BACKGROUND: Numerous methods of age estimation have been proposed. The Demirjian method is the most frequently used, which was first applied in a French Canadian population in 1973. The Willems method is a modification of the above and was applied in a Belgian population in 2002.
OBJECTIVES: The objectives of this study were to test the applicability of the two methods, namely Demirjian and Willems, for age estimation in a Malay population, and to find the correlation between body mass index and the difference between the dental age and the chronological age.
MATERIALS AND METHODS: A cross-sectional study involving 214 boys and 214 girls, selected by a simple stratified random sampling method was carried out. The orthopantomograph was used to score the seven left mandibular teeth, and the calculated maturity score was used to obtain the Demirjian dental age. Willems dental age was estimated using the tables proposed in the Willems method. Results. The Demirjian method overestimated the age by 0.75 and 0.61 years, while the Willems method overestimated the age by 0.55 and 0.41 years among boys and girls, respectively. In boys, the body mass index was significantly correlated to the difference in age using the Willems method.
CONCLUSION: Further modification of either method is indicated for dental age estimation among the Malay population.
MeSH terms: Adolescent; Age Determination by Teeth/methods*; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Mandible/radiography; Odontometry/methods*; Radiography, Panoramic; Reference Values; Sex Factors; Tooth/radiography*; Body Mass Index; Statistics, Nonparametric; Dentition, Permanent*
Our preliminary results indicated that fibrin and poly(lactic-co-glycolic acid) (PLGA) hybrid scaffold promoted early chondrogenesis of articular cartilage constructs in vitro. The aim of this study was to evaluate in vivo cartilaginous tissue formation by chondrocyte-seeded fibrin/PLGA hybrid scaffolds. PLGA scaffolds were soaked carefully, in chondrocyte-fibrin suspension, and polymerized by dropping thrombin-calcium chloride (CaCl2) solution. PLGA-seeded chondrocytes were used as a control. Resulting constructs were implanted subcutaneously, at the dorsum of nude mice, for 4 weeks. Macroscopic observation, histological evaluation, gene expression and sulphated-glycosaminoglycan (sGAG) analyses were performed at each time point of 1, 2 and 4 weeks post-implantation. Cartilaginous tissue formation in fibrin/PLGA hybrid construct was confirmed by the presence of lacunae and cartilage-isolated cells embedded within basophilic ground substance. Presence of proteoglycan and glycosaminoglycan (GAG) in fibrin/PLGA hybrid constructs was confirmed by positive Safranin O and Alcian Blue staining. Collagen type II exhibited intense immunopositivity at the pericellular matrices. Chondrogenic properties were further demonstrated by the expression of gene encoded cartilage-specific markers, collagen type II and aggrecan core protein. The sGAG production in fibrin/PLGA hybrid constructs was higher than in the PLGA group. In conclusion, fibrin/PLGA hybrid scaffold promotes cartilaginous tissue formation in vivo and may serve as a potential cell delivery vehicle and a structural basis for articular cartilage tissue-engineering.
Fifty faecal samples from diarrheic calves between 1 and 6 months old were collected per rectum from 5 farms around Petaling District in Selangor, Malaysia for Cryptosporidium species detection and genotyping investigation. Oocysts were purified using sedimentation and gradient centrifugation, then examined by immunofluorescence assay (IFAT). Genomic DNA was extracted from all samples and nested PCR was performed to amplify the SSU rRNA gene. Eighteen samples (36%) were positive for Cryptosporidium species by PCR. The sequence and phylogenetic analysis of 14 isolates indicated that Cryptosporidium parvum was most common (11 isolates) followed by Cryptosporidium deer-like genotype (3 isolates). The present work reports the first data on Cryptosporidium genotyping from cattle in Malaysia.
Japanese encephalitis virus (JEV) is an important encephalitis virus in Asia, but there are few data on Malaysia. A hospital-based surveillance system for Japanese encephalitis (JE) has been in operation in Sarawak, Malaysia, for the last 10 years. JEV is endemic in Sarawak, with cases occurring throughout the year and a seasonal peak in the last quarter (one-way anova, P < 0.0001). Ninety-two per cent of 133 cases were children aged 12 years or younger; the introduction of JE vaccination in July 2001 reduced the number of JE cases (84 in the four seasons prior to vs. 49 in the six seasons after, McNemar's test, P = 0.0001). After implementation of the programme, the mean age of infected children increased from 6.3 to 8.0 years (Student's t-test, P = 0.0037), suggesting the need for a catch-up programme.
Guidelines for how a member of the public should give first aid to a person who is becoming psychotic have been developed for English-speaking countries. However, these guidelines may not be appropriate for use in other cultures. A study was therefore carried out to examine whether it was possible to achieve consensus on guidelines that could apply in a range of Asian countries.
MeSH terms: Asia; Mental Disorders; Delphi Technique; First Aid; Consensus
Malay is an alphabetic language with transparent orthography. A Malay reading-related assessment battery which was conceptualised based on the International Dyslexia Association definition of dyslexia was developed and validated for the purpose of dyslexia assessment. The battery consisted of ten tests: Letter Naming, Word Reading, Non-word Reading, Spelling, Passage Reading, Reading Comprehension, Listening Comprehension, Elision, Rapid Letter Naming and Digit Span. Content validity was established by expert judgment. Concurrent validity was obtained using the schools' language tests as criterion. Evidence of predictive and construct validity was obtained through regression analyses and factor analyses. Phonological awareness was the most significant predictor of word-level literacy skills in Malay, with rapid naming making independent secondary contributions. Decoding and listening comprehension made separate contributions to reading comprehension, with decoding as the more prominent predictor. Factor analysis revealed four factors: phonological decoding, phonological naming, comprehension and verbal short-term memory. In conclusion, despite differences in orthography, there are striking similarities in the theoretical constructs of reading-related tasks in Malay and in English.
The performance of silver-loaded zeolite (HY and HZSM-5) catalysts in the oxidation of butyl acetate as a model volatile organic compound (VOC) was studied. The objective was to find a catalyst with superior activity, selectivity towards deep oxidation product and stability. The catalyst activity was measured under excess oxygen condition in a packed bed reactor operated at gas hourly space velocity (GHSV)=15,000-32,000 h(-1), reaction temperature between 150 and 500 degrees C and butyl acetate inlet concentration of 1000-4000 ppm. Both AgY and AgZSM-5 catalysts exhibited high activity in the oxidation of butyl acetate. Despite lower silver content, AgY showed better activity, attributed to better metal dispersion, surface characteristics and acidity, and its pore system. Total conversion of butyl acetate was achieved at above 400 degrees C. The oxidation of butyl acetate followed a simple power law model. The reaction orders, n and m were evaluated under differential mode by varying the VOC partial pressure between 0.004 and 0.018 atm and partial pressure of oxygen between 0.05 and 0.20 atm. The reaction rate was independent of oxygen concentration and single order with respect to VOC concentration. The activation energies were 19.78 kJ/mol for AgY and 32.26 kJ/mol for AgZSM-5, respectively.
PURPOSE: We determined the clinical efficacy and safety of terazosin in the treatment of patients with female lower urinary tract symptoms.
MATERIALS AND METHODS: A total of 100 females 20 to 70 years old who met the inclusion criteria of total International Prostate Symptom Score 8 or greater, symptom duration 1 or more months, and did not meet any exclusion criteria were entered into the study. Subjects were randomized to receive terazosin or placebo in titrated dose from 1 mg od, 1 mg twice daily to 2 mg twice daily during 14 weeks. Successful treatment outcomes use primary end point of International Prostate Symptom Score quality of life 2 or less and secondary end point of total International Prostate Symptom Score 7 or less. Other outcome measures included International Prostate Symptom Score individual item scores, King's Health Questionnaire quality of life domains, objective assessment parameters of 24-hour frequency volume chart, maximum flow rate and post-void residual urine.
RESULTS: Using a primary end point, 32 of 40 (80%) evaluable terazosin subjects responded in contrast to 22 of 40 (55%) evaluable placebo subjects (p <0.02). The secondary end point revealed a successful outcome in 85% of terazosin subjects vs 55% in placebo (p <0.01). Of the 7 International Prostate Symptom Score individual item scores, only item scores of frequency and straining showed statistically significant reductions with terazosin (p <0.01). All King's Health Questionnaire quality of life domains except domain of severity measures showed statistically significant improvement with terazosin (p <0.05). There were no differences between treatment groups in all objective assessment parameters. Of all evaluable subjects 23 of 40 (58%) on placebo experienced adverse events vs 16 of 40 (40%) on terazosin (p >0.05).
CONCLUSIONS: Terazosin proved to be more effective and safe than placebo in patients with female lower urinary tract symptoms.
Ramelteon is a novel MT1 and MT2 melatonin receptor selective agonist recently approved for the treatment of insomnia characterized by difficulty in sleep onset. It is a nonscheduled drug since it lacks the potential for abuse and does not interact with neurotransmitter receptors most associated with these phenomena. Although the effects of ramelteon use > 5 weeks are unknown, the available data confirms its safety and efficacy for short-term use. Clinical use and future research should uncover more information about ramelteon's properties.
We analysed the reproductive parameters of free-ranging female orangutans at Sepilok Orangutan Rehabilitation Centre (SORC) on Borneo Island, Sabah, Malaysia. Fourteen adult females produced 28 offspring in total between 1967 and 2004. The average censored interbirth interval (IBI) (i.e. offspring was still alive when mother produced a next offspring) was 6 years. This was shorter than censored IBIs reported in the wild but similar to IBIs reported for those in captivity. The nonparametric survival analysis (Kaplan-Meier method) revealed a significantly shorter IBI at SORC compared with wild orangutans in Tanjung Putting. The infant (0-3 years) mortality rate at SORC of 57% was much higher than rates reported both in the wild and captivity. The birth sex-ratio was significantly biassed toward females: 24 of the 27 sex-identified infants were females. The average age at first reproduction was 11.6 years, which is younger than the age in the wild and in captivity. The high infant mortality rate might be caused by human rearing and increased transmission of disease due to frequent proximal encounters with conspecifics around the feeding platforms (FPs). This young age of first reproduction could be because of the uncertainty regarding estimated ages of the female orangutans at SORC. It may also be affected by association with other conspecifics around FPs, which increased the number of encounters of the females with males compared with the number of encounters that would take place in the wild. Provision of FPs, which improves the nutritional condition of the females, caused the shorter IBI. The female-biassed birth sex-ratio can be explained by the Trivers and Willard hypothesis. The female-biassed sex ratio could be caused by the mothers being in poor health, parasite prevalence and/or high social stress (but not food scarcity) due to the frequent encounters with conspecifics around FPs.
MeSH terms: Animals; Borneo; Conservation of Natural Resources; Female; Male; Pongo pygmaeus/physiology*; Reproduction/physiology*; Sex Ratio; Time Factors; Survival Analysis
Chicken breast muscle powder (CBMP) and modified waxy cornstarch (MWCS) blends were prepared at different pH conditions (pH 4, 5, 6, 7, 8, and 9). The blends were characterized by light microscopy, frequency sweep, flow analysis, and freeze-thaw stability analysis. Light microscopy showed that the blend structure was coarse at pH conditions close to the isoelectric point of protein and became finer with increasing pH. Frequency sweep demonstrated that the blend was more liquid-like with relatively lower storage (G') and loss (G'') moduli as the pH was increased from pH 4 to pH 9. Flow analysis revealed that thixotropy behavior was evident in samples treated at pHs 4 and 5, whereas antithixotropy was shown by those adjusted to pHs 6, 7, 8, and 9. The CBMP-MWCS blends were found to show better freeze-thaw stability at pH 8 that could be attributed to the formation of a highly interactive network structure of CBMP and MWCS.
MeSH terms: Animals; Chickens; Drug Stability; Drug Storage; Food Preservation/methods*; Food Technology*; Humans; Hydrogen-Ion Concentration*; Isoelectric Point; Muscle Proteins/physiology; Muscle Proteins/chemistry*; Starch/chemistry*; Temperature; Time Factors
Fiji leaf gall is an important disease of sugarcane in Australia and other Asia-Pacific countries. The causative agent is the reovirus Fiji disease virus (FDV). Previous reports indicate that there is variation in pathology between virus isolates. To investigate the amount of genetic variation found in FDV, 25 field isolates from Australia, Papua New Guinea and Malaysia were analysed by partial sequencing of genome segments S3 and S9. There was up to 15% divergence in the nucleotide sequence among the 25 isolates. A similar amount of divergence and pattern of relationships was found for each of the two genomic segments for most of the field isolates, although reassortment of genome segments seems likely for at least one of the Papua New Guinean isolates. The finding of a high level of variation in FDV isolated in different regions has implications for quarantine and disease management.
: We present our initial experience using a simple and relatively cost effective system using existing mobile phone network services and conventional handphones with built in cameras to capture carefully selected images from hard copies of scan images and transferring these images from a hospital without neurosurgical services to a university hospital with tertiary neurosurgical service for consultation and management plan.
A preterm male infant who had an umbilical venous catheter (UVC) in situ for infusion of total parenteral nutrition (TPN) subsequently developed abdominal distension. He was initially diagnosed to have necrotising enterocolitis. However, a diagnostic abdominal paracentesis yielded fluid which biochemical analysis found to be consistent with TPN. TPN is often infused through a UVC, in the first few days of life, for the nutritional support of a premature infant. Various complications have been reported to be associated with this path of delivery, one of which will be illustrated in this case report.
MeSH terms: Ascites/etiology*; Catheters, Indwelling/adverse effects*; Extravasation of Diagnostic and Therapeutic Materials/complications; Extravasation of Diagnostic and Therapeutic Materials/etiology*; Humans; Infant, Newborn; Infant, Premature; Male; Parenteral Nutrition, Total/adverse effects*; Umbilical Veins; Paracentesis; Medical Errors
Non-tuberculous mycobacterial infection (NMI) occurs in elderly women with no pre-existing lung disease, and this has been termed the Lady Windermere syndrome. NMIs are increasing in prevalence and an increasing number of pulmonary mycobacterial infections is due to non-tuberculous mycobacteria. The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist. We report NMI in a 64-year-old woman, based on clinical and radiological findings. Although termed the Lady Windermere syndrome, the name does not correspond to the character in Oscar Wilde's play; hence the eponym is not widely used.
Clozapine is an atypical antipsychotic with superior efficacy in the treatment of refractory schizophrenia. But it can cause agranulocytosis, which occurs in one to two percent of patients. This paper was prepared to discuss the condoned and controversial issues of therapy with this drug, but only within a haematological context. The feasibility of attempting therapeutically controversial blood monitoring regimes, as opposed to following standardised Western guidelines, given the differences in terms of accessibility, convenience and financial considerations between the public and private sector medical care will also be discussed. The proposal of adopting a structured pro forma, with a risk-benefit assessment, in the event of unavoidable veering from the guidelines may allay medicolegal implications, especially in countries where blood monitoring is not mandatory. It is hoped that this article will stimulate further research in our region, bearing in mind the increasing awareness and focus on genetic polymorphism, and the possibility of drawing up our own monitoring guidelines in the near future.
MeSH terms: Agranulocytosis/chemically induced*; Agranulocytosis/diagnosis; Clozapine/adverse effects*; Developing Countries; Humans; Patient Education as Topic; Schizophrenia/drug therapy; Antipsychotic Agents/adverse effects*; Liability, Legal; Drug Monitoring/methods*; Practice Guidelines as Topic
INTRODUCTION: This study was designed to evaluate the histopathological features of skin microvasculature in patients with a diabetic foot, specifically the number of blood vessels, number of endothelial cells and endothelial thickness.
METHODS: This study involved 41 diabetic foot patients admitted to Hospital Universiti Sains Malaysia for surgical management of foot problems. Skin biopsies were taken for histological evaluation following surgical procedures, such as wound debridement or local foot amputation. The skin microvasculature features examined were the number of blood vessels, the endothelial thickness of the vessels and the cross-sectional endothelial cell count. The findings were compared with the similar parameters of non-diabetic patients (control) and analysed.
RESULTS: The mean blood vessel count (BVC), endothelial cell thickness (ECT) and endothelial cell count (ECC) for the diabetic group were 12.56 +/- 2.77, 4.81 +/- 1.5 micrometres and 7.07 +/- 1.88, respectively. The mean BVC, ECT and ECC for the non-diabetic control group were 5.25 +/- 1.98, 1.9 +/- 0.55 micrometres and 4.11 +/- 1.17, respectively. The mean BVC, ECT and ECC for the diabetic group were significantly higher than those for the non-diabetic control group.
CONCLUSION: The increased number of blood vessels to the skin and their endothelial cell number and thickness may be the contributing factors for problems related to the diabetic foot, such as tendency for skin ulceration, infection and poor wound-healing in these patients. These may also contribute to secondary changes of diabetic foot lesions, indicating failure of adequate vascularisation of the foot.
Oxidative stress can occur in sepsis and infection, when overproduction of free radicals is not countered by the host antioxidant system, leading to impairment of host cellular functions. Various disease states are accompanied by the accumulation of 15-F2t-IsoP in biological fluids. These isoprostanes are considered as markers of oxidative stress, and inflammation and inflammatory mediators.
This prospective observational study was conducted to determine the outcome of newborns with congenital diaphragmatic hernia (CDH). They were managed with a protocol of gentle ventilation to avoid barotraumas, and inhaled nitric oxide (iNO) or intravenous magnesium sulphate for treatment of persistent pulmonary hypertension of newborns (PPHN).
In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.