Many challenges arise in candidaemia treatment which involves emergence of antifungal resistance. New species have been identified due to improved methods of detection and some are resistant to commonly prescribed antifungal agents such as fluconazole and amphotericin B. Therefore, the objective of the study was to observe any changes in the susceptibility patterns and distribution of Candida species. This cross sectional study was conducted at the Department of Medical Microbiology and Immunology in UKMMC, a tertiary teaching hospital. One hundred and fifty one data were collected from the department’s laboratory records from January 2008 to December 2010. The yeasts were identified using ID32C carbohydrate assimilation tests whilst the antifungal susceptibility test was performed using Sensititre® YeastOne® broth microdilution method. Antifungal agents tested included amphotericin B, fluconazole, itraconazole, voriconazole, 5-flucytosine and caspofungin. Out of 151 blood isolates, 47 (31.1%) were Candida albicans and 104 (68.9%) were non-albicans Candida species. Candida tropicalis has surpassed C. albicans as the most commonly isolated Candida species from blood. Overall susceptibility (as compared to 2005-2006 data in brackets) to caspofungin was 99.3% (n/a), 5-flucytosine 97.4% (98%), amphotericin B 94.7% (100%), voriconazole 92.7% (98%), fluconazole 86.8% (90%) and
itraconazole 39.1% (40%). In conclusion, although the isolates were generally still susceptible to amphotericin B and fluconazole, resistance to these drugs is increasing.
The effect of composition on nickel cobaltites prepared by co-precipitation was investigated. Various compositions were synthesised under different heat treatment conditions. The formation mechanism, lattice parameter and crystallite size were determined by various techniques. X-ray diffraction (XRD) analysis revealed that the optimum condition for the formation of single phase nickel-cobalt oxide (NiCo2O4) can be obtained from solution containing Ni: Co ratio of 33.3 mol%: 66.7 mol% with heat treatment at 400 °C. The presence of pure phase NiCo2O4 with the particle size of approximately 34.10 nm was also observed in field emission scanning electron microscopy (FESEM). The crystallinity of the synthesized oxides was improved with the increment of Ni content.
The isolation of 66 streptomycetes from rhizosphere soil of chili plants was done for their inhibitory activities against three different dominant species of Colletotrichum namely C. acutatum, C. gloeosporioides and C. capsici. Twenty one streptomycetes strains were active against at least one of the Colletotrichum species. In addition, ten strains that inhibited the in vitro growth of Colletotrichum species showed chitinase activity. Strain P42, which displayed the highest inhibitory activity against all three anthracnose fungi species and high chitinase activity was tested as biological control agent in a greenhouse study. The strain successfully controlled chili anthracnose disease by significantly reducing the disease severity. Phylogenetic analysis of the 16S rRNA gene sequences showed that strain P42 belongs to the Streptomyces rochei clade. The results of the current study showed that rhizosphere-derived soil of chili plants is an important source of bioactive streptomycetes which are antagonistic against Colletotrichum.
This work is aimed to determine the characteristics of activated carbons derived from palm kernel shell (PKS) by microwave-induced zinc chloride activation for dye removal. Activation was performed in a microwave oven at power intensity of 70% for 10 min. The same procedures were repeated for activation using recycled ZnCl2 solution from the first activation. The activated carbons were characterized according to surface area, morphology, functional groups and batch adsorption. The yield for the first activation was 70.7% with surface area of 858m2/g. It was found that the activated carbon prepared using the recycled ZnCl2 still possesses good surface area for methylene blue removal. The adsorption behaviour of the continuous system was well fitted to and could be satisfactorily described by the Yoon and Nelson model.
Disposal of dye wastewater into water streams without treatment endangers human and marine lives. This work focused on the second largest class of textile dyes after azo dyes due to its high resistivity to biodegradation and high toxicity. The photocatalytic degradation of Reactive Blue 4 (RB4), an anthraquinone dye, has been investigated using pure anatase nano titanium (IV) oxide (TiO2). The dye molecules were fully degraded and the addition of hydrogen peroxide (H2O2) enhanced the photodegradation efficiency. It is found that the degradation as the hydroxyl radicals in the bulk solution is sufficient for complete mineralisation. The disappearance of the dye follows pseudo-first-order kinetics. The effect of pH, amount of photocatalyst, UV-light intensity, light source and concentration of hydrogen peroxide was ascertained.
Glioblastoma multiforme (GBM) is the most malignant subtype of brain cancer. However, current clinical treatments
for GBM are limited in effectiveness and often impose additional side effects on patients. Here, we developed targeted
anti-cancer therapy (TAT) using neural stem cells (NSC) as delivery agent to transport anti-cancer compounds directly to
GBM in vitro. Anti-cancer active compounds: Tannic acid (TA) and gallic acid (GA) were extracted from local medicinal
plant - Quercus infectoria (QI) using soxhlet technique with 100% methanol (QI-100%) or 70% methanol (QI-70%)
solvent. Concentration of TA and GA measured using HPLC were 72.56 and 43.66 μg/mL in QI-100%, while in QI-70%,
the concentrations were 72.41 and 43.31 μg/mL, respectively. Cytotoxicity effects of QI-100% and QI-70% on human
GBM cell line (DBTRG-05MG), human NSC line (H9-hNSC) and human normal brain glial cell line (SVG-p12) (as negative
control) were determined using MTT assay. Both QI-100% and QI-70% showed anti-proliferative properties against
DBTRG-05MG at IC50, but not on H9-hNSC and SVG-p12. Taken together, data indicated that both QI extracts contained
TA and GA which exhibit anti-proliferative effect specifically on cancerous cells only. Next, QI-treated H9-hNSC was
seeded in a modified Boyden chamber for 12 h to investigate its migration capacity towards DBTRG-05MG. The result
showed that H9-hNSC migrated towards DBTRG-05MG with 4-folds higher capacity compared to control. In addition,
the migration of QI-100% treated H9-hNSC successfully reduced the number of DBTRG-05MG, indicating the anti-GBM
potential of these cells after migration. In conclusion, NSC could be a specific anti-cancer compound delivery agent for
GBM, reducing unwanted side effects on patients.
Fukoidan adalah sejenis polisakarida bioaktif yang terdiri daripada fukosa, sulfat dan asid uronik. Fukoidan mempunyai
bau hanyir menyebabkan aplikasi dalam produk makanan menjadi sukar. Oleh itu, objektif kajian ini adalah untuk
menyahbau hanyir fukoidan yang diekstrak daripada Sargassum sp. (Fsar) dan mengkaji kesan penyahbauan terhadap
ciri-ciri fizikokimia dan aktiviti antipengoksidannya. Fsar dinyahbau dengan menggunakan butiran karbon teraktif (Fkar),
kaedah pengewapan haba (Fwap) dan gabungan kedua-dua kaedah tersebut (Fkw). Keberkesanan penyahbauan dikenal
pasti melalui penilaian sensori (ujian deskriptif kuantitatif) bagi menilai persepsi bau fukoidan yang telah dinyahbau.
Ciri fizikokimia iaitu ketulenan, warna dan nilai pH, manakala aktiviti antipengoksidaan ditentukan melalui ujian
pemerangkapan radikal bebas (DPPH), aktiviti pemerangkapan superoksida anion (SOA) dan pemerangkapan radikal
hidroksil (•OH). Kaedah penyahbauan Fkar menunjukkan nilai keamatan bau hanyir yang paling rendah dan tahap
penerimaan keseluruhan yang paling tinggi. Ketulenan Fkar tidak berbeza secara bererti (p>0.05) berbanding Fsar,
manakala ketulenan Fwap dan Fkw menurun secara signifikan berbanding Fsar. Keempat-empat sampel fukoidan (Fsar, Fkar,
Fwap, Fkw) menunjukkan warna dan nilai pH berbeza secara signifikan (p<0.05). Sebaliknya, tiada kesan yang signifikan
(p>0.05) terhadap kesan antipengoksidaan oleh kempat-empat sampel fukoidan selepas penyahbauan (Fsar, Fkar, Fwap, Fkw).
Pada keseluruhannya, kaedah penyahbauan menggunakan karbon teraktif (Fkar) didapati berpotensi kerana keberkesanan
dan tidak menyebabkan perubahan signifikan pada ketulenan dan aktiviti antipengoksidaan fukoidan.
Angiogenesis has an important role in the invasion, metastasis and growth of tumors. Increased microvessel density (MVD) has been described in oral squamous cell carcinoma (OSCC) compared to oral dysplasia and normal oral tissue. A morphometric study was designed to evaluate the MVD and to evaluate the presence of any association between MVD and keratin pearl in the three histopathological grades of OSCC (as defined in Bryne’s grading system). Forty-five samples of OSCC were graded into well differentiated (WDSCC), moderately differentiated (MDSCC) and poorly-differentiated (PDSCC) oral squamous cell carcinoma. Morphometric analysis showed that MVD was significantly lower in WDSCC compared to MDSCC (p<0.001) and PDSCC (p<0.001). The density in MDSCC was significant lower than PDSCC. The keratin pearl count was significantly higher in WDSCC compared to MDSCC (p<0.001) and PDSCC (p<0.001). Between MDSCC and PDSCC, the keratin pearl count was significantly higher for MDSCC (p=0.001). Pearson correlation test showed a significant negative correlation between keratin pearl and MVD (r=-0.805, p<0.001). The findings suggested that vascularity in OSCC is associated with its cellular differentiation and also associated with keratin pearl formation.
Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.
The purpose of this study was to study the association between selected demographic characters
and stress among primary school teachers. The respondents constituted of 60 male
and female school teachers who were chosen using stratified sampling technique. Study was
conducted in Jilin Province. Study design was cross sectional. SPSS was used to analyze
both descriptive and inferential statistics. The main results were as follows. Female teachers
experienced more stress compared to male teachers. Teachers below the age of 40 had more
stress probably, due to teaching experience, as this study revealed that teachers who had
more teaching experience had less stress. Marriage plays and important role in stress, unmarried
teachers experienced comparatively higher levels of stress compared to those married.
Furthermore, those living alone experienced more stress. Occupational stress is known
to cause burnout. It may be a good strategy to provide training in stress management techniques
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
Total immunoglobulin E (IgE) has been an indicator for early diagnosis of allergic diseases due the important role of IgE in the sensitization towards allergens. Although total IgE is a common diagnostic test that screens for possible allergic diseases, reports are still lacking on the profile of total IgE levels of allergic patients from the north-east region of Peninsular Malaysia. Hence, this study aimed to investigate the association of total IgE levels with clinico-demographic parameters and whether increasing total IgE levels were associated with certain allergic manifestations in this study cohort. A local cohort of allergic patients (n=71) diagnosed in between 2009 and 2016 in Hospital Universiti Sains Malaysia (HUSM) were evaluated for the relevance of total IgE levels in allergy diagnosis. Our study did not demonstrate significant association between total IgE with age (p=0.75) or gender (p=0.65). However, we showed that elevated total IgE levels were associated with disease severity. Our data suggests that increasing total IgE levels beyond the conventional cutoff used to define abnormal IgE levels were more commonly associated with patients presenting allergic asthma and skin allergy manifestations. Total IgE level is a useful indicator for diagnosis of allergic diseases. Although total IgE level might not be sufficient to confirm the sensitization status of an individual, it may reflect the severity of the allergic disease suffered and it has a high correlation with positive sIgE values.
Suffering experiences are common phenomena in palliative care. In this study, we aim to explore the different patterns of suffering in palliative care. Adult palliative care patients were recruited from the University of Malaya Medical Centre. Suffering scores were charted 3 times a day for a week. The characteristics of the suffering charts were analyzed using SPSS. The patterns of suffering were analyzed using structural pattern recognition. A total of 53 patients participated. The overall trends of suffering were downward (64%), upward (19%), and stable (17%). Median minimum and maximum suffering scores were 2/10 and 6/10, with an average of 3.6/10. Nine patterns of suffering were recognized from categorizing two key characteristics of suffering (intensity and fluctuation)-named S1 to S9. Understanding the different patterns of suffering may lead to better suffering management.
Blunt traumatic aortic injury (BTAI) is a crucial diagnosis to be made early in the management of trauma patients with aims to improve survival outcome. The objective of this case report is to highlight and explore the role of imaging especially Computed Tomography Angiography (CTA) thorax to diagnose a focal traumatic aortic isthmus pseudoan- eurysm in a young gentleman sustaining high impact thoracic trauma.
Substantial advances on the life expectancy have been achieved in Malaysia over the past few decades. It is essential that elderly lead a healthier old age which leans towards successful aging. Thus, this study describes the major causes of premature mortality among the elderly population in Malaysia, 2014.
Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient’s cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84% (RM167,439.00) (US$47,862.80) of the total patient’s cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis.
Introduction: Hepatic radioembolization is a minimally invasive procedure involving intrarterial administration of radioembolic microspheres for the treatment of liver tumours. In this study, a biocompatible polystyrene (PS) microspheres formulation containing radioactive Samarium-153 (153Sm) was synthesized and tested. The 153Sm emits both diagnostic gamma energy and therapeutic beta radiation, renders the synthesized microspheres an ideal theranostic radioembolic agent for hepatic radioembolization. Methods: First, the 152Sm2O3 (20 – 50%, w/v) was encapsulated in PS microspheres using solid-in-oil-in-water solvent evaporation method. The 152Sm-labelled PS microspheres were then activated to 153Sm (Eβmax = 807.6 keV, half-life = 46.3 hours) via 152Sm (n,γ) 153Sm reaction in a nuclear reactor with a neutron flux of 2.0 x 1012 n.cm-2.s-1. Physicochemical characterization, gamma spectroscopy and in-vitro radiolabeling studies were carried out to study the properties and stability of the microspheres before and after neutron activation. Results: The 153Sm -labelled PS microspheres achieved a nominal activity of 4.0 GBq.g-1 after 6 hours of neutron activation. Scanning electron microscope (SEM) and particle size analysis show that the microspheres remained spherical with diameters within 15 – 60 μm after neutron activation. No long half-life radioimpurities were found in the samples as revealed by the gamma spectroscopy results. The 153Sm-labelled PS microspheres achieved radiolabeling efficiency of more than 95% in saline and blood plasma over 480 hours. Conclusion: A biocompatible 153Sm-radiolabelled PS microspheres formulation has been successfully developed. The formulation achieved desirable properties for theranostic treatment of liver tumours. The formulation is relatively cheaper, easier to be produced and more readily available.
Three groups of people with different clinical histories and manifestations to house dust were skin tested with Dermatophagoides pteronyssinus extracts. The results showed close correlation between positive skin tests and clinical sensitivity to dust. The correlation was not, however, perfect and, although D. pteronyssinus is a major factor in house dust allergy, it does not appear to be the sole antigen involved.