Background and objectives: Radiation treatment in nasopharyngeal carcinoma (NPC) is known to be associated with increased prevalence of carotid stenosis. The objectives of the study was to determine the prevalence of radiation-induced extracranial carotid stenosis, plaque, carotid intima thickness (CIMT) in NPC patients; to explore whether the stenosis is due to direct effect of radiation rather than general tendency to atherosclerosis. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from July 2011 to February 2012. The study subjects consisted of 47 NPC patients who were treated with radiation, and 47 healthy control. The patients and control had carotid duplex ultrasound and transcranial Doppler (TCD). Results: The mean age of the patients was 55.1 years, the time lapse from radiation was 76.7 ± 95.3 months. Internal carotid artery (ICA) and common carotid artery (CCA) stenosis of ≥50% was seen in 17.0% of patients vs 2.1 % of controls (p = 0.031), with 61.7% of patients and 19.1% of controls having plaque in ICA and CCA (p=0.004). CIMT was increased in 70.2% of patients and 44.7% of controls (p =0.022). Both the patient group and control had similar rate of intracranial stenosis of 12.8% in TCD.
Conclusion: Extracranial internal carotid artery is the most common site of stenosis following radiotherapy in NPC. This suggests that local trauma from irradiation is the most important factor in predisposition to atherosclerosis following radiation therapy.
Introduction: None of the identified studies employed quantitative scales correlating the knowledge and attitudes toward epilepsy. Method: This study aimed to study the relationship between the knowledge and attitudes toward epilepsy, using the Epilepsy Knowledge Questionnaire (EKQ) and the Public Attitudes Toward Epilepsy (PATE) scale. Results: A total of 279 publics with a mean age of 36.6±14.7 years (ranged from 15-77 years), 50.8% female with majority (63.0%) Chinese, and 49.5% with tertiary education level, were recruited. The mean score of epilepsy knowledge questionnaire (EKQ) was 21.05±3.92 (95% CI: 20.57-21.48). Higher score in EKQ was associated with higher education level (p
The International Pharmaceutical Federation (FIP) adopted a set of Good Pharmacy Practice (GPP) guidelines in 1993 and recommended that the regulatory bodies of individual countries should adapt the guidelines in accordance with their resources. The Malaysian Pharmaceutical Society (MPS) introduced its benchmarking guidelines (BMG) in 2003 as a means to raise the professional standards of the community pharmacy practice in Malaysia. Therefore, this study aimed to determine the extent to which community pharmacies have adopted the BMG. A cross-sectional study was conducted using mail questionnaires, which were posted to all community pharmacies in Malaysia. A total of 371 questionnaires (29.2%) were returned. Only 51.0% of the respondents were aware of the BMG. The extent of compliance with the guidelines was 62.6+21.1% (mean + standard deviation), with a median of 65%. The type and ownership of the community pharmacies were significantly associated with compliance with certain aspects of the guidelines. The main problem in complying with the BMG was financial constraint, and this problem was more likely to occur with independent than with chain pharmacies. However, the respondents generally agreed that most aspects of the BMG could be achieved in less than five years. Since the level of awareness among community pharmacists regarding the BMG is low, the MPS should promote or publicise the BMG further. The BMG should be reviewed before being used as part of the criteria for the accreditation of community pharmacies, as proposed by the MPS to further improve the quality and standards of community pharmacies in Malaysia.
Cephalometric analyses using computer software have more advantages than manual analyses. However, the software should be evaluated for the accuracy and reproducibility before it can be used. The aims of the present study were: 1) to compare the differences in accuracy and precision between utilizing scanned images and soft copy images with the software 2) to assess the reproducibility of software and manual cephalometric analyses. Fifteen cephalograms were selected randomly from the Record Unit, Hospital Universiti Sains Malaysia. All films had 10 fiducial points marked and were scanned at 75 dots per inch (dpi) and 300 dpi. Manual and digital measurements were compared to obtain magnification factors. Seven digital x-ray images of a caliper were taken. The mean differences were measured between the fixed caliper measurement and digital measurements. Subsequently, 37 cephalograms were traced manually and digitally with Computer-Assisted Simulation System for Orthognathic Surgery (CASSOS) software to assess its accuracy and reproducibility after applying the obtained magnification factor. Steiner analysis was utilized and T tests were used to evaluate the mean difference. P
The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.
Numerical studies of blood flow system of aorta coronary sinus conduit were carried out using ANSYSTMCFD simulation. A different model of conduit, which differs in the inlet diameter, was investigated. Theinvestigated inlet diameters are 3 mm, 4 mm and 5 mm. Pressure drop from 80 mmHg to 15 mmHgwas achieved for all the models. The comparison chart was produced to compare the pattern of pressurereduction as well as velocity distribution in each model. From the analysis of coronary sinus conduit,it was found that a narrow tube needs to be incorporated into the conduit produced. This is to inducea venturi effect to reduce the pressure drop of blood within a specific throat length. As conclusion, amodel of 3 mm inlet and a throat diameter of 1.13 mm show satisfactory result for pressure reductionfrom 80 mmHg to 15 mmHg. This particular model also has a lower peak velocity at the inlet zone ofthe throat section, which is more preferable in terms of Reynolds number.
Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
This paper aims to determine acute responses of standardized resistance training load on cardio-respiratory variables in recreationally active participants. The methodology involved twelve recreationally active males with an age of 23.5 (± 4.07) years, a mass of 70.5 (± 7.84 kg), a height of 1.69 (± 0.06 m), and a body mass index of 24.8 (± 2.14) kg/m2). The participants performed an exercise protocol that comprises five exercises on a standardized load. Each exercise was performed in a duration of 60 seconds with uncontrolled lifting velocity. Cardio-respiratory responses were measured using a portable metabolic system analyzer during the exercises. A wrist digital blood pressure monitor was used to determine pre- and postprotocol blood pressure responses. Based on the results, pre- and postprotocol systolic (p=0.744) and diastolic (p=0.758) blood pressure indicated no significant responses. However, significant differences were observed in pre- and post-heart rate responses (p=0.000). Peak cardio-respiratory responses recorded during the protocol were 30.2 (± 4.02) ml/Kg/min for oxygen consumption, 138 (± 61.9) bpm for heart rate, and 633 (± 71.2) kcal for energy expenditure (estimated per hour). On average, the Metabolic Equivalent of Task (MET) was recorded at a value of 8.62 (± 1.19). For a short duration standardized load circuit training exercise protocol, cardio respiratory responses were similar to other protocols. The metabolic cost of the predefined exercises was nearly half of the recommended energy expenditure through exercise per week. The prescribed protocol was comparable with other exercise protocols for cardiorespiratory variables. The single set protocol used was efficient in terms of caloric expenditure, and was less strenuous over similar exercise duration. Furthermore, the prescribed protocol is applicable and beneficial for active and healthy individuals.
Sepsis causes high mortality and morbidity. Static lactate concentration and early lactate clearance are cited to be a predictor for sepsis survival. This study examined the clinical utility of static lactate concentration and early lactate clearance within the first six hours of admission in Emergency Department (ED) to predict 28-day mortality rate in sepsis patients. Patients who presented with sepsis, severe sepsis or septic shock and admitted to ED of Universiti Kebangsaan Malaysia Medical Centre were recruited. Blood lactate concentrations were measured upon admission (H0), at 1st hour (H1) and 6th hour (H6), respectively. Either standard treatment of sepsis or early goal directed therapy was initiated according to sepsis severity. A follow-up report was conducted at 28 days via telephone call, e-mail or case notes. Patients were later classified into survivor and non-survivor as final outcome. Static lactate concentration appeared to be significantly higher for non-survivor as compared to the survival group at H0, H1 and H6 (p
Electrophoresis is a crucial step for the studies of proteins, allozymes, DNAs and RNAs. Two commonly used electrophoresis systems are agarose gel and polyacrylmide gel. Agarose gel is frequently used for DNAs and RNAs studies whereas polyacrylmide gel is widely used for the studies of other macromolecules such as proteins, allozymes (isozymes), DNAs and RNAs. The banding patterns of the gels, rather than the numbers of bands appearing on the gels are important for scoring in fingerprinting, footprinting and in population genetic studies.
An electronic database has been developed and implemented for ko-INAA method in Malaysia. Databases are often developed according to national requirements. This database contains constant nuclear data for ko-INAA method; Hogdahl-convention and Westcott-formalism as 3 separate command user interfaces. It has been created using Microsoft Access 2007 under a Windows operating system. This database saves time and the quality of results can be assured when the calculation of neutron flux parameters and concentration of elements by ko-INAA method are utilised. An evaluation of the database was conducted by IAEA Soil7 where the results published which showed a high level of consistency.
This study is an attempt to investigate the adsorption of petroleum hydrocarbon (toluene) from aqueous solutions using granular activated carbon (GAC) synthesized from oil palm shell (OPS) (referred as OPSbased GAC). This study involved a series of batch experiments to determine the adsorption equilibrium and kinetics. The batch experiments were conducted by shaking 200 mL toluene solution containing 0.4 g GAC (initial concentrations of 5, 15, 25 and 30 mg/L) at 180 rpm at 30°C. The OPS-based GAC achieved more than 80% toluene removal in all the experiments. The adsorption capacity of the OPSbased GAC estimated using Freundlich isotherm was 6.039 mg/g (L/mg)1/n. The adsorption kinetic study showed that the adsorption of toluene was of chemisorption as the experimental data fitted better to the pseudo-second-order kinetic model than the pseudo-first-order kinetic model.
In this paper, we introduce T-DepExp system to simulate the transitive dependence based coalition formation (CF). It is a multi-agent based simulation (MABS) tool that aims to enhance cooperation between agents through transitive dependence. Previously, the transitive dependence was introduced by An and his colleagues for expressing the indirect dependence between agents in their cooperation. However, it did not receive much attention. Although it has a few problems need to be addressed, we try to propose our own mechanism to increase the efficiency of the transitive dependence based CF. To simulate MAS dependence relationship, we have included two fundamental dependence relationships in this MABS tool, which are AND-Dependence and OR-Dependence. In addition, the architecture of the T-DepExp system is presented and discussed. It allows possible integration of other features such as budget mechanism and trust model. Subsequently, hypothesis for the experiments and experimental setup are explained. The overall system will be demonstrated for its functionality and the experimental results will also be discussed.
Several binary and ternary medium- and long-chain triacylglycerol (MLCT)-enriched margarine formulations were examined for their solid fat content, heating profile, polymorphism and textural properties. MLCT feedstock was produced through enzymatic esterification of capric and stearic acids with glycerol. The binary formulations were produced by mixing MLCT feedstock blend (40%–90%) and palm olein (10%–60%) with 10% increments (w/w). Solid fat profiles of commercial margarines were used as a reference to determine the suitability of the formulations for margarine production. The solid fat content of the binary formulations of MO 82 and MO 91 (M, MLCT, O, palm olein) were similar to the commercial margarines at 25°C which met the basic requirement for efficient dough consistency. Ternary formulations using reduced MLCT feedstock blend proportion (from 80%–90% to 60%–70%) were also developed. The reduction of MLCT feedstock blend was
done as it had the highest production cost (3USD/kg) in comparison to palm olein (0.77USD/kg) and palm stearin (0.7USD/kg). The proportions of 5%–15% of palm stearin were substituted with palm olein in MO 64 and MO 73 (M, MLCT; O, palm olein) formulations with 5% increment (w/w). As a result, MOS 702010 and MOS 603010 (M, MLCT; O, palm olein; S, palm stearin) margarine formulations showed similar SFC % to the commercial margarines at 25ºC. These formulations were subsequently chosen to produce margarines. The onset melting and complete melting points of MLCT-enriched margarine formulations were high (51.04ºC –57.93ºC) due to the presence of a high amount of long chain saturated fatty acids. Most of the formulations showed β΄- crystals. MOS 702010 was selected as the best formulation due to values for textural parameters comparable (P
Palmaris longus is a dispensable muscle with a long tendon which is very useful in reconstructive surgery. It is absent 2.8 to 24% of the population depending on the race/ethnicity studied. Four hundred and fifty healthy subjects (equally distributed among Malaysia's 3 major ethnic groups) were clinically examined for the presence or absence of palmaris longus. This tendon was found to be absent unilaterally in 6.4% of study subjects, and bilaterally in 2.9% of study participants. Malays have a high prevalence of palmaris longus absence at 11.3% followed closely by Indians at 10.7% whilst Chinese had a low absence rate of 6.0%.
Community-acquired pneumonia (CAP) is one of the most common infectious diseases and the world’s leading cause of mortality and morbidity, especially in patients aged 65 years and above.1,2 It is the 6th cause of mortality and the most important cause of hospitalisation in Malaysia. According to the British Thoracic Society, the gold standard in diagnosing CAP is based on radiological findings and it is defined into 2 different settings – community and hospital.3
Basal stem rot (BSR) caused by species Ganoderma, is one of the most serious disease of oil palm in Malaysia. As far as the disease problem to oil palm in Malaysia is concerned, BSR is the only disease requiring urgent solution. The BSR is not new to Malaysia, it has been known to attack oil palm since the early years when the crop was introduced into this country. There is an indication that there are differences in susceptibility to basal stem rot between germplasm materials from different genetic origin [2]. This provides hope in generating oil palm varieties with reduced level of susceptibility using existing genetic materials. There is also interest in developing diagnostic tools such as using PCR primers for detection of the pathogen in oil palms [1]. Altered expression of several classes of genes was observed in plants in response to fungal infection. These include genes associated with cell maintenance and development, genes involved in biosynthesis of lignin and phenolics and genes implicated in oxidative burst, programmed cell death or hypersensitive response [5].
This is a cross-sectional study on 218 pregnant mothers in an urban government Hospital.The study aimed to assess knowledge, attitudes and sources of information on breastfeeding. The results could be utilised to promote breastfeeding. Almost all the respondents (96.8%) intended to breastfeed their newborns. Most of them (74.8%) were knowledgeable about breastfeeding i.e. colostrum and breast milk was the best food, good for resistance against disease and allergy, filling up stomach easily, helpful in teeth development and maternal recovery after birth, increased bonding, was easy and economical. The two main misconceptions were mothers would stop breastfeeding when infant or mother was sick, and giving clear fluid to the exclusively breastfed infants to prevent dehydration. Most mothers (83.9%) responded positively towards breastfeeding i.e. it was easier than infant formula, had no negative effect on marital relationship or family care, would commence breastfeeding straight after delivery, agreeable to the banning of bottles and teats in hospital and they would not stop breastfeeding even if husband discouraged them. Only 56.9% of the mothers believed they could breastfeed their babies with modesty anywhere. The main sources of information were attained from the mass media (34.9%), antenatal class (32.1%) and other mothers with breastfeeding experiences.
One of the most important cervical cancer risk factors is human papillomavirus (HPV) infection. The p53 gene is one of the most important targets of the HPV E6 gene. E6 protein has the ability to stimulate p53 degradation, inhibits several functions of wild-type p53 and it competes with its function including suppression of malignant growth. The aim of this study is to determine the differences in p53 expressions in pre-malignant and malignant cervical neoplasms. This is a retrospective study on 100 cases of cervical neoplasms. There were 21 cases of CIN 1, 8 cases of CIN 2, 25 cases of CIN 3, 36 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 3 cases of adenosquamouscarcinoma. All cases were evaluated by immunohistochemistry using p53 monoclonalantibody. Thirty six of the 54 pre-malignant cases (66.7%) were positive for p53 protein, n contrast to the malignant cases in which, 40 of the 46 cases (87.0%) were positive. he majority of CIN showed absent to focal staining (29/54, 53.7%). In contrast, 84.8% (39/46( of the invasive carcinoma showed regional to diffuse staining. The expression of p53 is greater in the malignant cervical neoplasms than the pre-malignant cervical lesions, suggesting that p53 overexpression is not an early phenomenon in the pathogenesis of cervical cancer. It is also shown to be slightly higher in percentage in CIN 2 and 3 when compared with CIN 1. However, a number of cases were p53 negative, suggesting that other factors may be involved and further HPV studies are indicated.
Placenta praevia is a known obstetric condition that causes complications to mother and fetus. This study was done to evaluate the knowledge of placenta praevia amongst the obstetric patients. A cross sectional study was carried out in Hospital Ipoh, Perak among 323 antenatal and postnatal patients. Socio-demographic parameters (ie age, race, parity, occupation, educational level) and history of placenta praevia were studied in relation to level of knowledge and attitude towards placenta praevia. Twenty (6.2%) from 323 women had current or past history of placenta praevia. Three had history of placenta praevia while 17 had current placenta praevia with prevalence of 5.3%. The mean score of knowledge achieved by patients was 11.8 which indicated overall poor knowledge. Occupation, level of education and history of placenta praevia were found to have a relationship with level of knowledge regarding placenta praevia in all obstetric patients. There was a significant relationship between attitude of patients with current and history of placenta praevia to level of knowledge regarding placenta praevia. (p=0.037,