Browse publications by year: 2008

Role of mebo (moist exposed burn ointment) in the treatment of fournier's gangrene

Al-Meshaan M, Abdul Hamid M, Quider T, Al-Sairafi A, Dham R

Ann Burns Fire Disasters, 2008 Mar 31;21(1):20-2.
PMID: 21991105

Objectives. Fournier's gangrene (FG), though rare, is a life-threatening extensive fulminant infection of the genitals, perineum, or abdominal wall caused by a mixture of aerobic and anaerobic micro-organisms. Early and aggressive surgical debridement of the necrotic tissue and complete antibiotic coverage are the gold standards in treating FG. The purpose of our study was to assess the role of MEBO (moist exposed burn ointment) in topical treatment of the wound secondary to surgical debridement. Methods. Eleven patients (age range, 40-75 yr; mean, 55 yr) were admitted to the clinical facilities of the Department of Urology at Al Sabah Hospital, Kuwait, suffering from Fournier's gangrene, in the 31-month period between January 2004 and July 2006. All these patients were treated with broad-spectrum triple antimicrobial therapy as well as extensive debridement of necrotic tissue. The resultant wounds were treated with MEBO in six randomly selected patients and with a placebo in the remaining five patients. Results. The duration of hospital stay was reduced by 41.7% in the MEBO-treated group (30.0 vs 51.5 days) and pain control of pain was faster, which could be attributed to the faster control of infection and wound healing in this group. Conclusion. A combination of appropriate antibiotic coverage and aggressive surgical therapy is mandatory for the treatment of FG. MEBO promotes the healing of the resulting, quite extensive wound, reducing pain and controlling infection. It is a also a cost-effective therapy as it accelerates healing and reduces hospital stay by 41.7%.
Fulltext HIV/AIDS-Related Knowledge Among Malaysian Young Adults: Findings From a Nationwide Survey

Wong LP, Chin CK, Low WY, Jaafar N

J Int AIDS Soc, 2008 Jun 24;10(6):148.
PMID: 19825143 DOI: 10.1186/1758-2652-10-6-148

PURPOSE: HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults.
METHODS: A total of 1075 young adult respondents aged 15-24 years participated in this survey. The response rate was 82.2%.
RESULTS: The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets.
CONCLUSION: Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.
Fulltext Evaluation of Antioxidant and Wound Healing Effects of Alcoholic and Aqueous Extract of Ocimum sanctum Linn in Rats

Shetty S, Udupa S, Udupa L

Evid Based Complement Alternat Med, 2008 Mar;5(1):95-101.
PMID: 18317555 DOI: 10.1093/ecam/nem004

In recent years, oxidative stress and free radicals have been implicated in impaired wound healing. Ocimum sanctum (O. sanctum), a plant widely used in Ayurveda, possesses anti-inflammatory and antioxidant properties. The present study was undertaken to assess the potential of alcoholic and aqueous extracts in wound healing in Wistar albino rats. The rats were divided into five groups of six animals each. Group 1 is normal wounded control and the other four groups were treated with two different doses each of alcoholic and aqueous extract of O. sanctum. The wound healing parameters were evaluated by using incision, excision and dead space wounds in extract-treated rats and controls. Both the doses of alcoholic and aqueous extract significantly increased wound breaking strength, hydroxyproline, hexuronic acid, hexosamines, superoxide dismutase, catalase, reduced glutathione and significantly decreased percentage of wound contraction and lipid peroxidation when compared with the control group. The results suggest that O. sanctum has antioxidant properties, which may be responsible and favorable for faster wound healing and this plant extract may be useful in the management of abnormal healing and hypertropic scars.
Tooth wear prevalence and sample size determination : a pilot study

Abd Karim NB, Ismail NM, Naing L, Ismail AR

Malays J Med Sci, 2008 Oct;15(4):35-40.
PMID: 22589636

Tooth wear is the non-carious loss of tooth tissue, which results from three processes namely attrition, erosion and abrasion. These can occur in isolation or simultaneously. Very mild tooth wear is a physiological effect of aging. This study aims to estimate the prevalence of tooth wear among 16-year old Malay school children and determine a feasible sample size for further study. Fifty-five subjects were examined clinically, followed by the completion of self-administered questionnaires. Questionnaires consisted of socio-demographic and associated variables for tooth wear obtained from the literature. The Smith and Knight tooth wear index was used to chart tooth wear. Other oral findings were recorded using the WHO criteria. A software programme was used to determine pathological tooth wear. About equal ratio of male to female were involved. It was found that 18.2% of subjects have no tooth wear, 63.6% had very mild tooth wear, 10.9% mild tooth wear, 5.5% moderate tooth wear and 1.8 % severe tooth wear. In conclusion 18.2% of subjects were deemed to have pathological tooth wear (mild, moderate & severe). Exploration with all associated variables gave a sample size ranging from 560 - 1715. The final sample size for further study greatly depends on available time and resources.
An approach for assessment of tumor volume from mammography in locally advanced breast cancer

Singh G, Thulkar S, Seith A, Parshad R, Kumar P

Malays J Med Sci, 2008 Jan;15(1):37-41.
PMID: 22589613

Tumor size is an important independent indicator in patients with carcinoma of the breast. Repeated size measurements during primary systemic therapy produce detailed information about response that could be used to select the most effective treatment regimen and to estimate the patient's prognosis. Measurement of tumor burden with ultrasonography and computed tomography is being used with increasing frequency to assess the effectiveness of cytotoxic anticancer drugs. Standardization of assessment and results reporting are important steps that aim at increasing the amount of usable therapeutic information at the physician's disposal. The purpose of our study is to calculate the tumor volume by mammography after demagnification and compare the tumor volume measured from this method with ultrasonography volumes.
Fulltext Validating the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate physiology curriculum

Abraham R, Ramnarayan K, Kamath A

BMC Med Educ, 2008 Jul 24;8:40.
PMID: 18652649 DOI: 10.1186/1472-6920-8-40

BACKGROUND: It has been proved that basic science knowledge learned in the context of a clinical case is actually better comprehended and more easily applied by medical students than basic science knowledge learned in isolation. The present study intended to validate the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate medical curriculum at Melaka Manipal Medical College (Manipal Campus), Manipal, India.
METHODS: COPT was a teaching strategy wherein, students were taught physiology using cases and critical thinking questions. Three batches of undergraduate medical students (n = 434) served as the experimental groups to whom COPT was incorporated in the third block (teaching unit) of Physiology curriculum and one batch (n = 149) served as the control group to whom COPT was not incorporated. The experimental group of students were trained to answer clinically oriented questions whereas the control group of students were not trained. Both the group of students undertook a block exam which consisted of clinically oriented questions and recall questions, at the end of each block.
RESULTS: Comparison of pre-COPT and post-COPT essay exam scores of experimental group of students revealed that the post-COPT scores were significantly higher compared to the pre-COPT scores. Comparison of post-COPT essay exam scores of the experimental group and control group of students revealed that the experimental group of students performed better compared to the control group. Feedback from the students indicated that they preferred COPT to didactic lectures.
CONCLUSION: The study supports the fact that assessment and teaching patterns should fall in line with each other as proved by the better performance of the experimental group of students compared to the control group. COPT was also found to be a useful adjunct to didactic lectures in teaching physiology.

MeSH terms: Curriculum*; Education, Medical, Undergraduate*; Educational Measurement/methods; Humans; Physiology/education*; Teaching/methods*
Starch from the Sago (Metroxylon sagu) Palm Tree-Properties, Prospects, and Challenges as a New Industrial Source for Food and Other Uses

Karim AA, Tie AP, Manan DMA, Zaidul ISM

Compr Rev Food Sci Food Saf, 2008 Jul;7(3):215-228.
PMID: 33467803 DOI: 10.1111/j.1541-4337.2008.00042.x

The common industrial starches are typically derived from cereals (corn, wheat, rice, sorghum), tubers (potato, sweet potato), roots (cassava), and legumes (mung bean, green pea). Sago (Metroxylon sagu Rottb.) starch is perhaps the only example of commercial starch derived from another source, the stem of palm (sago palm). Sago palm has the ability to thrive in the harsh swampy peat environment of certain areas. It is estimated that there are about 2 million ha of natural sago palm forests and about 0.14 million ha of planted sago palm at present, out of a total swamp area of about 20 million ha in Asia and the Pacific Region, most of which are under- or nonutilized. Growing in a suitable environment with organized farming practices, sago palm could have a yield potential of up to 25 tons of starch per hectare per year. Sago starch yield per unit area could be about 3 to 4 times higher than that of rice, corn, or wheat, and about 17 times higher than that of cassava. Compared to the common industrial starches, however, sago starch has been somewhat neglected and relatively less attention has been devoted to the sago palm and its starch. Nevertheless, a number of studies have been published covering various aspects of sago starch such as molecular structure, physicochemical and functional properties, chemical/physical modifications, and quality issues. This article is intended to piece together the accumulated knowledge and highlight some pertinent information related to sago palm and sago starch studies.

MeSH terms: Agriculture; Attention; Manihot; Edible Grain; Zea mays; Fabaceae; Solanum tuberosum; Oryza; Soil; Starch; Triticum; Molecular Structure; Peas; Ipomoea batatas; Arecaceae; Sorghum; Wetlands; Forests; Vigna
Fulltext The Medical Research Handbook. Planning a Research Project

Amar Singh HSS, Azman AB, Sararaks S

ISBN: 978-983-42269-8-5

Amar Singh HSS, Azman AB, Sararaks S. The Medical Research Handbook. Planning a Research Project, First Edition. Kuala Lumpur: Institute of Health Systems Research; 2008

Newer edition (Second Edition): no free full text

MeSH terms: Research
Fulltext Management of HIV Infection in Children

Citation: Management of HIV Infection in Children. Putrajaya: Ministry of Health, Malaysia; 2008

Keywords: CPG

MeSH terms: Acquired Immunodeficiency Syndrome; Child; Humans; Malaysia; HIV Infections; Guidelines as Topic
Fulltext Management of HIV Infection in Pregnant Women

Citation: Management of HIV Infection in Pregnant Women. Putrajaya: Ministry of Health, Malaysia; 2008

Keywords: CPG

MeSH terms: Acquired Immunodeficiency Syndrome; Humans; Malaysia; Pregnancy; HIV Infections; Guidelines as Topic
Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2008;2008:4070-3.
PMID: 19163606 DOI: 10.1109/IEMBS.2008.4650103

Skin colour is vital information in dermatological diagnosis. It reflects pathological condition beneath the skin and commonly being used to indicate the extent of a disease. Psoriasis is a skin disease which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI. Commonly, the erythema is assessed visually, thus leading to subjective and inconsistent result. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring. The colour of psoriasis lesion is analyzed by DeltaL, Deltahue, and Deltachroma of CIELAB colour space. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score can be determined objectively and consistent with dermatology scoring.

MeSH terms: Algorithms; Dermatology/methods*; Diagnosis, Computer-Assisted; Equipment Design; Humans; Models, Theoretical; Pattern Recognition, Automated/methods*; Psoriasis/diagnosis*; Psoriasis/physiopathology*; Skin/metabolism; Skin Pigmentation*; Vision, Ocular; Models, Statistical; Observer Variation
An overview of the phenotypic and genotypic characteristics of multidrug-resistant Mycobacterium tuberculosis isolates from four Asian countries

Ang CF, Ong CS, Rukmana A, Pham Thi KL, Yap SF, Ngeow YF, et al.

J Med Microbiol, 2008 Aug;57(Pt 8):1039-1040.
PMID: 18628510 DOI: 10.1099/jmm.0.47850-0
MeSH terms: Antitubercular Agents/pharmacology; Antitubercular Agents/therapeutic use; Asia; Genotype; Humans; Mycobacterium tuberculosis/drug effects; Mycobacterium tuberculosis/genetics*; Mycobacterium tuberculosis/isolation & purification*; Phenotype; Tuberculosis/drug therapy; Drug Resistance, Multiple*
Primary immunodeficiency disorders in Kuwait: first report from Kuwait National Primary Immunodeficiency Registry (2004--2006)

Al-Herz W

J Clin Immunol, 2008 Mar;28(2):186-93.
PMID: 18008151

Primary immunodeficiency disorders are heterogeneous group of illnesses that predispose patients to serious complications. Registries for these disorders have provided important epidemiological data and shown both racial and geographical variations. The clinical features of 76 patients with primary immunodeficiency disorders registered in Kuwait National Primary Immunodeficiency Registry from 2004 to 2006 were recorded. Ninety-eight percent of the patients presented in childhood. The prevalence of these disorders in children was 11.98 in 100,000 children with an incidence of 10.06 in 100,000 children. The distribution of these patients according to each primary immunodeficiency category is: combined T and B cell immunodeficiencies (21%), predominantly antibody immunodeficiency (30%), other well defined immunodeficiencies (30%), diseases of immune dysregulation (7%), congenital defects of phagocyte number, function or both (8%), and complement deficiencies (4%). The consanguinity rate within the registered patients was 77%. The patients had a wide range of clinical features affecting different body systems. Primary immunodeficiency disorders are prevalent in Kuwait and have a significant impact into the health system.

MeSH terms: Adolescent; Adult; Child; Child, Preschool; Consanguinity; Female; Humans; Immunologic Deficiency Syndromes/diagnosis; Immunologic Deficiency Syndromes/genetics; Immunologic Deficiency Syndromes/epidemiology*; Infant; Infant, Newborn; Kuwait/epidemiology; Male; Registries*; Prevalence
Fulltext MHC class I characterization of Indonesian cynomolgus macaques

Pendley CJ, Becker EA, Karl JA, Blasky AJ, Wiseman RW, Hughes AL, et al.

Immunogenetics, 2008 Jul;60(7):339-51.
PMID: 18504574 DOI: 10.1007/s00251-008-0292-4

Cynomolgus macaques (Macaca fascicularis) are quickly becoming a useful model for infectious disease and transplantation research. Even though cynomolgus macaques from different geographic regions are used for these studies, there has been limited characterization of full-length major histocompatibility complex (MHC) class I immunogenetics of distinct geographic populations. Here, we identified 48 MHC class I cDNA nucleotide sequences in eleven Indonesian cynomolgus macaques, including 41 novel Mafa-A and Mafa-B sequences. We found seven MHC class I sequences in Indonesian macaques that were identical to MHC class I sequences identified in Malaysian or Mauritian macaques. Sharing of nucleotide sequences between these geographically distinct populations is also consistent with the hypothesis that Indonesia was a source of the Mauritian macaque population. In addition, we found that the Indonesian cDNA sequence Mafa-B7601 is identical throughout its peptide binding domain to Mamu-B03, an allele that has been associated with control of Simian immunodeficiency virus (SIV) viremia in Indian rhesus macaques. Overall, a better understanding of the MHC class I alleles present in Indonesian cynomolgus macaques improves their value as a model for disease research, and it better defines the biogeography of cynomolgus macaques throughout Southeast Asia.

MeSH terms: Alleles*; Animals; Genes, MHC Class I*; Genetics, Population; Indonesia; Macaca fascicularis/genetics*; Macaca fascicularis/immunology
Fulltext Seasonal variations in markers of stress and oxidative stress in rats

Bhat S, Rao G, Murthy KD, Bhat PG

Indian J Clin Biochem, 2008 Apr;23(2):191-4.
PMID: 23105750 DOI: 10.1007/s12291-008-0042-2

High ambient temperature has been reported to increase oxidative stress by increasing lipid peroxidation and decreasing antioxidant defence in transition dairy cows. It is also known to cause an increase in plasma cortisol levels in goats, European hedgehog and human volunteers. High levels of glucocorticoids have been reported to decrease blood glutathione and erythrocyte superoxide dismutase activity in rats. Although institutional animal houses in research laboratories of developed countries maintain animals in air-conditioned rooms at constant temperature, the same is not true of animal houses in the developing countries especially those belonging to smaller institutions and this could affect the results of the experiments being conducted on these animals. The present research study was done to assess the effects of seasonal variations on the status of erythrocyte oxidative damage, antioxidant defence and plasma cortisol levels in adult female Wistar rats. Rats were kept in their home cages and were left in non-air-conditioned procedure rooms in two different seasons, Hot season (March-May) and Cool season (June to September). Erythrocyte Thiobarbituric acid reactive substances and plasma cortisol levels were significantly increased in rats exposed to high ambient temperature and humidity of the hot season as compared to the rats of the cool season. Erythrocyte reduced glutathione levels, erythrocyte glutathione peroxidase and superoxide dismutase activities were significantly decreased in the hot season group of rats. The results of our experiments showed that exposure of adult female Wistar rats to high ambient temperature and humidity of the hot season increases neuroendocrine stress, oxidative stress and decreases antioxidant defence in them.
Fulltext The diagnostic MRCP examination: overcoming technical challenges to ensure clinical success

Mandarano G, Sim J

Biomed Imaging Interv J, 2008 Oct;4(4):e28.
PMID: 21611015 DOI: 10.2349/biij.4.4.e28

The magnetic resonance cholangiopancreatography (MRCP) examination has all but replaced the diagnostic endoscopic retrograde cholangiopancreatography (ERCP) examination for imaging the biliary tree and pancreatic ducts in many practical aspects of the clinical setting. Despite this increase in popularity, many magnetic resonance imaging (MRI) radiographers still find aspects of the MRCP examination quite challenging. The aim of this tutorial paper is to provide useful technical advice on how to overcome such perceived challenges and thus produce a successful diagnostic MRCP examination. This paper will be of interest to novice MRI radiographers who are at the beginning of their learning curve in MRCP examination. Other MRI radiographers who are interested in practical tips for protocol variations may also find the paper useful.
Fulltext Budgeting for PACS

Sim L

Biomed Imaging Interv J, 2008 Oct;4(4):e32.
PMID: 21611017 DOI: 10.2349/biij.4.4.e32

There are a number of models for the acquisition of digital image management systems. The specific details for development of a budget for a PACS/RIS acquisition will depend upon the acquisition model - although there are similarities in the overarching principles and general information, particularly concerning the radiology service requirements that will drive budget considerations.While budgeting for PACS/RIS should follow the same principles as budgeting for any new technology, it is important to understand how far the implementation of digital image management systems can reach in a healthcare setting. Accurate identification of those elements of the healthcare service that will be affected by a PACS/RIS implementation is a critical component of successful budget formation and of the success of any business case and subsequent project that relies on those budget estimates.A budget for a PACS/RIS capital acquisition project should contain capital and recurrent elements. The capital is associated with the acquisition of the system in a purchase model and capital budget may also be required for upgrade - depending upon a facility's financial management processes.The recurrent (or operational) cost component for the PACS/RIS is associated with maintaining the system(s) in a sustainable operational state.It is also important to consider the service efficiencies, cost savings and service quality improvements that PACS/RIS can generate and include these factors into the economic analysis of any proposal for a PACS/RIS project.
Dengue virus regulates type I interferon signalling in a strain-dependent manner in human cell lines

Umareddy I, Tang KF, Vasudevan SG, Devi S, Hibberd ML, Gu F

J Gen Virol, 2008 Dec;89(Pt 12):3052-3062.
PMID: 19008393 DOI: 10.1099/vir.0.2008/001594-0

Outbreaks of dengue disease are constant threats to tropical and subtropical populations but range widely in severity, from mild to haemorrhagic fevers, for reasons that are still elusive. We investigated the interferon (IFN) response in infected human cell lines A549 and HepG2, using two strains (NGC and TSV01) of dengue serotype 2 (DEN2) and found that the two viruses exhibited a marked difference in inducing type I IFN response. While TSV01 infection led to activation of type I antiviral genes such as EIF2AK2 (PKR), OAS, ADAR and MX, these responses were absent in NGC-infected cells. Biochemical analysis revealed that NGC but not TSV01 suppressed STAT-1 and STAT-2 activation in response to type I IFN (alpha and beta). However, these two strains did not differ in their response to type II IFN (gamma). Although unable to suppress IFN signalling, TSV01 infection caused a weaker IFN-beta induction compared with NGC, suggesting an alternative mechanism of innate immune escape. We extended our study to clinical isolates of various serotypes and found that while MY10245 (DEN2) and MY22713 (DEN4) could suppress the IFN response in a similar fashion to NGC, three other strains of dengue [EDEN167 (DEN1), MY02569 (DEN1) and MY10340 (DEN2)] were unable to suppress the IFN response, suggesting that this difference is strain-dependent but not serotype-specific. Our report indicates the existence of a strain-specific virulence factor that may impact on disease severity.

MeSH terms: Animals; Antiviral Agents/metabolism; Cell Line; Dengue Virus/classification; Dengue Virus/pathogenicity*; Gene Expression Regulation*; Humans; Interferon Type I/metabolism*; Liver/cytology; Liver/virology*; Lung/cytology; Lung/virology*; Phosphorylation; Serotyping; Species Specificity; Signal Transduction*; Cell Line, Tumor; STAT1 Transcription Factor/metabolism; STAT2 Transcription Factor/metabolism; Host-Pathogen Interactions
Secrets of omega-3 oil

Suvarna BS

Kathmandu Univ Med J (KUMJ), 2008 7 1;6(23):406-11.
PMID: 20071830
MeSH terms: Adult; Feeding and Eating Disorders/diet therapy; Arthritis, Rheumatoid/diet therapy; Asthma/diet therapy; Attention Deficit Disorder with Hyperactivity/diet therapy; Bipolar Disorder/diet therapy; Burns/diet therapy; Cardiovascular Diseases/diet therapy; Child; Diabetes Mellitus/diet therapy; Drug Interactions; Dysmenorrhea/diet therapy; Female; Humans; Macular Degeneration/diet therapy; Male; Neoplasms/diet therapy; Obesity/diet therapy; Osteoporosis/diet therapy; Skin Diseases/diet therapy; Inflammatory Bowel Diseases/diet therapy; Treatment Outcome; Dietary Supplements*; Fatty Acids, Omega-6/therapeutic use*
Fulltext Annual Report of the Diabetes in Children & Adolescent Registry (DiCARE) 2006-2007

Md Zain F, Hong JYH, Wu LL, Harun F, Rasat R, Jalaludin MY, et al.

Citation: Annual Report of the Diabetes in Children & Adolescent Registry (DiCARE) 2006-2007. Kuala Lumpur: Clinical Research Centre; 2008

The objective of Diabetes in Children and Adolescents Registry (DiCARE) under the Ministry of Health (MOH) is to collect information about diabetes mellitus in children and adolescents in Malaysia. This is important in estimating the incidence of diabetes mellitus among children and adolescents and at the same time evaluating the risk factors and the management. The registry aims to evaluate the efficiency and effectiveness of health care among the young diabetics and the health economics of diabetes. The issues related to diabetes care can be looked into and solved when the patients are still young, with the hope that they will become knowledgeable adults who can reasonably handle their diabetes well and thus decrease the long term complications. This information is deemed important in assisting the MOH, Non-Governmental Organizations, healthcare providers and industries in the planning and evaluation of diabetes mellitus prevention and control.

MeSH terms: Adolescent; Adult; Child; Diabetes Mellitus, Type 1; Humans; Malaysia; Registries; Incidence

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