Malaysia). Presumably it is widespread in tropical south east Asia. Elsewhere there are tantalising glimpses of the tip of what may be a large iceberg. Since a specific diagnosis of melioidosis requires awareness on the part of clinicians, and the existence of a laboratory capable of isolating and identifying Burkholderia pseudomallei, a luxury not available in most rural tropical areas, the size of this iceberg is likely to remain unknown for the foreseeable future. There is mounting evidence that the disease is endemic in the Indian sub-continent and the Caribbean, and there have been unsubstantiated reports of recent cases in South Africa and the Middle East. It is unclear whether melioidosis has really spread to such areas relatively recently, or has been there but unrecognised for a long time. Almost all cases diagnosed in temperate climates have been imported from the tropics, with the exception of a unique outbreak which occurred in France in the mid-1970s. With increasing world wide travel of both humans and other animals, the potential exists for melioidosis to spread to new and fertile pastures.
We compared the result of radiofrequency (RF)-assisted valvotomy and balloon dilation with closed surgical valvotomy and Blalock Taussig (BT) shunt as primary treatment in selected patients with pulmonary atresia and intact ventricular septum (PA-IVS).