Enterococci are commonly found in humans, animals and environments. Their highly adaptive mechanisms are related to several virulent determinants and their ability to resist antibiotics. Data on the relationship between the esp gene, biofilm formation and antibiotic susceptibility profiles may differ between countries. This cross-sectional study was conducted to determine the proportion of esp gene and biofilm formation among Enterococcus faecalis and Enterococcus faecium clinical isolates. We also investigated the possible association between the esp gene with antibiotic susceptibility patterns and biofilm formation. The isolates were collected from clinical samples and identified using biochemical tests and 16SRNA. Antibiotic susceptibility patterns and a biofilm assay were conducted according to the established guidelines. Molecular detection by PCR was used to identify the esp gene using established primers. In total, 52 and 28 of E. faecalis and E. faecium were identified, respectively. E. faecium exhibited higher resistance rates compared to E. faecalis as follows: piperacillin/tazobactam (100% versus 1.9%), ampicillin (92.8% versus 1.9%), high-level gentamicin resistance (HLGR) (89.3% versus 25.0%) and penicillin (82.1% versus 7.7%). E. faecium produced more biofilms than E. faecalis (59.3% versus 49.0%). E. faecium acquired the esp gene more frequently than E. faecalis (78.6% versus 46.2%). Interestingly, the associations between ampicillin and tazobactam/piperacillin resistance with the esp gene were statistically significant (X2 = 4.581, p = 0.027; and X2 = 6.276, p = 0.012, respectively). Our results demonstrate that E. faecium exhibits high rates of antimicrobial resistance, esp gene acquisition and biofilm formation. These peculiar traits of E. faecium may have implications for the management of enterococcal infections in hospitals. Thus, concerted efforts by all parties in establishing appropriate treatment and effective control measures are warranted in future.
The worldwide declining trend in male fertility has been a steady concern since the past few decades. Male infertility reportedly accounts for half of the overall infertility cases in the world. Despite the evidences of reduced fertility rates in Malaysia in the recent years, there is lack of interventions regarding the reproductive parameters in Malaysian men. Complexity in determining the underlying causatives in most of the male subfertility and infertility cases limits the scope of management. The sociodemographic impacts upon overall health as well as on reproductive health of men are undeniable. The present study has analysed the data collected from patients' records in the Fertility Clinic, International Islamic University Malaysia (IIUM), from the January 2009 until December 2018. A total of 300 male patients were included in the study and were categorised according to their seminal fluid analysis (SFA) records. The sociodemographic characteristics for each subject were analysed. The results presented significant correlations among essential sociodemographic factors, such as educational attainment, marital duration as well as the age of wife, with the levels of semen abnormalities in the subjects. The study thereby unleashes scope for further investigations focusing upon the demographic factors for better insights to ameliorate male reproductive health in the Malaysian population.
Mixed-species flocks (MSFs) serve important roles in bird communities, especially in tropical forests. Although structure of mixed-species bird flocks and its benefits has been intensively studied globally, the foraging plasticity of a species when joining MSFs has rarely been evaluated. The present study examines foraging strategies of the Rufous-crowned Babbler (Malacopteron magnum), Chestnut-winged Babbler (Cyanoderma erythropterum) and Black-naped Monarch (Hypothymis azurea) when participating in MSFs in the Krau Wildlife Reserve, central Peninsular Malaysia. These species exhibit active foraging shifts in utilisation of vertical strata, foraging substrate, attack manoeuvres and foliage density, when foraging in MSFs, compared to when foraging outside MSFs. While the Rufous-crowned Babbler and Chestnut-winged Babbler commonly used gleaning and stretching (to completely extend the legs or neck to reach the food items) manoeuvres when foraging outside MSFs, respectively, they adopted probing manoeuvre and frequently used higher strata upon joining MSFs. The Chestnut-winged Babbler tended to forage on the underside of leaves and the Black-naped Monarch frequently utilised branches when joining MSFs, while they exclusively used aerial leaf litter and live green leaves, respectively, when foraging with conspecifics. The monarch also adopted the hovering manoeuvre and frequently foraged within denser foliage cover when joining MSFs. This study demonstrated that flock members exhibits foraging plasticity either through an expansion or active shift in foraging niches when participating in MSFs, thus suggesting the occurrence of possible foraging improvement and/or reductions in predation risk.
Quarter vehicle model is the simplest representation of a vehicle that belongs to lumped-mass vehicle models. It is widely used in vehicle and suspension analyses, particularly those related to ride dynamics. However, as much as its common adoption, it is also commonly accepted without quantification that this model is not as accurate as many higher-degree-of-freedom models due to its simplicity and limited degrees of freedom. This study investigates the trade-off between simplicity and accuracy within the context of quarter vehicle model by determining the effect of adding various modeling details on model accuracy. In the study, road input detail, tire detail, suspension stiffness detail and suspension damping detail were factored in, and several enhanced models were compared to the base model to assess the significance of these details. The results clearly indicated that these details do have effect on simulated vehicle response, but to various extents. In particular, road input detail and suspension damping detail have the most significance and are worth being added to quarter vehicle model, as the inclusion of these details changed the response quite fundamentally. Overall, when it comes to lumped-mass vehicle modeling, it is reasonable to say that model accuracy depends not just on the number of degrees of freedom employed, but also on the contributions from various modeling details.
A young adult patient with 46XX congenital adrenal hyperplasia (CAH) presented with recurrent painful haematuria. CAH was diagnosed at birth following ambiguous genitalia. Hormonal treatment was started, female gender was assigned and feminising genitoplasty was planned, however the patient was lost to follow-up. Gender dysphoria started to occur during childhood which prompted the family to raise the patient as a boy. He eventually identified himself as a male. Examination revealed a male phenotype with severely virilised genitalia. Imaging studies confirmed the presence of uterus with low confluent urogenital sinus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and the troublesome symptoms were cured.
Research has shown that rehabilitation lower limb exoskeletons (RLLEs) are effective tools for improving recovery or regaining lower limb function. This device interacts with the limbs of patients. Thus, actuators and power transmission mechanisms are the key factors in determining smooth human‒machine interaction and comfort in physical therapy activities. A multitude of distinct technologies have been proposed. However, we questioned which consideration point in actuator selection and power transmission mechanisms are used for RLLE. A review of the technical characteristics and status of advanced RLLE designs is discussed. We review actuator selection for RLLE devices. Furthermore, the power transmission mechanisms over the years within each of the RLLE devices are presented. The development issues and possible research directions related to actuators and power transmission mechanisms are provided. Most RLLEs are still in the research phase, and only a few have been commercialized. The aim of this paper is to provide researchers with useful information for investigating technological progress and highlight the latest technological choices in RLLE development.
The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher's exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17-7.92). Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated.
Recent studies suggested that Eurycoma longifolia, a herbal plant, may have the potential to treat osteoporosis in elderly male. This study aimed to determine the effects of Eurycoma longifolia supplementation on the trabecular bone microarchitecture of orchidectomised rats (androgen-deficient osteoporosis model). Forty-eight-aged (10-12 months old) Sprague Dawley rats were divided into six groups of sham-operated (SHAM), orchidectomised control (ORX), orchidectomised + 7 mg/rat testosterone enanthate (TEN) and orchidectomised + Eurycoma longifolia 30 mg/kg (EL30), orchidectomised + Eurycoma longifolia 60 mg/kg (EL60), orchidectomised + Eurycoma longifolia 90 mg/kg (EL90). Rats were euthanized following six weeks of treatment. The left femora were used to measure the trabecular bone microarchitecture using micro-CT. Orchidectomy significantly decreased connectivity density, trabecular bone volume, and trabecular number compared to the SHAM group. Testosterone replacement reversed all the orchidectomy-induced changes in the micro-CT parameters. EL at 30 and 60 mg/kg rat worsened the trabecular bone connectivity density and trabecular separation parameters of orchidectomised rats. EL at 90 mg/kg rat preserved the bone volume. High dose of EL (90 mg/kg) may have potential in preserving the bone microarchitecture of orchidectomised rats, but lower doses may further worsen the osteoporotic changes.
The dynamic behavior of a body-in-white (BIW) structure has significant influence on the noise, vibration, and harshness (NVH) and crashworthiness of a car. Therefore, by improving the dynamic characteristics of BIW, problems and failures associated with resonance and fatigue can be prevented. The design objectives attempt to improve the existing torsion and bending modes by using structural optimization subjected to dynamic load without compromising other factors such as mass and stiffness of the structure. The natural frequency of the design was modified by identifying and reinforcing the structure at critical locations. These crucial points are first identified by topology optimization using mass and natural frequencies as the design variables. The individual components obtained from the analysis go through a size optimization step to find their target thickness of the structure. The thickness of affected regions of the components will be modified according to the analysis. The results of both optimization steps suggest several design modifications to achieve the target vibration specifications without compromising the stiffness of the structure. A method of combining both optimization approaches is proposed to improve the design modification process.
The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.
INTRODUCTION: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts.
OBJECTIVES: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues.
METHODS: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques.
RESULTS: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra-observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment.
CONCLUSION: Semi-automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.
The Bio-ecological Drainage System, or BIOECODS, is an urban drainage system located at the Engineering Campus, Universiti Sains Malaysia. It consists of a constructed wetland as a part of the urban drainage system to carry storm water in a closed system. In this closed system, the constructed wetland was designed particularly for further treatment of storm water. For the purpose of studying the water balance of the constructed wetland, data collection was carried out for two years (2007 and 2009). The results show that the constructed wetland has a consistent volume of water storage compared to the outflow for both years with correlation coefficients (R(2)) of 0.99 in 2007 and 0.86 in 2009.
Sporotrichosis is a mycosis caused by a saprophytic dimorphic fungus named Sporothrix schenckii. Infections occur following traumatic inoculation of fungus from plants and infected cat bites and scratches. We report a case of a farmer who presented with a solitary subcutaneous nodule initially diagnosed as a soft tissue tumour. A history of agricultural activity and feline contact should draw the clinician's attention to sporotrichosis, as the diagnosis can be easily missed in atypical cases. The diagnosis, microbiology and management of the case are discussed.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral complications after radiation therapy. The management of xerostomia has been reviewed in Part I of this series. In this article, the management of dental caries, a sequalae of xerostomia following radiation therapy is reviewed.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they receive radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. Part I of this series reviews the management of xerostomia. The management of the effect of xerostomia to the dentition/oral cavity is discussed in Part II.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. Osteoradionecrosis (ORN) is a severe debilitating condition that impairs healing due to reduction in vascularity and osteocyte population in the affected bone. This article reviews methods of treatment used to treat ORN such as antibiotics, hyperbaric oxygen therapy, therapeutic ultrasound, surgery, and other modalities.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. The management of radiation-induced caries, a sequelae of xerostomia has been reviewed in Part II of this series. In this article, the management of difficulty with dentures, another sequelae of xerostomia following radiation therapy is reviewed.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. The last part of this series reviews the opportunistic infections that can occur to the perioral structure. Their management is briefly discussed.
Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. The second last part of this series reviews and discusses the management of complication that commonly occur to the oral mucosa, i.e. mucositis.
Susuk, or charm needles, are inserted and worn subcutaneously in the face and other parts of the body, as they are believed to enhance beauty and youth, and for many other reasons such as treatment of headache, aches and pains in the joints, back or abdomen. The practice of inserting susuk is a traditional belief, genuinely cultural and superstitious, and common in the south-east Asian region. We present 13 cases of susuk, which was found incidentally on the radiographs as the patients came for various types of treatment at our centre.