Making a medical diagnosis in an elderly person presenting with first time psychiatric symptoms can be challenging.
A 61 year old lady presented with 4 years history of tactile hallucinations in her legs and delusions of persecution,
and 2 weeks history of depression and mild cognitive impairment. There were no other significant physical findings,
except for dysarthria and fine bilateral hand tremors. As patient had no prior psychiatric history, she was investigated
for differential diagnoses of late-onset schizophrenia, psychotic depression and early dementia. A thorough
investigation for concomitant medical illnesses was done which revealed low serum calcium, high serum phosphate
and relatively low serum parathyroid hormone levels. A diagnosis of Fahr’s syndrome (FS) was made based on
history, hematological findings of idiopathic hypoparathyroidism and bilateral basal ganglia calcifications (BGC)
on neuroimaging. Treatment of FS is non-specific and mainly symptomatic. This patient improved with treatment
comprising antidepressant, antipsychotic and calcium supplement.
Introduction: Group B Streptococcus (GBS), infection and recurrence in newborns and pregnant women can lead to
chronic medical illness resulting in significant morbidity, and mortality. Pathogenesis of GBS may be due to reasons
such as activation of the immune system, followed by the production of inflammatory markers and toxic components
by immune cells including macrophages. Methods: The studies on invasive and colonizing GBS strains inoculated
either with peripheral or brain macrophages, the expression of nitric oxide (NO), cell viability, and CD40 were
also measured by Griess assay, methyl tetrazolium assay (MTT), and flow cytometry, respectively. Furthermore, the
clinical manifestations of the selected patients were also assessed for this study. Results: Outcome of inflammatory
markers studies, after GBS inoculation indicated that, invasive GBS strains induced higher inflammatory markers
in comparison to colonizing GBS strains. Furthermore, patients’ clinical data showed that patients with invasive
GBS infections had severe condition unlike among patients with colonizing GBS strains. The fatality rate in patients
with invasive GBS strain were 30.8% while there was no death among carriers. Conclusion: This study, aimed to
understand the immune response to GBS, and strengthen the knowledge on GBS pathogenesis. It was concluded
that invasive GBS strains not only showed higher expression of inflammatory markers on immune cells but also had
higher pathogenesis effect in comparison to colonizing GBS strains.
Introduction: Water pipe use is becoming increasingly common among Iranian adolescents. This study examined the prevalence and predictors of water pipe use among public high schoolchildren aged 14-17 in Iran.
Methods: A cross-sectional study was conducted among 1st, 2nd and 3rd grade public high schoolchildren in Sanadaj City, capital of Kurdistan province of Iran during the academic year 2012-2013. Cluster sampling was used to select a sample from 8 public high schools. The data were collected using validated self-administrated questionnaire that included questions on water pipe use, socio-demographic characteristics, smoking-related knowledge, attitude toward smoking, normative believes regards perceived prevalence water pipe use among peer and adults, perception of harm, self-esteem and refusal skill. A multivariate logistic regression analysis was performed to assess predictors of water pipe use.
Results: A total of 1837 students participated in this study. Students’ ages ranged from 14 to 17 years (mean age±15.09; SD±0.82 years). The overall prevalence of ever water pipe use was 36.2% (43.1% in male and 29.2% in female, (p<0.001). Age, gender, living arrangement, pocket money, academic grade, parental history of smoking, attitude, and normative believes regards perceived prevalence water pipe use among peer and adults were predictors of water pipe use among study participants.
Conclusions: The overall prevalence of water pipe is high among high school children in Sanandaj. Age, gender, pocket money, academic grade, parents smoking, attitude toward smoking and normative believes were identified as the most important predictors increasing the risk of water pipe use in the studied students.
Keywords: Water pipe use, Prevalence, Predictors of Water Pipe, High school children
Introduction: Adolescence is a crucial period with impressive emotional changes. Emotional disorders such as
depression, anxiety and stress are high among adolescents worldwide; however the psychosocial changes are often
neglected. The aim of the current study was to determine the depression, anxiety and stress symptoms and their
associated factors among adolescents. Methods: A cross-sectional study using cluster sampling was carried out
among school-going adolescents in 10 secondary schools in Pasir Gudang, Johor, Malaysia. Respondents answered
a self-administered questionnaire including socio-demographic, Inventory of Parent and Peer Attachment (IPPA),
Depression Anxiety Stress Scale-21 (DASS-21) and Strength and Difficulties Questionnaire (SDQ). Using SPSS-21,
chi-square test and binomial logistic regression were conducted to examine the associations between dependent and
independent variables. Results: Respondents (52.6% female and 53.9% Malay) had 46.0% prevalence of depression
symptoms, 59.1% anxiety, 38.1% stress and 45.6% psychosocial status (internalizing and externalizing problems).
Age, father occupation and parental bonding were significantly predicted having moderate to extremely severe
depression symptom (p
A nanocomposite consisting of a few layers of graphene (FLG) and tin dioxide (SnO2) was prepared by ultrasound-assisted synthesis. The uniform SnO2 nanoparticles (NPs) on the FLG were characterized by X-ray diffraction in terms of lattice and phase structure. The functional groups present in the composite were analyzed by FTIR. Electron microscopy (HR-TEM and FE-SEM) was used to study the morphology. The effect of the fraction of FLG present in the nanocomposite was investigated. Sensitivity, selectivity and reproducibility towards resistive sensing of liquid propane gas (LPG) was characterized by the I-V method. The sensor with 1% of FLG on SnO2 operated at a typical voltage of 1 V performs best in giving a rapid and sensitive response even at 27 °C. This proves that the operating temperature of such sensors can be drastically decreased which is in contrast to conventional metal oxide LPG sensors. Graphical abstract Schematic of a room temperature gas sensor for liquefied petroleum gas (LPG). It is based on the use of a few-layered graphene (1 wt%)/SnO2 nanocomposite that was deposited on an interdigitated electrode (IDEs). A sensing mechanism for LPG detection has been established.
Introduction: Worm infection is one of the major global public health problems especially among rural communities.
Objectives: to determine the prevalence of intestinal worm infection and factors associated among Semai Aboriginal
children aged between 6 to 13 years in Tapah, Malaysia. Methods: A cross-sectional study design was used in this
study. The estimated sample size was 508. Data was collected using a validated pretested questionnaire. Faecal
samples were also examined. Data was analysed using SPSS version 22. Results: The response rate was 80.9%.
The overall mean age of the 411 respondents was 10.1 years(95% CI = 9.89, 10.22). Majority (71.5%) were poor.
Prevalence of intestinal worm infections was 60.8% and 57.2% had multiple infections. The multiple logistic
regression analysis showed that those with poor hygiene practices were 2.18 times the odds of worm infection
when compared with children with good hygiene practices (95% CI = 1.4, 3.4). Similarly, poor attitudes towards
prevention of worm infection increased the odds of having worm infection by 1.62 times among Orang Asli children.
Children living without toilets had 2.45 times higher odds as compared with those who had proper toilets. Absence
of river near by these areas where there is no safe water supply also increases the risk of worm infection among
children by 1.84 times among Orang Asli children. Conclusions: the prevalence of worm infection is still very
high among rural Aboriginal community. Current control measures should be reassessed to enable introduction of
effective measures to reduce the worm infection among Orang Asli children.
MeSH terms: Attitude; Child; Cross-Sectional Studies; Helminthiasis; Humans; Hygiene; Intestinal Diseases, Parasitic; Malaysia; Public Health; Surveys and Questionnaires; Regression Analysis; Rural Population; Water Supply; Prevalence; Sample Size; Rivers
Introduction: Home visits are complex processes for clients and occupational therapists. Despite the benefits of home
visits, the numbers of home visits being conducted are decreasing in international settings due to service constraints
or client reluctance. Published international studies may not be applicable to Malaysia due to cultural and geodemographic
differences relating to the home context. This study aimed to explore the experience of occupational
therapists in Malaysia in conducting home visits. Materials and Methods: A focus group discussion was conducted
with seven occupational therapists in one teaching hospital in Kuala Lumpur. The group session was audio-recorded,
transcribed, summarised and analysed using thematic analysis. Results: Themes developed were: i) client factors
inhibiting effective service provision, ii) uninformed policies and guidelines, and iii) professional identity and
growth. Conclusions: Our study has revealed major challenges for Malaysian occupational therapists with regards
to conducting home visits. Future studies should now evaluate factors underlying reluctance to participate in home
visits and effective strategies to overcome these difficulties.
MeSH terms: Allied Health Personnel; Biological Phenomena; Fibrinogen; Hospitals, Teaching; House Calls; Humans; Malaysia; Focus Groups; Occupational Therapists
Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of nonsmall
cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT
scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern
of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR)
inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR
inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned
from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for
all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized
into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic
disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median
survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial
metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response
(CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of
patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic
treatment response of NSCLC towards EGFR inhibitor treatment.
Neurodegeneration resulting from pathogen invasion or tissue damage has been associated with
activation of microglia, and exacerbated by the release of neurotoxic mediators such as pro-inflammatory cytokines,
chemokines and reactive oxygen species. Activation of microglia stimulated by lipopolysaccharide is mediated in
part by GSK-3 signaling molecule. Induced IL-10 expression via GSK-3 inhibition is noteworthy since IL-10 has been
remarkably shown to suppress inflammation. Objectives: We aimed to inactivate microglia through inhibition of
GSK-3 signaling and to determine its effects on the production of pro- and anti-inflammatory mediators. Methods:
LPS-stimulated BV-2 cells were treated with a GSK-3 inhibitor (LiCl, NP12, SB216763 or CHIR99021). Inhibition
of GSK-3 was determined by the phosphorylation status of GSK-3β. The effects of GSK-3 inhibition on microglial
inflammatory response were investigated by examining various mediators and CD200R marker. Production of nitric
oxide (NO), glutamate and pro- and anti-inflammatory cytokines were measured using flow cytometry, Griess assay,
glutamate assay and Cytometric Bead Array (CBA) respectively. Results: GSK-3β signaling in LPS-stimulated microglia
was blocked by GSK-3 inhibitor through increased phosphorylation at Serine 9 residue. GSK-3 inhibitors had also
led to reducing in microglia activity via increased expression of CD200R. Inhibition of GSK-3 also diminished
inflammatory mediators such as nitric oxide (NO), glutamate, pro-inflammatory cytokines (TNF-α and IL-6) and
chemokine, MCP-1. Reduction of pro-inflammatory mediators by GSK-3 inhibitor was coincided with increased
IL-10 production. Conclusions: Suppression of microglia-mediated inflammatory response was facilitated by GSK-3
inhibition with associated increased in IL-10 production.
Rifapentine is an anti-tuberculosis (anti-TB) drug with a prolonged half-life, but oral delivery results in low concentrations in the lungs because of its high binding (98%) to plasma proteins. We have shown that inhalation of crystalline rifapentine overcomes the limitations of oral delivery by significantly enhancing and prolonging the drug concentration in the lungs. The delivery of crystalline particles to the lungs may promote inflammation. This in vivo study characterizes the inflammatory response caused by pulmonary deposition of the rifapentine particles. The rifapentine powder was delivered to BALB/c mice by intratracheal insufflation at a dose of 20 mg/kg. The inflammatory response in the lungs and bronchoalveolar lavage (BAL) was examined at 12 h, 24 h, and 7 days post-treatment by flow cytometry and histopathology. At 12 and 24 h post-treatment, there was a significant influx of neutrophils into the lungs, and this returned to normal by day 7. A significant recruitment of macrophages occurred in the BAL at 24 h. Consistent with these findings, histopathological analysis demonstrated pulmonary vascular congestion and significant macrophage recruitment at 12 and 24 h post-treatment. In conclusion, the pulmonary delivery of crystalline rifapentine caused a transient neutrophil-associated inflammatory response in the lungs that resolved over 7 days. This observation may limit pulmonary delivery of rifapentine to once a week at a dose of 20 mg/kg or less. The effectiveness of weekly dosing with inhalable rifapentine will be assessed in murine Mycobacterium tuberculosis infection.
We report a case of 28-year-old Malay woman who initially presented with multiple joints pain with underlying poorly controlled asthma since her childhood. She was treated as seronegative arthritis. However, the involvement of joints, asthma and high-eosinophil counts raised suspicion of Churg-Strauss syndrome. This disease is undoubtedly rare in Malaysians or even in Asian populations. After appropriate therapy was delivered for the correct diagnosis her clinical condition improved. She is currently receiving maintenance treatment.
In this paper, the wear properties of nano-filled Glass Fibre Reinforced Polymer (GFRP) composite are
studied based on the effects of the architecture of the glass fibre and test environment. Wear tests were
done under two different conditions; dry environment test and wet environment test. The dry and wet
environment tests were conducted using the abrasion resistance tester (TR600) and slurry erosion tester,
respectively; the slurry mixture of sand and water were used in the wet environment test. Two types of
glass fibres architecture were understudied; unidirectional and woven. It was found that 3 wt.% filler
content is the optimum amount to be used for the GFRP composite. Unidirectional nano-filled GFRP
composites exhibited the lowest wear rates due to their closely aligned glass fibre arrangement. The
unidirectional fibre alignment provided less empty spots for the interlocking process to take place, thus
reducing the ploughing action of wearing. However, when tested in the wet environment, effects of
other testing parameters such as the architecture of fibre and filler contents became less significant. The
composites, which were tested in wet environment, showed the lowest wear rates compared to the ones
tested in the dry environment. This is due to the presence of water that helps to wash away the pulverised
glass fibre, thus reducing the friction and the three-body wear effect
This paper presents a study on node impersonation attack in Wireless Sensor Networks (WSN)
environment. Node cloning is a major attack among sensor where the leak of node identity is easy to clone
if it is not secured. For this purpose, an analysis that explores techniques to prevent node cloning attack
was done using a unique node identity. An algorithm to generate the unique identity was developed on
high performance ARM hardware and programmed the data authentication together with sensor nodes.
Communication among the sensor nodes and base station depends on a successful authentication using the
unique identity (UID). The sensor nodes are resistant against node cloning attack when the UID identity
is unequal. Results present successful generation of the UID, while execution time between two nodes
is faster and low power consumption is used on the technique. The analysis has proven that the unique
UID is secured by the developed node identity algorithms and against cloning attack. This outcome is
significant for new development of secured WSN sensor hardware, which can be implemented in new
network technology.
In dentistry, determining position and orientation parameters for each tooth mostly based on orthodontic
qualitative perception. There is no quantitative method to obtain those parameters in three dimensional
(3D) images, especially in some complicated cases. This study proposed a quantitative approach for
locating centroid of tooth position and also its frame axes orientation. Based on Cone Beam Computed
Tomography (CBCT) x-ray images, a 3D model of teeth was obtained to visualise dental features. A
few dental features were used to calibrate the location of centroid and identify tooth reference axes, or
frames. Two definitions of centroid and frame axes were proposed for single root and for multiple roots
of teeth. Based on these two definitions, the positions and orientations of each tooth were determined
and evaluated. Teeth positions and orientations were obtai
This study was carried out to investigate effects of acoustic and thermofluid performance of a RanqueHilsch
Vortex Tube (RHVT) with different numbers of swirl generator nozzles. The number of nozzle
used in the experiment was 1, 2, 3, 4, 5 and 6 nozzle(s), respectively. Sound signal produced by the device
was recorded using two microphones located at hot side and cold side of the tube. The sound signal
was transformed using Fast-Fourier Transform (FFT) to obtain the frequency representation. Then, the
frequencies produced were related to its themofluid performance of each configuration.
Implementation of Trivial File Transfer Protocol (TFTP) in embedded system is significant because of the
speed and simplicity. However, no security service in TFTP marks its major limitations. In this work, a
pre-shared Diffie Hellman Key Exchange (DHKE) technique was proposed for mutual authentication to
achieve the same secret key in TFTP communication protocol. We also integrated the system with feasible
compression and encryption process to significantly improve the TFTP communication performance.
The DHKE proof of concept is discussed briefly to show the feasibility of the pre-shared technique
on the protocol. Also, the experiment was performed on constrained embedded devices to analyse the
performance of compression/encryption scheme in TFTP. From the results obtained, the combined
encryption and compression process is able to reduce the time by about 30% compared to the original
file transmission time. Thus, the proposed work presents both advantages to reduce file size and provide
security for the data. This is a preliminary work to provide a secure T
Self-similarity network traffic is considered as one of stochastic process studies in telecommunications
engineering. In determining self-similarity traffic, Hurst value is an important parameter to be measured.
This paper presents self-similarity traffic measurement using Rescaled Range, R/S statistical method in
estimating Hurst parameter value. Inbound internet traffics on an IP-based campus network in Malaysia,
which implements a 16.0 Mbps speed to internet and supports 10GE bandwidth at switch level, are
captured and measured. The objectives of this research are to observe and present the existence level of
Hurst parameter value, type of self-similarity and overall percentage of Hurts parameter estimation. The
inbound traffic is measured due to its relevancy to next development on policing and shaping algorithm
traffic model. Solarwinds Net Flow machine is setup on a campus gateway to its Wide Area Network
(WAN). Data of the traffic like in flow, size and speed were taken over 20 days and 14 weeks in different
inter-arrival time. These traffics are analysed, which lead to the impacts of packet loss, throughput and
speed in network performance. Results present the Hurst parameter value, the existence of Long Range
Dependant Self-similarity traffic distribution and percentage level of Hurst parameter value for the three
types of captured traffic
Pedestrian level in the urban area is an important area where most of pedestrians’ activities occur at this
level. Therefore, the purpose of this study is to investigate effects of various building layouts on mean
wind speed ratio at the pedestrian level. The mean wind speed ratio at the pedestrian level was analysed
in order to determine whether the building layouts configured within this research are able to enhance
outdoor ventilation and ensure good pedestrian comfort level. The simulation model consists of two main
areas which are the upstream area and downstream area with a setback distance, d. The building layouts
at upstream area are arranged in staggered arrangements (ST) or square arrangements (SQ), while the
downstream areas are in a fixed staggered arrangement (ST). Packing density in both areas is 25% with
three setback distances which are 3H, 5H and 7H. Based on the results, the mean wind speed ratio at the
pedestrian level in a downstream area with longer setback distance will provide a higher mean speed ratio,
and the influence of upstream building arrangements on the mean wind speed ratio of the downstream
area decreases as the setback distance increases. Hence, the mean wind speed ratio of downstream area
depends on the setback distance between the upstream and downstream areas.
Palm Oil Fuel Ash (POFA) is a biomass produced from palm oil industries. POFA is known to contain
a high amount of silica and has been proven by XRF spectroscopy, in which the silicon dioxide content
is 72.63%. In this study, silica was synthesised from POFA. To extract the silica, POFA was fused
with alkaline agent (Na2CO3) before mixing with Cethyltrimetyl Ammonium Bromide (CTAB) and
Sulphuric Acid (H2SO4). Sodium silicate solution from the fusion was used as silica precursor replacing
conventionally used silica source, Tetraethoxilane (TEOS). XRD pattern showed that raw POFA
dominantly consists of silica. Meanwhile, FTIR analysis of the synthesised silica exhibited spectra
bands at 3393 cm-1, 1635 cm-1, 1028 cm-1 and 787 cm-1 that corresponded to the functional groups of
Si-O and O-H. Thus, it could be concluded that silica was successfully extracted from POFA by the
alkaline fusion method.
Inhibition of cytochrome P450 (P450) enzymes (CYP) has been shown to lower the metabolism of drugs that are P450 substrates and to consequently alter their pharmacokinetic profiles. Curcumin (CUR), piperine (PIP), and capsaicin (CAP) are spice components (SC) that inhibit the activities of a range of P450 enzymes, but the selection of which SC to be prioritized for further development as an adjuvant will depend on the ranking order of the inhibitory potential of the SCs on specific P450 isozymes. We used common human recombinant enzyme platforms to provide a comparative evaluation of the inhibitory activities of CUR, PIP, and CAP on the principal drug-metabolizing P450 enzymes. SC-mediated inhibition of CYP3A4 was found to rank in the order of CAP (IC50 1.84 ± 0.71 µM) ∼ PIP (2.12 ± 0.45 µM) > CUR (11.93 ± 3.49 µM), while CYP2C9 inhibition was in the order of CAP (11.95 ± 4.24 µM) ∼ CUR (14.58 ± 4.57 µM) > PIP (89.62 ± 9.17 µM). CAP and PIP were significantly more potent inhibitors of CYP1A2 (IC50 2.14 ± 0.22 µM and 14.19 ± 4.15 µM, respectively) than CUR (IC50 > 100 µM), while all three SCs exhibited weak activity toward CYP2D6 (IC50 95.42 ± 12.09 µM for CUR, 99.99 ± 5.88 µM for CAP, and 110.40 ± 3.23 µM for PIP). Of the three SCs, CAP thus has the strongest potential for further development into an inhibitor of multiple CYPs for use in the clinic. Data from this study are also useful for managing potential drug-SC interactions.