This work was conducted to study the ability of bacterial and fungal isolates from keratitis cases in Upper Egypt to produce enzymes, toxins, and to test the isolated fungal species sensitivity to some therapeutic agents.
OBJECTIVES: The objectives of this study were 1) to obtain information regarding the prescribing pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting at a Malaysian university, 2) to determine the prevalence and types of potential NSAID prescription related problems (PRPs), and 3) to identify patient characteristics associated with exposure to these potential PRPs.
METHODS: We retrospectively collected data from 1 academic year using the electronic medical records of patients in the University Sains Malaysia (USM) primary care system. The defined daily dose (DDD) methodology and the anatomical therapeutic chemical (ATC) drug classification system were used in the analysis and comparison of the data. Statements representing potential NSAID PRPs were developed from authoritative drug information sources. Then, algorithms were developed to screen the databases for these potential PRPs. Descriptive and comparative statistics were used to characterize DRPs.
RESULTS: During the study period, 12,470 NSAID prescriptions were prescribed for 6,509 patients (mean ± SD = 1.92 ± 1.83). This represented a prevalence of 35,944 per 100,000 patients, or 36%. Based on their DDDs, mefenamic acid and diclofenac were the most prescribed NSAIDs. 573 potential NSAID-related PRPs were observed in a cohort of 432 patients, representing a prevalence of 6,640 per 100,000 NSAIDs users, or 6.6% of all NSAID users. Multivariate logistic regression analysis revealed that patients with a Malay ethnic background (p < 0.001), members of the staff (p < 0.001), having 4 or more prescribers (p < 0.001) or having 2 - 3 prescribers (p = 0.02), and representing 4 or more long-term therapeutic groups (LTTGs) (p < 0.001) or 2 - 3 LTTGs (p < 0.001) were significantly associated with an increased chance of exposure to potential NSAID related PRPs.
CONCLUSIONS: This is the first study in Malaysia that presents data on the prescribing pattern of NSAIDs and the characteristics of potential NSAID-related PRPs. The prevalence of potential NSAID-related PRPs is frequent in the primary care setting. Exposure to these PRPs is associated with specific sociodemographic and health status factors. These results should help to raise the awareness of clinicians and patients about serious NSAID PRPs.
Study site: University Sains Malaysia (USM) primary care system.
Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine.
Corporate governance is the way of governing a firm in order to increase its accountability and to avoid any massive damage before it occurs. The aim of this paper is to investigate the impact of capital structure, firms' size, and competitive advantages of firms as control variables on credit ratings. We investigate the role of corporate governance in improving the firms' credit rating using a sample of Jordanian listed firms. We split firms into four categories according to WVB credit rating. We use both the binary logistic regression (LR) and the ordinal logistic regression (OLR) to model credit ratings in Jordanian environment. The empirical results show that the control variables are strong determinants of credit ratings. When we evaluate the relationship between the governance variables and credit ratings, we found interesting results. The board stockholders and board expertise are moderately significant. The board independence and role duality are weakly significant, while board size is insignificant.
This cross-sectional study determined the appreciation of the learning environment and development of higher-order learning skills among students attending the Medical Curriculum at the International Medical University, Malaysia which provides traditional and e-learning resources with an emphasis on problem based learning (PBL) and self-directed learning. Of the 708 participants, the majority preferred traditional to e-resources. Students who highly appreciated PBL demonstrated a higher appreciation of e-resources. Appreciation of PBL is positively and significantly correlated with higher-order learning skills, reflecting the inculcation of self-directed learning traits. Implementers must be sensitive to the progress of learners adapting to the higher education environment and innovations, and to address limitations as relevant.
Primary histoplasmosis of the larynx is not a common disease. Most cases of laryngeal histoplasmosis results from hematogenous spread of disseminated histoplasmosis usually originating from pulmonary infection by Histoplasma capsulatum. We report a 52-year-old male chronic smoker who had prolonged hoarseness and was initially diagnosed with laryngeal carcinoma. However, biopsy of the laryngeal mucosa confirmed the diagnosis of histoplasmosis. There were no signs of pulmonary or systemic involvement. Treatment with intravenous amphotericin B was given for a week and oral ketaconazole was given for a month with complete resolution of symptoms.
Exposure to aflatoxins in the adult Malaysian diet was estimated by analysing aflatoxins in 236 food composites prepared as "ready for consumption". Dietary exposure to aflatoxin B1 (AFB1) ranged from 24.3 to 34.00 ng/kg b.w./day (lower to upper bound), with peanuts being the main contributor. Estimated liver cancer risk from this exposure was 0.61-0.85 cancers/100,000 population/year, contributing 12.4%-17.3% of the liver cancer cases. Excluding AFB1 occurrence data higher than 15 µg/kg reduced exposure by 65%-91% to 2.27-11.99 ng/kg b.w./day, reducing the cancer risk to 0.06-0.30 cancers/100,000 population/year (contributing 1.2%-6.1% liver cancer cases). Reducing further the ML of AFB1 from 15 to 5 µg/kg yielded 3%-7% greater drop in the exposure to 0.47-10.26 ng/kg b.w./day with an estimated risk of 0.01-0.26 cancers/100,000 population/year (0.2%-5.1% liver cancer cases attributed to dietary AFB1). These findings indicate that current MLs are adequate in protecting Malaysians' health.
This report deals with a young man having prolonged fever presenting with hypercalcaemic crisis. Subsequent investigations confirmed tuberculosis (TB) peritonitis in the absence of pulmonary involvement as the cause of his symptoms. His hypercalcaemia and fever resolved with anti-TB therapy. Abdominal TB needs to be included in the differential diagnosis of otherwise unexplained hypercalcaemia especially in our region where TB is an endemic problem and is treatable.
A study on lead exposure among school children aged between 7 and 12 years from Kajang and Sepang in the state of Selangor, Malaysia was carried out using delta-aminolevulinic acid (delta-ALA) levels in the urine as an index. The delta-ALA levels in urine were linked to variables which could contribute to lead exposure. Out of 1628 school children studied [Kajang (43.5%) and Sepang (56.5%)], only 194 subjects (16 and 8.8% from Kajang and Sepang, respectively) had urinary delta-ALA levels between 0.6 and 2.0 mg/100 ml. However, chi 2 analysis demonstrated significant association between delta-ALA of this group to some of the variables. The strongest association was found in the habit of biting fingernails (P < 0.025). Other statistically significant correlations were found between delta-ALA and father's occupation (P < 0.05) and the amount of time spent playing in the field (P < 0.01). Generally, this study indicates that school children in Kajang and Sepang are still relatively safe from excessively high lead exposure. However, a more sensitive indicator, which is based on a lower tolerable lead limits, such as lead in blood, are necessary to affirm this finding.
This paper analyses maternal mortality as seen in the Obstetric Unit of the University Kebangsaan Malaysia. During the 10 year study period, the maternal mortality rate was 74/100,000 total births. Women who were non-booked, aged above 40 years, gradmultiparous and of India ethnicity were at the highest risk of maternal death. The commonest causes of death were hemorrhage, hypertension, embolism and sepsis. Post-mortem examinations were performed in only 8.2% of women who died.
Injectable vitamin A was given to six pregnant beef cows in their last third of pregnancy to study the effect of this vitamin in their calves. Average birth weight and growth rate of calves from the treated cows were higher than that of calves from the nontreated cows. Prepartum vitamin A injections also resulted in a significant increase (P less than 0.05) in the mean corpuscular volume (MCV), total serum protein and globulin fraction of serum protein in calves of treated cows.
Brachiaria decumbens toxicity resulted in an altered reticulorumen environment in the sheep. This adversely affected the growth and activity of microorganisms in the rumen as reflected by greatly decreased concentrations of the volatile fatty acids (acetic, propionic and butyric) in B decumbens-intoxicated sheep.
Introduction: Estimation of gestational age (GA) is clinically crucial for managing pregnancy and assessing the foetal anatomy, growth and development. Transverse cerebellar diameter (TCD) has been reported as an accurate tool for dating the pregnancy. This study aimed to determine the accuracy of foetal TCD for dating the pregnancy and to con- struct a reference chart for GA of Yemeni foetuses. Methods: We conducted this prospective cross-sectional study among 400 Yemeni pregnant women between 18 and 40 weeks of gestation provided that they were with known last menstrual period and singleton normal pregnancies. Sonographic TCDs were measured for each foetus. The mean TCD was measured for gestational weeks separately, and a polynomial regression model was then used to predict the GA by TCD. Results: There was a robust correlation between GA and TCD (r = 0.995, p
This study was conducted to evaluate the implementation of the School Supplement Feeding Program (SSFP) among primary school in terms of financial management and budget disbursement, food preparation, selection of menus and nutrient content of food served. A total of 129 schools comprising 77 national type, 31 Chinese and 21 Tamil vernacular schools in four different regions (northern, eastern, central and southern) of Peninsular Malaysia were selected for this study. The results of this cross-sectional study showed a need to improve the budget disbursement to schools. Most of the schools followed the guidelines provided by the Ministry of Education for selection of eligible children. The quality of food prepared by contracted (local community members) and voluntary (teachers) operators. The use of 10 recommended menus provided for a 2-week cycle by most of the schools has shown increased acceptance and less monotonous feeling towards the food among the children. Nutrient content of food served increased relatively with an increase in budget from RM0.45 to RM0.80 per child. Parents surveyed indicated that the program should continue as this will keep children from low income families from being hungry during school hours. A continued process of monitoring and evaluation is necessary to improve its implementation.
Introduction: Iontophoresis of vasoactive substances such as acetylcholine (ACh) and sodium nitroprusside (SNP) combined with Laser Doppler fluximetry (LDF) is a non-invasive tool used to determine microvascular endothelial function. This study aims to test the effect of sodium chloride on
non-specific vasodilatation when used as a vehicle in the process of iontophoresis. This study also aims to define the number of current pulses needed to get the maximum effect during iontophoresis with ACh and SNP using low current strength. Methods: The experiment was conducted in five healthy females. Baseline skin perfusion was taken before administration of seven current pulses. Current strength of 0.007 mA and current density of 0.01 mA/cm2 were used. Acetylcholine was used to assess endothelial dependent vasodilatation, while SNP was used to assess endothelial independent vasodilatation. The mean skin perfusion (AU) responses to the iontophoresis of ACh at the anodal and SNP at the cathode leads were recorded. Sodium chloride (0.9%) was used as a vehicle to obtain concentration of 1% for both ACh and SNP. Iontophoresis of pure vehicle (NaCl) was conducted on a separate day to observe the effect of vehicle only on the iontophoresis process at both anode and cathode. Results: Iontophoresis of NaCl showed no significant increase in perfusion compared to baseline at both anode and cathode. Significant increases in skin perfusion were observed with SNP and ACh; a plateau of ACh was reached from the 3rd pulse onwards; while the plateau of SNP was reached from the 4th pulse onwards. Conclusion: NaCl could be used as a vehicle for Ach and SNP during iontophoresis as it did not cause non-specific vasodilatation. Using five current pulses are adequate for iontophoresis of ACh and SNP to assess microvascular endothelial function.
The disposition kinetics and cumulative urinary excretion of sulfamethazine were compared in goats fed normally (control) and following a 72-hour period of starvation (fasting). The only pharmacokinetic parameter which showed a statistically significant difference between the two groups was the body (systemic) clearance. This decreased from 2.26 +/- 0.28 ml/min.kg (means +/- SD, n = 6) in the control group to 1.16 +/- 0.54 ml/min.kg in the fasting group (p less than 0.01). Since the apparent volume of distribution was not affected by starvation, the decreased clearance was attributed to slower metabolism of the drug. Because of the analytical method used to measure sulfamethazine concentrations in plasma and urine, no conclusion could be drawn as to whether the rates of hydroxylation or of acetylation, or both metabolic pathways were decreased in the starved condition.
A 3-year-old child presented with congenital bilateral facial nerve palsy with bilateral profound sensorineural hearing loss. High Resolution Computed Tomogram (HRCT) of the temporal bones found bilateral atresia of cochlear nerve canals, incomplete partition of the cochleae and narrow facial nerve canals. Magnetic resonance imaging (MRI) revealed bilateral hypoplasia of facial nerves and aplasia of both vestibulocochlear nerves. There have been no other reported cases with this presentation. The possible aetiology and treatment options for the patient are discussed. We highlighted the review of aplasia/hypoplasia of the facial nerve and hypoplasia of cochlear nerve canal.
Post-traumatic pseudoaneurysms of internal carotid arteries are uncommon. The patients may present with massive epistaxis due to rupture of the aneurysm into the sphenoid sinus. Early diagnosis and treatment is mandatory as the likelihood of exsanguinations increases with each subsequent episode of epistaxis. The clinical features of unilateral blindness and massive epistaxis after head injury should indicate the diagnosis. The high mortality of this entity underlines the importance of early angiography in these patients to confirm this diagnosis. We present 3 cases of post-traumatic aneurysm of the ICA.
Necrotizing fasciitis is an aggressive infection involving fascia and subcutaneous tissue thus causing infectious thrombosis of the nutrient vessels to the overlying skin ultimately leading to extensive necrosis. Although necrotizing fasciitis is common in the perineum, abdominal wall and extremities it is relatively uncommon in the head and neck region. This is a case report of a 65 year old female visiting from India who presented with diabetic ketoacidosis precipitated by cervical necrotizing fasciitis. Computed tomography imaging showed involvement of the left parapharyngeal space and there was soft tissue gas present. This patient subsequently underwent an emergency neck exploration and desloughing. Repeated pus culture studies isolated Klebsiella species as the sole pathogen. Our case illustrates that prompt diagnosis and treatment of cervical necrotizing fasciitis can ensure a good outcome.
Early identification and management of hearing impairment is very valuable. The goal standard measurement of hearing loss is by brainstem evoked response (BSER). This prospective study was conducted in Hospital University Kebangsaan Malaysia (HUKM) to determine the sensitivity and specificity of transient evoked otoacoustic emission (TEOAE) as a screening tool for hearing impairment from February 1999 to February 2000. One hundred and thirty-three newborns from postnatal ward and seventy-eight newborns from neonatal intensive care unit (NICU) were screened for possible hearing loss using portable TEOAE. This study showed that TEOAE is a very sensitive but moderately specific screening tool.