Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4 weekly for 3 months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P
Burn injuries are one of the most devastating injuries in the world. A uniform burn wound is essential for burn research. The objective of this study was to describe a new model for inducing deep partial-thickness burns in rats. Burn wounds were performed on the dorsal part of Sprague-Dawley rats using a constructed heating device in our laboratory. Digital images of each animal were captured every day for macroscopic evaluation and for assessment of the wound contraction rate. Six animals were sacrificed on days 1, 3, 7, 11, 14, and 21 after onset of burn and their skin tissues were harvested for histological analysis. Uniform deep partial-thickness burns could be achieved in Sprague-Dawley rats under the condition of a contact temperature of 70°C, with the weight of heating devices of 300 g, and a duration of 10 s. Macroscopic evaluation recorded the general appearance of the deep partial-thickness burns. Evaluation of the wound contraction rate showed that the deep partial-thickness wound area was reduced by 90.39% of the original wound area by day 21 after burn. Microscopic evaluation by hematoxylin-eosin staining revealed the histological changes during the wound healing process. This is a standardized and reproducible model for inducing deep partial-thickness burns in Sprague-Dawley rats.
Introduction: The aim of this study was to determine the effects of pedometer-based intervention and the relationship between daily walking steps and nutritional status among overweight/obese university students in Kuala Terengganu. Materials and methods: The study was an 8-week intervention study that included 23 overweight/obese university students. After 7 days of baseline activity, anthropometric data such as weight, height and waist circumference and a one-day dietary record were taken. The participants were divided into a control and case group. The control group (n=15) was instructed to continue with their normal activities and habits throughout the 8 weeks. The case group (n=8) was instructed to walk based on the targeted number of steps. Data such as body weight, waist circumference and a one-day dietary record were taken after the intervention. Results: Both case and control group show significant differences in body mass index (BMI) with p=0.017 and p=0.047 respectively. However, there is a large and significant difference between walking steps and BMI before and after intervention for the case group. There were no differences in any other study parameters during the 8-week study. Conclusion: In conclusion, short-term intervention with a pedometer increased physical activity and positively affected the BMI of overweight/obese participants. The use of a pedometer was efficient in measuring daily physical activity (r= 0.756, p< 0.05).
Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
Introduction: The aim of this study was to assess the overall diet quality of husbands and wives in a selected urban area in Selangor.
Methodology: This cross-sectional study was carried out in Bandar Baru Bangi, Selangor among 150 married couples aged 20 and above, who voluntarily agreed to participate and were not practicing any special diet. Data were collected using a 2-day 24-Hour Dietary Recall and a Food Frequency Questionnaire (FFQ) to evaluate the quality of diet among husbands and wives using the Diet Quality Index Revised (DQI-R).
Result: Majority of husbands and wives in this study were in the middle-age group, had received tertiary education, had household monthly income of more than RM3, 500 and encompass household size of 3 to 5 persons. The mean DQI-R score for husbands (mean age= 43.33 + 11.16 years) and wives (mean age= 41.28 + 10.93 years) were 67.8 + 9.1 and 64.4 + 9.3 respectively and there was a significant different in scores between the husbands and wives (p < 0.001). In general, the diet quality of this study population was not satisfactory and that the diet quality of husbands was better compared to their wives.
Conclusion: This study gives an insight picture of husbands and wives’ quality of diet. It can be used as a guideline to improve health intervention programs in the future.
Forest clearing for agriculture plantations and local community settlements may trigger food insecurity, which causes poor development, predominantly in Orang Asli children. This cross-sectional study was conducted to determine the relationships between food security and anthropometric and cognitive function among Orang Asli children in Temerloh, Pahang. Materials and methods:A total of one hundred and sixty-seven children (ages 7 to 11) from five selected Orang Asli villages (Kampung Sungai Enggang, Kampung Penderas, Kampung Pasu, Kampung Lubok Wong, and Kampung Pian) were involved in this study. The food security index was assessed using the Radimer/Cornell Hunger and Food Insecurity Instrument. Anthropometric indices were based on height-for-age and BMI-for-age Z-scores, while cognitive performance was tested using Raven’s Coloured Progressive Matrices (R-CPM). Results:A majority (91.6%) of the respondents reported some kind of food insecurity (12.6% household food insecure, 74.2% individual food insecure, and 4.8% child hunger). Rates of stunting, thinness, and overweight/obesity were 25.8%, 16.2%, and 18.0%, respectively. A majority (46.1%) of the children had average cognitive scores, followed by below average (38.3%) and above average (15.6%), respectively. Height-for-age was significantly associated with cognitive function (p=0.008). Among sociodemographic factors, household size (p=0.007) and household income (p
The importance of universal newborn hearing screening (UNHS) in identifying hearing-impaired infants as early as possible is already well recognized. Transient evoked otoacoustic emissions (TEOAE) have been established as a reliable method for UNHS in full term infants. This is a cross sectional study between April 2003--December 2005. Thirteen thousand five hundred and ninety eight (13,598) newborns were screened for hearing loss with portable otoacoustic emission (OAE) before discharge. The initial coverage rate during the 3 years study period was 85.9% (13,598) with 89.2% (3762), 79.0% (4480) and 90.3% (5356) for 2003, 2004 and 2005 respectively. The mean age when hearing loss was diagnosed using ABR were 3.56 months old, 3.08 months old, and 2.25 months old and 3.01 months old for 2003, 2004, 2005 respectively and it was statistically significant. The defaulter rate at the third stage during the 3 years study period was 35% (21), 15.2% (7) and 18.2% (2) for 2003, 2004 and 2005 respectively. This study showed significant improvement in initial referral rate, coverage rate and age of diagnosis. However, we need to improve on high defaulter rates.
A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication.
Cat scratch disease (CSD) is a benign condition caused by the inoculation of Bartonella henselae. The imaging findings are non-specific, and it is difficult to diagnose the disease via imaging. However, imaging studies help exclude other differential diagnoses in diagnostic dilemmas. We encountered a case of a 17-year-old adolescent who presented with painful neck swelling. CT showed multiple bilateral cervical lymphadenopathies with triangular soft tissue mass at the anterior mediastinum likely to be thymic hyperplasia, which is unusual in CSD and was mistaken for a lymphoproliferative disorder. Tissue diagnosis with a thorough clinical history yielded the diagnosis of cat scratch disease, and follow-up imaging showed resolution of the cervical lymphadenopathy and thymic hyperplasia.
To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.
The inherent toxicity, mutagenicity and carcinogenicity of dyes that are discharged into aquatic ecosystems, harming the health of humans and animals. ZIF-8 based composites are regarded as good adsorbents for the breakdown of dyes in order to remove or degrade them. In the course of this research, metal-organic framework materials known as ZIF-8 and its two stable composites, ZIF-8/BiCoO3 (MZBC) and ZIF-8/BiYO3 (MZBY), were produced via a hydrothermal process and solvothermal process, respectively, for the dangerous Congo red (CR) dye removal from the solution in water using adsorption method. According to the findings, the most significant amount of CR dye that could be adsorbed is onto MZBC, followed by MZBY and ZIF-8. The pseudo-second-order kinetic model was used effectively to match the data for adsorption behavior and was confirmed using the Langmuir isotherm equation. There is a possibility that the pH and amount of adsorbent might influence the adsorption behavior of the adsorbents. According to the experiment results, the technique featured an endothermic adsorption reaction that spontaneously occurred. The higher adsorption capability of MZBC is because of the large surface area. This results in strong interactions between the functional groups on the surface of MZBC and CR dye molecules. In addition to the electrostatic connection between functional group Zn-O-H on the surface of ZIF-8 in MZBC and the -NH2 or SO3 functional group areas in CR molecules, it also includes the strong π-π interaction of biphenyl rings.
The main objective of this study was to determine the motives underlying the selection of foods between husbands and wives in an urban community. Thiscross-sectional study was carried out in Bandar Baru Bangi, Selangor, Malaysia among 150 married couples aged 20 and above, who voluntarily agreed to participate and were not on any special diet. Data were collected using the Food Choice Questionnaire (FCQ) which measured the health-related and non health related factor that influence people's food choices. It consisted of 36 items designed to assess the reported importance of nine factors: health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern. In this study, the FCQ was adapted and a new factor, religion (religious guidelines), was included. Demographic characteristics including age, occupation, education, household income and household size were also collected. Data were analysed using SPSS version 16. Results showed that 40.7% of husbands (mean age= 43.33 + 11.16 years) and 55.3% of wives (mean age= 41.28 + 10.93 years) perceived themselves as the main food shopper while 12.0% of the husbands and 85.3% of the wives perceived themselves as the main meal planner. Husbands rated religion as the most prominent factor in food choice motives with a mean average rating of 4.56 + 0.59 on a 5-point rating scale, followed by health and convenience factor. Meanwhile, the wives rated health as the most essential factor with mean average rating of 4.49 + 0.58, followed by religion and convenience factor. Sensory appeal, ethical concerns and familiarity were rated as the bottom three factors of food choice motives among these two groups. Price of foods was not considered as an important factor in making food choices for the subjects in this study. In conclusion, the husbands and wives of this urban community rated religion, health and convenience as the three most important food choice motives in food selection.
This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma.
Congenital cholesteatoma (CC) is rare clinical condition and It is known as a pearly white mass medial to an intact tympanic membrane. In this case report, we describe a 6-year-old boy who presented with a one year history of left ear discomfort, reduced hearing, followed by ear discharge two months prior to admission. Otoscopic examination revealed a large attic perforation. Radiological investigation showed extensive cholesteatoma in the mastoid, mesotympanum and epitympanum with destruction of the ossicles including the stapes footplate. He underwent radical mastoidectomy in view of extensive cholesteatoma with tympanoplasty type V. In this case report, the classification, treatment and theories related to CC are discussed.
This study was designed to compare the sensitivity and specificity of detecting sensorineural hearing loss (SNHL) using the transient-evoked otoacoustic emissions (OAE) machine (the Madsen TE Echoscreen) and automated auditory brainstem response (AABR) machine (the Sabre Compac portable AABR) in term neonates exposed to severe hyperbilirubinaemia.
To review the long term outcome of Uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnoea syndrome in a tertiary referral centre. 38 records were traced where UPPP was done from July 2000 to December 2007. 14 patients were followed up for one to seven years where the Epworth sleepiness scale was scored, long term side effects documented and post operative muller's manoeuvre done. Success of UPPP is defined as a reduction in apnoea hypopnea index (AHI) more than 50%. Sixty percent (60%) were successfully treated with UPPP in the long term. Mean ESS was significantly reduced from 12 +/- 6 to 7 +/- 4. 11 out of 14 patients (78.5%) were reported to develop long term side effects of UPPP, the highest being velopharyngeal insufficiency (42.8%). In conclusion, UPPP is effective in improving symptoms of OSA in the long term. However, in view of its side effects, uvula preserving surgery should be considered as a surgical option.
Ethylmalonic encephalopathy is a rare metabolic disease presenting in infancy with developmental delay, acrocyanosis, petechiae, chronic diarrhea and early death. The biochemical characteristics of this autosomal recessive disease are urinary organic acid abnormalities. Recently it has been found to be caused by mutations in the ETHE1 gene, located on Ch19q13. Only about 30 patients have been reported, and we describe two additional cases. The first patient showed a typical clinical picture and biochemical abnormalities, with additional atypical clinical features. Neuroimaging studies showed extensive changes. A new homozygous mutation in exon 3 of the ETHE1 gene was found. The second patient was not investigated genetically; however besides the typical clinical picture and biochemical profile he was found to have cytochrome C oxidase deficiency.
Large Vestibular Aqueduct Syndrome (LVAS) is the most common radiographic malformation in children with early onset of hearing loss. Usually its occurrence is non-familial, however intriguingly a portion of patients with LVAS is found to have evidence of genetic predisposition. We described cases of LVAS in two siblings of a Chinese family. The elder sister first presented with reduced hearing since childhood and her brother has a similar complaint upon further questioning. Their hearing test showed bilateral sensorineural hearing loss (SNHL) and computed tomography (CT) of temporal bone showed enlarged vestibular aqueduct in both patients. We described an approach to diagnosis of LVAS and highlight the importance of hearing assessment in genetic link hearing loss.
Dye-Sensitized Solar Cells (DSSCs) have attracted great attention due to environmentally friendly low-cost processing, excellent working ability in diffuse light, and potential to meet the power demands of future buildings due the true class of building integrated photovoltaics (BIPV). Nevertheless, DSSCs have relatively low photoconversion efficiency (PCE) due to multiple issues. Several strategies have been employed to enhance its PCE. For instance, bi-layered structure of photoelectrode i.e., mesoporous TiO2 transparent layer with top scattering layer was introduced which scatter light inside on large angles improves the harvesting ability of photoelectrode thus enhanced PCE. However, scattering layer is composed of aggregated small particles which offer sluggish electron transport due to multiple grain boundaries, consequently, unwanted recombination reaction which leads to poor PCE. This issue has been addressed for transparent layer immensely but ignored for scattering layer. Mostly for scattering layer in previous studies novel structures have been proposed to enhance scattering properties and dye adsorption only. Therefore, in this study for the first time presenting dual functional graphene/TiO2 scattering layer in which solvent exfoliated graphene is incorporated in TiO2 submicron spheres which enhanced electron transport properties, while submicron spheres scatter light effectively. Scattering and electron transport characteristics of DSSCs are thoroughly investigated with the function of graphene loading. Electrochemical impedance spectroscopy (EIS) has revealed that diffusion coefficient length and coefficient and conductivity attained maximum value at 0.01 wt%. while other important parameters such as electron lifetime and electron density in conduction band have been improved till 0.020 wt% graphene loading. However, results indicated that with 0.01 w% graphene 33% higher PCE was achieved than without scattering layer and 13% higher than scattering layer without graphene. The depraving in PCE at >0.01 wt% graphene despite of excellent electron transport improvement is attributed to the loss of diffuse reflectance and higher optical absorption by graphene.