Threatened miscarriage is a common complication of pregnancy. Despite initial viability confirmation by ultrasound scan, some of these patients had further spontaneous abortion. A highly sensitive and specific biomarker would be useful to determine the outcome of pregnancy and to prevent emotional impact to these women. A prospective 14-month cohort study was conducted in the Obstetrics and Gynaecology Department of Universiti Kebangsaan Malaysia Medical Centre to determine whether low serum levels of pregnancy-associated plasma protein A (PAPP-A) measured in early pregnancy can predict the outcome of threatened abortion. 42 pregnant women between 6 to 22 weeks of gestation with threatened abortion and 40 controls were enrolled. Serum samples were collected at presentation and PAPP-A was assayed by electrochemiluminescent immunoassay technique. Pregnancies were followed-up until 22 weeks of gestations and the outcome documented. Nine patients (11%) developed spontaneous abortion and 73 patients (89%) had successful pregnancy. The median PAPP-A level was significantly lower in patients with spontaneous abortion compared to those who had successful pregnancies in the threatened abortion group: 0.78 MoM (0.41-1.00 MoM) vs 1.00 MoM (1.00-2.0 MoM) respectively (p < 0.05). The best sensitivity of 44% and specificity of 93% were obtained at the cut of value of 0.66 MoM (95% CI, 0.561-0.773). In conclusion, low PAPP-A value in threatened abortion women is associated with pregnancy failure, although the use of PAPP-A as a one-time single marker has limited value.
Nonsteroidal anti-inflammatory drugs and their adverse effects on the gastric mucosa are yet another set of unresolved medical problems. This study examined the effects of various antioxidants on several gastric parameters after a single exposure to indomethacin. Forty-eight male rats of the Sprague-Dawley (200-250 g) strain were randomly divided to receive a single antioxidant (tocopherol, tocotrienol, or ubiquinone) or a combination of two (tocopherol-tocotrienol, tocopherol-ubiquinone or tocotrienol-ubiquinone) for 28 days. The rats were then challenged with a single dose of indomethacin and killed six hours later. Findings showed that the severity of gastric lesions was comparable in all groups. Only groups that received a combination of antioxidants exhibited reduced lipid peroxidation compared with all other groups (p < 0.05). The combination groups had a higher level of gastric prostaglandin E2 (PGE2) content compared with all other groups (p < 0.05). There was no significant difference among the groups in the gastric acid concentration and the glutathione/oxidized glutathione (GSH/GSSG) ratio. We conclude that although supplementation of these antioxidants in combination had desirable effects on lipid peroxidation and gastric PGE2 level, they did not reduce the lesions produced by indomethacin.
Staphylococcus aureus infection remains the commonest organism causing musculoskeletal infection and antibiotic is the mainstay of treatment apart from adequate and appropriate surgical intervention. The exact figure of antibiotic resistance in orthopaedic practice is not known but it is expected to be higher than previously reported as the use of antibiotics is rampant. Its sensitivity to various antibiotics differs from one center to another making local surveillance necessary. From 66 patients with musculoskeletal infections studied in our centre, Staphylococcus aureus was cultured in 50-65% of patients, depending on the sample taken. Fifteen percent of this were methicillin resistant Staphylococcus aureus (MRSA). Staphylococcus aureus was found to be sensitive to cloxacillin in 95% of patients' sample. MRSA remained highly sensitive to vancomycin, clindamycin and fucidic acid.
Cross-correlating two surface EMG signals detected at two different locations along the path of flow of action potential enables the measurement of the muscle fiber average conduction velocity in those active motor units monitored by the electrodes. The position of the peak of the cross-correlation function is the time delay between the two signals and hence the velocity may be deduced. The estimated velocity using this technique has been observed previously to depend on the location of the electrodes on the muscle surface. Different locations produced different estimates. In this paper we present a measurement system, analyze its inherent inaccuracies and use it for the purpose of investigating the reliability of measurement of conduction velocity from surface EMG. This system utilizes EMG signals detected at a number of locations on the biceps brachii, when under light tension, to look for any pattern of variations of velocity as a function of location and time. It consists of a multi-electrode unit and a set of eight parallel on-line correlators. The electrode unit and the parallel correlators ensure that these measurements are carried out under the same physical and physiological conditions of the muscle. Further, the same detected signals are used in different measurement configurations to try to understand the reasons behind the observed variations in the estimated velocity. The results obtained seem to suggest that there will always be an unpredictable random component superimposed on the estimated velocity, giving rise to differences between estimates at different locations and differences in estimates with time at the same location. Many factors contribute to this random component, such as the non-homogeneous medium between the muscle fibers and the electrodes, the non-parallel geometry and non-uniform conduction velocity of the fibers, and the physical and physiological conditions of the muscle. While it is not possible to remove this random component completely from the measurement, the user must be aware of its presence and how to reduce its effects.
A study was conducted among out-patients attending the Melaka Tengah Health Clinic to determine their compliance status towards antihypertensive, antidiabetic and antiasthmatic drugs. A total of 585 patients were enrolled in this study. Assessment of compliance was carried out using pill-counting and house-to-house interviews 14 days from the date of medication dispensed at the counter. The noncompliance rate among the 464 successfully interviewed patients was 56%. The mean noncompliance percentage was 78.0 +/- 43.1% (range: -10.0-314.3%). Among the four variables of compliance studied, race was not seen as a determinant of compliance. The older age group and those taking two or more drugs were statistically significant to be a noncomplier. Females were highly likely not to comply with drug therapy. Patients who conform to their refill dates were not really drug compliers. Forgetting to take their drugs and inability to read instructions on drug labels were the main reasons given. Underdosing was more common than overdosing, with an estimated cost of RM20,261.00 of unused medications per year.
Study site: Klinik Kesihatan Melaka Tengah, Melaka, Malaysia
We are reporting a case of autologous blood transfusion in a patient who underwent a repair of her aortic aneurysm. Even though the operation was major and carried a high mortality, no homologous blood was used at all.
Thirty-six strains of Escherichia coli isolated from animals in Bario, a remote area in Sarawak, Malaysia, were examined for presence of plasmid DNA and their susceptibility to nine antimicrobial agents. Of the total 36 isolates, five bovine and six canine isolates were found to contain plasmid DNA ranging in sizes from 2.6 to 70 kilobases. All were susceptible to chloramphenicol, erythromycin, gentamicin, nalidixic acid and neomycin but resistance to ampicillin (47%), erythromycin (19%), streptomycin (25%) and tetracycline (11%) was observed. Resistance was associated with carriage of a 47 kb (SC98), 70 kb, (SC133) and 56 and 4.6 kb (SC119) plasmids which were transmissible to the Escherichia coli K12 recipient. It is concluded that animals form a potential reservoir of R plasmids carrying E. coli in the study area.
A series of chelating reagents, 1-phenyl-3-methyl-4-(2-fluorobenzoyl)-5-pyrazolone, 1-phenyl-3-methyl-4-(3-fluorobenzoyl)-5-pyrazolone and 1-phenyl-3-methyl-4-(4-fluorobenzoyl)-5-pyrazolone, has been synthesized. The extraction of Ln(III), (Ln = La, Eu and Lu) into chloroform with these reagents at 30 +/- 1 degrees has been studied. The composition of the complexes extracted has been determined by the slope method, and the extraction constants K(ex), were measured. The presence of the fluorine atom in the reagents does not make the K(ex), values much different from those obtained with the parent pyrazolone.
Similar to other surgical fraternities, endoscopic ear surgery (EES) faced great challenges during the COVID-19 pandemic. Many elective operations involving EES needed to be postponed, resulting in accumulated cases. Throughout one year during COVID-19, Hospital Sultan Ismail, Johor, Malaysia continued to perform various EES procedures. Although EES is an aerosol-generating procedure, it has become evidence that this minimallyinvasive surgical approach offers lesser bony drilling and shorter operative time as compared to open mastoidectomy. Thus, this reduced the risk of viral transmission to the surgeons and operating staffs.
Fourier transform infrared (FT-IR), X-ray diffraction (XRD), and transference number measurement (TNM) techniques were applied to investigate the complexation, structural, and ionic transport properties of and the dominant charge-carrier species in a solid biopolymer electrolyte (SBE) system based on carboxymethyl cellulose (CMC) doped with ammonium fluoride (NH4F), which was prepared via a solution casting technique. The SBEs were partially opaque in appearance, with no phase separation. The presence of interactions between the host polymer (CMC) and the ionic dopant (NH4F) was proven by FT-IR analysis at the C-O band. XRD spectra analyzed using Origin 8 software disclose that the degree of crystallinity (χc%) of the SBEs decreased with the addition of NH4F, indicating an increase in the amorphous nature of the SBEs. Analysis of the ionic transport properties reveals that the ionic conductivity of the SBEs is dependent on the ionic mobility (μ) and diffusion of ions (D). TNM analysis confirms that the SBEs are proton conductors.
Addition of doping materials can possibly enhance the ionic conduction of solid polymer electrolyte (SPE). In this work, a new SPE using 2-hydroxyethyl cellulose (2-HEC) incorporated with different ammonium nitrate (NH4NO3) composition was prepared via solution casting method. Studies of structural properties were conducted to correlate the ionic conductivity of 2-HECNH4NO3SPE using X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. Encouraging result was obtained as the ionic conductivity increased about two orders of magnitude upon addition of 12wt% of NH4NO3. XRD analysis shows the most amorphous SPE was obtained at 12-NH4NO3. From FTIR spectra, the interactions between 2-HEC and NH4NO3were observed by the shifts of COH peak from 1355cm-1to 1330cm-1and the presence of new NH peak in the OH region. The spectrum has been validated theoretically using Gaussian software. The results obtained from this study corroborate that the complexes of 2-HEC and NH4NO3responsible to promote the ionic conductivity to the higher value.
The plasticized solid bio-polymer electrolytes (SBEs) system has been formed by introducing glycerol (Gly) as the plasticizer into the carboxymethyl cellulose (CMC) doped with oleic acid (OA) via solution casting techniques. The ionic conductivity of the plasticized SBEs has been studied using Electrical Impedance Spectroscopy. The highest conductivity achieved is 1.64 × 10(-4) S cm(-1) for system containing 40 wt. % of glycerol. FTIR deconvolution technique had shown that the conductivity of CMC-OA-Gly SBEs is primarily influenced by the number density of mobile ions. Transference number measurement has shown that the cation diffusion coefficient and ionic mobility is higher than anion which proved the plasticized polymer system is a proton conductor.
Honey is rich in phenolic compounds, which act as natural antioxidants and are becoming increasingly popular because of their potential role in contributing to human health. A wide range of phenolic constituents is present in honey like quercetin, caffeic acid phenethyl ester (CAPE), acacetin, kaempferol, galangin which have promising effect in the treatment of cardiovascular diseases. Many epidemiological studies have shown that regular intake of phenolic compounds is associated with reduced risk of heart diseases. In coronary heart disease, the protective effects of phenolic compounds include mainly antithrombotic, anti-ischemic, anti-oxidant, and vasorelaxant. It is suggested that flavonoids decrease the risk of coronary heart disease by three major actions: improving coronary vasodilatation, decreasing the ability of platelets in the blood to clot, and preventing low-density lipoproteins (LDLs) from oxidizing. In this review paper, we discussed the preventive role of polyphenols of honey against cardiovascular diseases.
The amino acid compositions of bovine, porcine and fish gelatin were determined by amino acid analysis using 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate as derivatization reagent. Sixteen amino acids were identified with similar spectral chromatograms. Data pre-treatment via centering and transformation of data by normalization were performed to provide data that are more suitable for analysis and easier to be interpreted. Principal component analysis (PCA) transformed the original data matrix into a number of principal components (PCs). Three principal components (PCs) described 96.5% of the total variance, and 2 PCs (91%) explained the highest variances. The PCA model demonstrated the relationships among amino acids in the correlation loadings plot to the group of gelatins in the scores plot. Fish gelatin was correlated to threonine, serine and methionine on the positive side of PC1; bovine gelatin was correlated to the non-polar side chains amino acids that were proline, hydroxyproline, leucine, isoleucine and valine on the negative side of PC1 and porcine gelatin was correlated to the polar side chains amino acids that were aspartate, glutamic acid, lysine and tyrosine on the negative side of PC2. Verification on the database using 12 samples from commercial products gelatin-based had confirmed the grouping patterns and the variables correlations. Therefore, this quantitative method is very useful as a screening method to determine gelatin from various sources.
This is a review of research done in the area of substance abuse in Malaysia. There were 109 articles related to substance abuse found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. Only 39 articles were reviewed, and case series, case report, reviews and reports were excluded. Research reviewed include the epidemiology of substance abuse, genetics, treatment and its relation to health behaviour, and health management. Studies have shown that more males than females use drugs. There was also a high prevalence of blood-bourne virus diseases and sexually transmitted diseases among drug users. Two studies showed some genetic polymorphism (Cyp 3a4 gene and FAAH Pro129Thr) among heroin and amphetamine users respectively that may contribute to drug dependence. Study on pharmacological treatment for substance abuse were limited to methadone and it was shown to improve the quality of life of heroin dependant patients. Alternative treatments such as acupunture and spiritual approach play a role in the management of substance abuse. Data also showed that treatment centres for substance abuse are lacking facilities for screening, assessment and treatment for medical illness related to substance use, e.g. Hepatitis C and tuberculosis. Studies on the effectiveness of current drug rehabilitation centres were inconclusive.
This study investigated improvements in quality of life associated with eight weeks of montelukast and/or intranasal steroid treatment for moderate to severe allergic rhinitis.
In-house method validation was conducted to determine amino acid composition in gelatin by a pre-column derivatization procedure with the 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate reagent. The analytical parameters revealed that the validated method was capable of selectively performing a good chromatographic separation for 18 amino acids in less than 40 min; the overall detection and quantitation limit for amino acids fell into ranges of 5.68-12.48 and 36.0-39.0 pmol/μl, respectively; the matrix effect was not observed, and the linearity range was 37.5-1000 pmol/μl. The accuracy (precision and recovery) analyses of the method were conducted under repeatable conditions on different days in random order. Method precision revealed by HorRat values was significantly less than 2, except for histidine with a precision of 2.19, and the method recoveries had a range of 80-115% except for alanine which was recovered at 79.4%. The findings were reproducible and accurately defined, and the method was found to be suited to routine analysis of amino acid composition in gelatin-based ingredients.
Mycotic descending thoracic aneurysm with aortobronchial fistula is a rare condition which is associated with high mortality. Treatment in the era of minimally invasive procedure can often be controversial. The risk of graft infection should be considered as well as the unknown long term behavior of the endovascular stent. Here, we describe our initial experience of performing emergency thoracic endovascular aneurysm repair in an unstable patient presenting with haemoptysis.
Arteriovenous malformation (AVM) are commonly congenital in origin. We hereby describe the case of a 24-year-old male who was diagnosed of left thigh intramuscular AVM at the time of 14 years old. The computerized tomography (CT) scan confirmed a large deep seated intramuscular AVM with the size of 20 x 15 cm, with dilated and distended feeding vessel from profunda femoris artery (PFA) and superficial femoral artery (SFA). He also had another AVM near the left supracondylar region adherent to the sciatic nerve. The main AVM lesion was earlier treated with surgical resection and it remained for asymptomatic for next seven years. Following this, the patient presented again to the clinic with recurring swelling, pain and occasional paraesthesia on the same site. He was then managed with a series of embolization (total of 6 attempts) with histoacryl glue. These attempts of embolization were successful. The interesting case of pulmonary embolism due histoacryl glue following embolization of an AVM is described.