The low conductivity of separation electrolytes employed in nonaqueous capillary electrophoresis (NACE) limits the use of on-line sample concentration or stacking by field enhancement. Herein, micelle-to-solvent stacking (MSS) was performed by the simple injection of a micellar solution plug prior to electrokinetic injection of sample prepared under field-enhanced stacking conditions (known as field-enhanced sample injection, FESI). The proposed approach allowed a 214-625-fold improvement in peak signals for targeted anticancer drugs (e.g., tamoxifen) and its major metabolites in NACE using 100% methanol-based separation electrolyte that comprised of 7.5mM deoxycholic acid sodium salt, 15mM acetic acid and 1mM 18-crown-6. These improvements yielded tamoxifen and its metabolites with 2-5 times better stacking efficiency as compared to those obtained without micellar solution injection or FESI only. This is comparable to the results typically achieved when FESI is combined with isotachophoresis (electrokinetic supercharging). The FESI-MSS-NACE was tested for the measuring levels of target drugs in plasma. The analytical figures of merit are also reported.
A new sample preparation method, ion-pair vortex assisted liquid-liquid microextraction (VALLME-BE), for the determination of a highly polar anti-diabetic drug (metformin) in plasma sample was developed. The VALLME-BE was performed by diluting the plasma in borate buffer and extracted to 150µL 1-octanol containing 0.2M di-(2-ethylhexyl)phosphoric acid as intermediate phase. The drug was next back-extracted into 20µL of 0.075M HCl solution. The effects of pH, ion-pair concentration, type of organic solvent, volume of extraction phases, ionic strength, vortexing and centrifugation times on the extraction efficiency were investigated. The optimum conditions were at pH 9.3, 60s vortexing and 2min centrifugation. The microextract, contained metformin and buformin (internal standard), was directly injected into a HPLC unit using C1 column (250mm×4.6mm×10µm) and detected at 235nm. The method was validated and calibration curve was linear with r2>0.99 over the range of 20-2000µgL-1. The limits of detection and quantitation were 1.4 and 4.1µgL-1, respectively. The accuracy was within 94.8-108% of the nominal concentration. The relative standard deviation for inter- and intra-day precision was less than 10.8%. The method was conveniently applied for the determination of metformin in plasma samples.
Thermally assisted hydrolysis and methylation-gas chromatography (THM-GC) in the presence of an organic alkali was validated for the compositional analysis of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) [P(3HB-co-3HHx)] accumulated in whole bacterial cells. Recombinant Cupriavidus necator Re2058/pCB113 was grown in a batch fermentation with different concentration of palm oil and fructose in order to control the molar fraction of 3HHx in P(3HB-co-3HHx) produced in the cells. Trace amounts (30μg) of freeze-dried cells were directly subjected to THM-GC in the presence of tetramethylammonium hydroxide (TMAH) at 400°C. The obtained chromatograms clearly showed nine characteristic peaks, attributed to the THM products from 3HB and 3HHx units in the polymer chains, without any appreciable interference by the bacterial matrix components. Based on these peak intensities, the copolymer compositions were determined rapidly without using any cumbersome and lengthy sample pretreatment as in conventional GC method. Moreover, the compositions thus obtained were strongly correlated with those by NMR and conventional GC involving solvent extraction.
INTRODUCTION: Children who develop any hypersensitivity reaction to eggs are routinely referred to hospital for Measles-Mumps-Rubella (MMR) vaccination as inpatients to prevent anaphylaxis. We aimed to study the association between hypersensitivity reactions after egg exposure and similar reactions after MMR immunisation; and examine the necessity of hospital admission for vaccination.
METHODS: A prospective observational study was conducted in Paediatric Department in Bukit Mertajam Hospital, Penang, between March and December 2014. Children referred from local polyclinics for inpatient MMR vaccination because of a history of egg allergy were recruited. The children were observed in the ward for post vaccination allergic reactions. Concurrently, a group of children without egg allergy was recruited from those admitted for other illnesses but had recent MMR vaccination at polyclinics. Parents of these children were interviewed and asked if they had observed any reactions post vaccination. In both groups, sociodemographics, medical history and family history of atopy were collected.
RESULTS: Eighty-seven subjects were recruited in this study. Fifty-four infants with egg allergy had previous mild allergic reactions after exposure to eggs or egg-related products. They were associated with a family history of egg hypersensitivity, personal history of acute gastroenteritis and upper respiratory tract infections. Two of them developed cutaneous rashes post vaccination during observation, but none developed anaphylactic or anaphylactoid reactions. Two infants among those without egg allergy had post vaccination fever. There was no association between egg allergy and hypersensitivity reactions to MMR vaccine (p=0.632).
CONCLUSIONS: MMR vaccine can be safely administered to children with mild egg allergy, hence admission for vaccination in the hospital is not warranted. Risk stratification is required to ensure only infants with severe reactions will be admitted for vaccination.
Jellyfish stings are the most frequently reported marine animal envenomation worldwide. However, data on jellyfish sting from Malaysia remains obscure due to inadequate research.
MeSH terms: Adult; Aged; Bites and Stings*; Child; Cnidaria; Cross-Sectional Studies; Female; Hospitals, District; Humans; Male
Induction of anaesthesia with propofol is often associated with a significant decrease in arterial pressure, especially in the older population. The aim of this study is to determine the efficacy of phenylephrine in two different doses i.e. 100mcg and 200mcg, given during induction to counteract the anticipated hypotensive effect of propofol in older patients aged over 55 years.
Open disclosure is poorly understood in Malaysia but is an ethical and professional responsibility. The objectives of this study were to determine: (1) the perception of parents regarding the severity of medical error in relation to medication use or diagnosis; (2) the preference of parents for information following the medical error and its relation to severity; and (3) the preference of parents with regards to disciplinary action, reporting, and legal action.
MeSH terms: Child; Cross-Sectional Studies; Humans; Malaysia; Parents; Truth Disclosure*
To evaluate the performance of contrastenhanced ultrasound (CEUS) in the risk stratification of indeterminate renal lesions picked up incidentally on abdominal imaging, in patients with renal impairment.
Accessory muscles are relatively rare anatomic duplications of muscles that may appear anywhere in the muscular system. Though a wide array of accessory and supernumery muscles involving the ankle have been described in the literature, this is the first reported case we are aware of that features two accessory muscles. Accessory muscles are typically asymptomatic and often picked up as incidental findings but are important to be identified in the presence of chronic persistent ankle pain and the absence of other more common aetiologies.
MeSH terms: Case Reports; China/ethnology; Humans; Muscles/abnormalities; Singapore; Young Adult
This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.
Meckel's diverticulitis or Meckel's associated pathology frequently presents in childhood with gastrointestinal bleeding. It is rarely seen in adults. It is a congenital abnormality that commonly goes undetected. We present a case of a perforated Meckel's diverticulum due to fishbone ingestion in an elderly gentleman. The aim of this case report is to highlight the rare presentation of a perforation in a Meckel's diverticulum due to an extrinsic pathology and to outline diagnostic and management options in cases of Meckel's diverticulum.
Differences in systolic blood pressure reading between arms are common but could signal trouble if the discrepancy is significant. Early detection of aortic dissection could invariably determine patient's survivability. Hence, a high index of suspicion with prompt diagnostic imaging is vital for accurate diagnosis.
MeSH terms: Adult; Aortic Aneurysm*; Case Reports; Female; Hospitals, General; Humans; Malaysia
Pulmonary toxicity is a rare complication of Rituximab therapy. Although Rituximab is relatively safe and can be administered in an outpatient setting, Rituximab-associated lung disease has been reported and may cause mortality despite early detection. Typically the pulmonary toxicity occurs at around the fourth cycle of Rituximab. High index of suspicion is crucial and other concurrent pathology such as infective causes should be excluded. Radiological imaging and histological confirmation should be obtained and early treatment with corticosteroid should be initiated. Patients should receive counselling regarding respiratory symptoms and possible pulmonary toxicity.
MeSH terms: Rituximab*; Case Reports; Hospitals, University; Humans; Lung Diseases; Lymphoma; Malaysia; Male; Drug-Related Side Effects and Adverse Reactions
Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
Aluminium phosphide (ALP) is highly toxic and poisoning can result in high mortality rates. A 26-year-old female who allegedly ingested a toxic dose of ALP presented with vomiting and diarrhoea. She developed cardiac arrest with refractory pulseless ventricular tachycardia. Despite aggressive resuscitation, she succumbed to death seven hours following ingestion. In cases like this, a better outcome can be achieved with early arrival, prompt diagnosis, aggressive resuscitation and intensive monitoring.
Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.
Coronary artery anomalies are often discovered incidentally during cardiac catheterization or computed tomography coronary angiography and may involve the affected coronary artery origin and its course. Coronary artery anomalies are associated with congenital heart disease. The affected coronary arteries may have an unusual high take off origin, origin from contralateral or non-coronary sinus, origin from the pulmonary artery, single coronary system or coronary artery fistula.
MeSH terms: Aged; Case Reports; Coronary Vessel Anomalies*; Female; Humans; Malaysia
Blunt trauma to the right proximal subclavian artery is uncommon and tends to be associated with pseudoaneurysm formation. We report a patient with right proximal subclavian artery pseudoaneurysm after blunt chest trauma following a motor vehicle accident. The condition was successfully treated with a combined insertion of a covered stent and carotid-carotid bypass as a hybrid procedure. Duplex scans at 6 month and 1 year follow-up documented good stent-graft positioning and no pseudoaneurysm recurrence.