The mandibulotomy is a procedure that was developed to improve access in tumour resection. This study aimed to investigate the complications associated with mandibulotomy and analyze factors that could affect the risks of developing these complications. The hospital records of all patients who underwent a mandibulotomy as part of their tumour ablative surgery at two major centres in Malaysia were reviewed retrospectively. Demographic, clinical, and complications data were recorded and analyzed. Early postoperative complications occurred in 46.5% of the patients and post-radiation therapy complications in 16.1%. Wound dehiscence (27.9%) and inferior alveolar nerve injury (25.6%) were the common early postoperative complications. Dental injuries (9.7%) and plate exposure/infection (9.7%) were the common post-radiation therapy complications. Furthermore, inferior alveolar nerve injury and early abscess formation were significantly associated with the site of the mandibulotomy. The T-stage of a tumour but not the site of mandibulotomy was significantly associated with tumour margin clearance. Mandibulotomy does pose an added risk of complications for a patient undergoing tumour surgery. The benefits of mandibulotomy in terms of gaining margin clearance could not be proven in this study. The site of mandibulotomy appears to increase the risk of developing an inferior alveolar nerve injury.
The skin of a fast swimming shark reveals riblet structures that help reduce the shark's skin friction drag, enhancing its efficiency and speed while moving in the water. Inspired by the structure of the shark skin denticles, our team has carried out a study as an effort in improving the hydrodynamic design of marine vessels through hull design modification which was inspired by this riblet structure of shark skin denticle. Our study covers on macroscaled design modification. This is an attempt to propose an alternative for a better economical and practical modification to obtain a more optimum cruising characteristics for marine vessels. The models used for this study are constructed using computer-aided design (CAD) software, and computational fluid dynamic (CFD) simulations are then carried out to predict the effectiveness of the hydrodynamic effects of the biomimetic shark skins on those models. Interestingly, the numerical calculated results obtained show that the presence of biomimetic shark skin implemented on the vessels give about 3.75% reduction of drag coefficient as well as reducing up to 3.89% in drag force experienced by the vessels. Theoretically, as force drag can be reduced, it can lead to a more efficient vessel with a better cruising speed. This will give better impact to shipping or marine industries around the world. However, it can be suggested that an experimental procedure is best to be conducted to verify the numerical result that has been obtained for further improvement on this research.
AIM: This study was performed to determine the accuracy of ultrasound (USG) as compared to mammography (MMG) in detecting breast cancer.
METHODS: This was a review of patients who had breast imaging and biopsy during an 18-month period. Details of patients who underwent breast biopsy were obtained from the department biopsy record books and imaging request forms. Details of breast imaging findings and histology of lesions biopsied were obtained from the hospital Integrated Radiology Information System (IRIS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of USG and MMG were calculated with histology as the gold standard.
RESULTS: A total of 326 breast lesions were biopsied. Histology results revealed the presence of 74 breast cancers and 252 benign lesions. USG had a sensitivity of 82%, specificity of 84%, PPV = 60%, NPV = 94% and an accuracy of 84%. MMG had a sensitivity of 49%, specificity of 89%, PPV = 53%, NPV = 88% and an accuracy of 81%. A total of 161 lesions which were imaged with both modalities were analyzed to determine the significance in the differences in sensitivity and specificity between USG and MMG. Sensitivity of USG (75%) was significantly higher than sensitivity of MMG (44%) (X(2)1=6.905, p=0.014). Specificity of MMG (91%) was significantly higher than specificity of USG (79%) (X(2)1=27.114, p<0.001). Compared with MMG, the sensitivity of USG was 50% (95% CI 10%-90%) higher in women aged less than 50 years (X(2)1=0.000, p=1.000) and 27% (95% CI 19%-36%) higher in women aged 50 years and above (X(2)1=5.866, p=0.015). Compared with MMG, the sensitivity of USG was 40% (95% CI 10%-70%) higher in women with dense breasts (X(2)1=0.234, p=0.628) and 27% (95% CI 9%-46%) higher in women with non-dense breasts (X(2)1=4.585, p=0.032).
CONCLUSION: Accuracy of USG was higher compared with MMG. USG was more sensitive than MMG regardless of age group. However, MMG was more specific in those aged 50 years and older. USG was more sensitive and MMG was more specific regardless of breast density. In this study, 20% of breast cancers detected were occult on MMG and seen only on USG.
The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.
Streptococcosis is an important disease of tilapia throughout the world. In Malaysia, streptococcosis outbreak was commonly reported during the 3-month period of high water temperature between April and July. This study describes the duration of protection following single and double booster dose regimes against streptococcosis in tilapia using a feed-based vaccine containing formalin-killed Streptococcus agalactiae. A total of 510 tilapias of 120 ± 10 g were selected and divided into 3 groups. Fish of Group 1 were vaccinated at weeks 0 and 2 (single booster group) while fish of Group 2 were vaccinated at weeks 0, 2 and 6 (double booster group) with a feed-based vaccine against streptococcosis. Fish of Group 3 was not vaccinated. Serum samples were collected weekly to determine the antibody level while samples of eye, brain and kidney were collected for bacterial isolation. At week 10, all fish were challenged with live S. agalactiae and the survival rate was determined.
A tilapia farm experiencing endemic streptococcosis was selected to study the effect of vaccination with a feed-based vaccine on naturally ocurring streptococcosis. A total of 9000 red tilapia, Oreochromis niloticus × Oreochromis mossambicus of 100 ± 20 g were divided into 9 cages. Fish of Group 1 in cages 1, 2 and 3 were not vaccinated. Group 2 in cages 4, 5 and 6 were vaccinated on days 0 and 14 (single booster) while Group 3 in cages 7, 8 and 9 were vaccinated on days 0, 14 and 42 (double booster). Vaccination was done by oral administration of the feed-based bacterin vaccine at 4% bodyweight. Samples of serum for antibody study and the brain, eyes and kidney for bacterial isolation were collected at 14-day intervals. The study was carried out during the critical months between April and June. Following vaccination and booster, there was significant (p
Medicinal plants have many traditional claims including the treatment of ailments of infectious origin. In the evaluation of traditional claims, scientific research is important. The objective of the study was to determine the presence of antibacterial activity in the crude extracts of some of the commonly used medicinal plants in Malaysia, Andrographis paniculata, Vitex negundo, Morinda citrifolia, Piper sarmentosum, and Centella asiatica. In this preliminary investigation, the leaves were used and the crude extracts were subjected to screening against five strains of bacteria species, Methicillin Resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, using standard protocol of Disc Diffusion Method (DDM). The antibacterial activities were assessed by the presence or absence of inhibition zones and MIC values. M. citrifolia, P. sarmentosum and C. asiatica methanol extract and A. paniculata (water extract) have potential antibacterial activities to both gram positive S. aureus and Methicillin Resistant S. aureus (MRSA). None of the five plant extracts tested showed antibacterial activities to gram negative E. coli and K. pneumoniae, except for A. paniculata and P. sarmentosum which showed activity towards P. aeruginosa. A. paniculata being the most potent at MIC of 2 g/disc. This finding forms a basis for further studies on screening of local medicinal plant extracts for antibacteria properties.
In a previous communication we showed that atrovirinone, a 1,4-benzoquinone isolated from the roots of Garcinia atroviridis, was able to inhibit several major proinflammatory mediators of inflammation. In this report we show that atrovirinone inhibits NO and PGE(2) synthesis through inhibition of iNOS and COX-2 expression. We also show that atrovirinone inhibits the secretion of IL-1beta and IL-6 in a dose dependent fashion whereas the secretion of IL-10, the anti-inflammatory cytokine, was enhanced. Subsequently we determined that the inhibition of proinflammatory cytokine synthesis and inducible enzyme expression was due to a dose-dependent inhibition of phosphorylation of p38 and ERK1/2. We also showed that atrovirinone prevented phosphorylation of I-kappaBalpha, which resulted in a reduction of p65NF-kappaB nuclear translocation as demonstrated by expression analysis. We conclude that atrovirinone is a potential anti-inflammatory drug lead that targets both the MAPK and NF-kappaB pathway.
Zingiber zerumbet Sm., locally known to the Malay as "Lempoyang," is a perennial herb found in many tropical countries, including Malaysia. The rhizomes of Z. zerumbet, particularly, have been regularly used as food flavouring and appetizer in various Malays' cuisines while the rhizomes extracts have been used in Malay traditional medicine to treat various types of ailments (e.g., inflammatory- and pain-mediated diseases, worm infestation and diarrhea). Research carried out using different in vitro and in vivo assays of biological evaluation support most of these claims. The active pharmacological component of Z. zerumbet rhizomes most widely studied is zerumbone. This paper presents the botany, traditional uses, chemistry, and pharmacology of this medicinal plant.
Melastoma malabathricum L. (Melastomataceae) is one of the 22 species found in the Southeast Asian region, including Malaysia. Considered as native to tropical and temperate Asia and the Pacific Islands, this commonly found small shrub has gained herbal status in the Malay folklore belief as well as the Indian, Chinese, and Indonesian folk medicines. Ethnopharmacologically, the leaves, shoots, barks, seeds, and roots of M. malabathricum have been used to treat diarrhoea, dysentery, hemorrhoids, cuts and wounds, toothache, and stomachache. Scientific findings also revealed the wide pharmacological actions of various parts of M. malabthricum, such as antinociceptive, anti-inflammatory, wound healing, antidiarrheal, cytotoxic, and antioxidant activities. Various types of phytochemical constituents have also been isolated and identifed from different parts of M. malabathricum. Thus, the aim of the present review is to present comprehensive information on ethnomedicinal uses, phytochemical constituents, and pharmacological activities of M. malabathricum.
The hydrogels responding to pH synthesized by graft copolymerization only and then concurrent grafting and crosslinking of monomer N-isopropyl acrylamide (NIPAAM) and binary comonomers acrylamide, acrylic acid and acrylonitrile (AAm, AA and AN) onto chitosan support were explored for the percent upload and release study for anti-inflammatory diclofenac sodium drug (DS), w.r.t. time and pH. Diclofenac sodium DS was seized in polymeric matrices by the equilibration process. The crosslinked-graft copolymers showed the highest percent uptake than graft copolymers (without crosslinker) and chitosan itself. The sustainable release of the loaded drug was studied with respect to time at pH 2.2, 7.0, 7.4 and 9.4. Among graft copolymers (without crosslinking), Chit-g-polymer (NIPAAM-co-AA) and Chit-g-polymer (NIPAAM-co-AN) exhibited worthy results for sustainable drug deliverance, whereas Crosslink-Chit-g-polymer (NIPAAM-co-AA) and Crosslink-Chit-g-polymer (NIPAAM-co-AAm) presented the best results for controlled/sustained release of diclofenac sodium DS with 93.86 % and 96.30 % percent release, respectively, in 6 h contact time. Therefore, the grafted and the crosslinked graft copolymers of the chitosan showed excellent delivery devices for the DS with sustainable/prolonged release in response to pH. Drug release kinetics was studied using Fick’s law. The kinetic study revealed that polymeric matrices showed the value of n as n > 1.0, hence drug release took place by non-Fickian diffusion. Hence, the present novel findings showed the multidirectional drug release rate. The morphological changes due to interwoven network structure of the crosslinked are evident by the Scanning electron microscopy (SEM) analysis.
Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective randomised study of the efficacy of etoricoxib (Arcoxia) compared with mefenamic acid (Ponstan) in treating primary dysmenorrhoea. All single, sexually inactive women with primary dysmenorrhoea were randomised into two groups (mefenamic acid and etoricoxib) of pain relief and underwent a cross-over study. The success of treatment as evidenced by pain relief, the side-effects and complications were observed and analysed. Some 80% (20 women) had significantly better pain relief with etoricoxib, compared with only 20 per cent in the mefenamic acid group (p = 0.007). Etoricoxib has significantly fewer side-effects compared with mefenamic acid (p = 0.005) with significantly reduced menstrual blood loss (p = 0.025). In conclusion, etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief, less menstrual blood loss and fewer side-effects compared with mefenamic acid.
A 21-year-old primigravida with previous history of pulmonary tuberculosis had a normal but assisted vaginal delivery after a prolonged second stage. Within 12 hours, she complained of dyspnoea and was found to have abnormal neck and anterior chest wall swelling. A diagnosis of subcutaneous emphysema was made and this was confirmed with the chest radiograph, which also revealed pneumomediastinum. She recovered well within four days with conservative treatment.
The empty follicle syndrome (EFS) is a rare complication of in vitro fertilization (IVF) treatment, leading to cycle cancellation. Low human chorionic gonadotropin (hCG) bioavailability and ovarian dysfunction have been implicated with this condition. This case report illustrates a typical case of EFS and several strategies suggested to overcome this problem.
Sugar palm fibre (SPF) was treated with NaClO2, bleached with NaOH and subsequently hydrolyzed with acid to obtain sugar palm nanocrystalline cellulose (SPNCCs). Bionanocomposites in the form of films were prepared by mixing sugar palm starch (SPS) and sorbitol/glycerol with different nanofiller SPNCCs compositions (0-1.0 wt%) using solution casting method. The resulting fibres and nanocomposites were characterized in terms of morphology (FESEM and TEM), footprint, crystallinity (XRD), light transmittance, biodegradability, physical, water barrier, thermal (TGA, DSC and DMA) and mechanical properties. The length (L), diameter (D) and L/D values of the SPNCCs were 130 ± 30.23, 8.5 ± 1.82 nm, and 15.3, respectively. The SPS/SPNCCs nanocomposite films exhibited higher crystallinity, tensile strength, Young's modulus, thermal and water-resistance compared to the neat SPS film. The results showed that the tensile strength and moduli of the bionanocomposites increased after being reinforced with SPNCCs and the optimum nanofiller content was 0.5%.
Nanofibrillated cellulose (NFCs) were extracted from sugar palm fibres (SPS) in two separate stages; delignification and mercerization to remove lignin and hemicellulose, respectively. Subsequently, the obtained cellulose fibres were then mechanically extracted into nanofibres using high pressurized homogenization (HPH). The diameter distribution sizes of the isolated nanofibres were dependent on the cycle number of HPH treatment. TEM micro-images displayed the decreasing trend of NFCs diameter, from 21.37 to 5.5 nm when the number of cycle HPH was increased from 5 to 15 cycles, meanwhile TGA and XRD analysis showed that the degradation temperature and crystallinity of the NFCs were slightly increased from 347 to 347.3 °C and 75.38 to 81.19% respectively, when the number of cycles increased. Others analysis also were carried on such as FT-IR, FESEM, AFM, physical properties, zeta potential and yield analysis. The isolated NFCs may be potentially applied in various application, such as tissue engineering scaffolds, bio-nanocomposites, filtration media, bio-packaging and etc.
The effect of adding inhaled salmeterol to inhaled corticosteroids was studied in patients with poorly controlled nocturnal asthma. In a double-blind, cross-over study, 20 patients were randomized to receive either salmeterol 50 micrograms twice daily or placebo via a Diskhaler after a 1-week run-in period. After 4 weeks of treatment, patients were subsequently crossed over to receive the other treatment for a further 4 weeks with a 2-week wash-out period in between. The response to treatment was assessed by peak expiratory flow rates (PEF) measured in the morning and evening, symptom scores of asthma, number of bronchodilators used, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at regular intervals. Patients' preference for the Diskhaler or metered-dose inhaler was assessed at the last visit. The results showed that morning PEF was significantly higher while on salmeterol than on placebo (296.9 +/- 70.2 vs 274.6 +/- 77.4 L/min). Evening PEF showed a trend towards a higher value while on salmeterol than on placebo (321.1 +/- 73.4 vs 288.7 +/- 79.4 L/min), but the difference was not significant. There was no statistically significant improvement in symptom scores, number of rescue bronchodilators used and FEV1 or FVC between the two treatment groups. The occurrence of side effects in terms of tremors and palpitations between treatment and placebo were similar. There were more patients who preferred Diskhaler to metered-dose inhaler (70% vs 30%). We conclude that salmeterol 50 micrograms twice daily produces significant improvement in morning PEF and is well tolerated in patients with nocturnal asthma. Diskhaler is a device which is easy to use and preferred to a metered-dose inhaler.
Study site: Respiratory Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
A young East Malaysian lady presented with haemoptysis in 1989. Since then she had recurrent episodes of dyspnoea and two occasions of respiratory failure requiring assisted ventilation. An open lung biopsy showed intra-alveolar haemorrhage with diffuse interstitial fibrosis consistent with idiopathic pulmonary haemosiderosis after excluding secondary causes of pulmonary haemorrhage. She failed to respond to corticosteroid and continued to depend on oxygen until she succumbed to the illness 2 years after the presentation.