A 67-year-old mental institute resident was treated for smear-positive pulmonary tuberculosis. His background history included chronic essential hypertension which was well-controlled with amlodipine 10mg daily. However, his blood pressure became suboptimal one week into antitubercular treatment, necessitating escalation of antihypertensive therapy up to six medications. Following completion of antitubercular treatment, his blood pressure improved markedly. The number of antihypertensives was able to be reduced to only two after a month. We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.
The aim of this study was to characterize chicken skin gelatin/tapioca starch composite films with varying concentrations (0-5%) of zinc oxide nanoparticles using the casting technique. The incorporation of 5% zinc oxide nanoparticles increased the water vapor permeation (1.52-1.93 × 10-7 gmm/cm2hPa) and melting temperature of the films. The tensile strength (22.96-50.43 MPa) was increased, while elongation at break decreased with increasing concentrations of zinc oxide nanoparticles. The structures of the films were also investigated via Fourier transform infrared spectroscopy. The inhibitory zones for both the gram-positive (Staphylococcus aureus) (16-20 mm) and gram-negative (Escherichia coli) (15-20 mm) bacteria were larger in the film with 5% zinc oxide. Overall, chicken skin gelatin-tapioca starch composite films with 3% zinc oxide nanoparticles were found to have the optimal formulation, demonstrating good physical, mechanical and antibacterial properties. Gelatin-based composite films with nanoparticle incorporation show strong potential for use in biodegradable food packaging materials.
The increasing evidence that spirituality is a critical component for promoting health and well-being has made spirituality more significant to nursing practice. However, although nurses' perceptions of spirituality have been studied in western countries, there has been little research on this topic in Southeast Asian countries where religions other than Christianity predominate. This study explores Malaysian nurses' perceptions of spirituality and spiritual care and examines associations between socio-demographics and their perceptions. The Malaysian Nurse Forum Facebook closed group was used for data collection with 208 completed the online survey. The participants considered that spirituality is a fundamental aspect of nursing. Nonetheless, half of the respondents were uncertain regarding the use of the spiritual dimension for individuals with no religious affiliation. Significant differences were found between educational levels in mean scores for spirituality and spiritual care. There was also a positive relationship between perception of spirituality and spiritual care among the respondents. Despite the positive perceptions of nurses of spirituality in nursing care, the vast majority of nurses felt that they required more education and training relating to spiritual aspects of care, delivered within the appropriate cultural context.
12 years after the introduction of DNA-templated silver nanoclusters (DNA-AgNCs), exciting progress has been made and yet we are still in the midst of trying to fully understand this nanomaterial. The prominent excellence of DNA-AgNCs is undoubtedly its modulatable emission property, of which how variation in DNA templates causes emission tuning remains elusive. Based on the up-to-date DNA-AgNCs, we aim to establish the correlation between the structure/sequence of DNA templates and emission behaviour of AgNCs. Herein, we systematically present a wide-range of DNA-AgNCs based on the structural complexity of the DNA templates, including single-stranded DNA (ssDNA), double-stranded DNA (dsDNA), triple-stranded DNA (tsDNA) and DNA nanostructures. For each DNA category, we discuss the emission property, quantum yield and synthesis condition of the respective AgNCs, before cross-comparing the impact of different DNA scaffolds on the properties of AgNCs. A future outlook for this area is given as a conclusion. By putting the information together, this review may shed new light on understanding DNA-AgNCs while we are expecting continuous breakthroughs in this field.
Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and further characterised by Carteud.1 It is relatively rare, and the exact pathophysiology was not well known. Over the years, multiple treatment modalities were proposed. We report our experience with three cases of CRP which showed complete clearance with tetracycline group of antibiotics.
Pten deletion in the hematopoietic stem cells (HSC) causes a myeloproliferative disorder, which may subsequently develop into a T-cell acute lymphoblastic leukemia (T-ALL). β-catenin expression was dramatically increased in the c-KitmidCD3+Lin- leukemia stem cells (LSC) and was critical for T-ALL development. Therefore, the inactivation of β-catenin in LSC may have a potential to eliminate the LSC. In this study, we investigated the mechanism of enhancement of the β-catenin expression and subsequently used a drug to inactivate β-catenin expression in T-ALL. Western blot (WB) analysis revealed an increased level of β-catenin in the leukemic cells, but not in the pre-leukemic cells. Furthermore, the WB analysis of the thymic cells from different stages of leukemia development showed that increased expression of β-catenin was not via the pS9-GSK3β signaling, but was dependent on the pT308-Akt activation. Miltefosine (Hexadecylphosphocholine) is the first oral anti-Leishmania drug, which is a phospholipid agent and has been shown to inhibit the PI3K/Akt activity. Treatment of the PtenΔ/Δ leukemic mice with Miltefosine for different durations demonstrated that the pT308-Akt and the β-catenin expressions were inhibited in the leukemia blast cells. Miltefosine treatment also suppressed the TGFβ1/Smad3 signaling pathway. Analysis of TGFβ1 in the sorted subpopulations of the blast cells showed that TGFβ1 was secreted by the CD3+CD4- subpopulation and may exert effects on the subpopulations of both CD3+CD4+ and CD3+CD4- leukemia blast cells. When a TGFβR1 inhibitor, SB431542 was injected into the PtenΔ/Δ leukemic mice, the Smad3 and β-catenin expressions were down-regulated. On the basis of the results, we conclude that Miltefosine can suppress leukemia by degrading β-catenin through repression of the pT308-Akt and TGFβ1/Smad3 signaling pathways. This study demonstrates a possibility to inhibit Pten loss-associated leukemia genesis via targeting Akt and Smad3.
The article presents new results for plasma radiative compression in high-current discharges in the z-pinch configuration. The results are based on the 113 discharges performed in the plasma-focus PF-24 device operated with D2, Ar and (100%-x)D2+xAr mixtures, with Ar pressure fractions x ≈ 3-60% (mole fractions). The constant initial total pressure is about 2.9 mbar and the constant initial pressure of Ar is 1.2 mbar. Each experimental discharge was simulated individually using the 5-phase Lee model code to carry out the fitting procedure of the total discharge current waveform. The results from these 113 computed discharges fitted to the corresponding 113 experimental discharges show that the increase of the effective atomic number of the gas mixture increases the probability of occurrence of plasma radiative compression phenomenon. Relatively weak radiative compression was found for part of the discharges in 15-60% range of Ar mole fractions and in Ar, while the stronger radiative compression occurred for part of discharges in Ar only. This is because there was too little total x-ray line radiation emission during the equilibrium pinch lifetime related to the very small amount of swept up mass and the low current flow through pinched plasma, represented by the decreasing values of model parameters as the Ar mole fraction increases. The results show that the main pinch parameters influencing the occurrence and strength of radiative compression are: total x-ray line emission yield, effective atomic number, initial pinch radius, initial pinch ion number density and initial pinch ion/electron temperature.
Mycobacteriosis due to mycobacteria is one of the most common bacterial diseases in ornamental fish. We describe here the phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. using ATCC Mycobacterium marinum, Mycobacterium fortuitum and Mycobacterium chelonae as references. A total of four isolates (M1, M2, M3, M4) were obtained from four out of 106 fish samples using selective agar, and identified to Mycobacterium genus using acid-fast staining and 16s rRNA gene-based genus specific polymerase chain reaction. DNA sequencing and NCBI-BLAST analysis further identified isolate M1 as M. marinum and isolates M2, M3, M4 as M. fortuitum. Morphological, physiological and biochemical tests were carried out for phenotypic characterizations. Universal M13 and wild-type phage M13 RAPD dendogram was generated to illustrate the genetic relationship of the isolates and reference strains.
Severe dengue infection is life threatening as it can result in fatal complications such as intractable bleeding from coagulopathy, multiorgan failure from shock and haemophagocytic syndrome. There have been case reports of atypical manifestation of severe dengue infection such as pancreatitis, Guillian-Barre's syndrome, perforated viscus and myocarditis. However, to our knowledge, pancreatic pseudocyst from dengue-related pancreatitis has never been reported in the literature. We hereby report a case of infected pancreatic pseudocyst in a patient with persistent pyrexia, abdominal pain and raised inflammatory markers 10 weeks from the onset of severe dengue infection. Endoscopic ultrasound (EUS) guided transluminal drainage of the infected pancreatic pseudocyst with lumen-apposing metallic stent (LAMS) was performed with good clinical and radiological outcome.
Abdominal pain is one of the common presentations in severe dengue infection. We report a rare case of perforated gastric ulcer in a young man diagnosed with severe dengue infection and the challenges we faced in managing this patient. Perforated gastric ulcer need to be considered if there are signs of peritonitis and persistent abdominal pain that does not conform to the natural history of dengue. Proper imaging and early surgical intervention in perforated gastric ulcer is vital in preventing further complication and reducing the risk of mortality.
Locally advanced or recurrent carcinoma of the breast poses difficult management problems. These fungating and discharging tumours severely impair the quality of life in these unfortunate patients. We report two cases successfully treated with omental transposition flaps and split skin grafts. The operation is described in detail and the results discussed. This technique was found to be safe, effective and rewarding.
Both zinc and the α-subunit of hypoxia-inducible factor (HIF-1α) play important roles in the remodelling of mammary gland tissues. In the present study, we examined the level and the transcriptional activity of HIF-1α in mammary cells upon zinc treatment. In MCF-7 mammary adenocarcinoma and MCF-10A mammary epithelial cell lines, the toxicity levels of zinc differ. Interestingly, both cell lines overexpress HIF-1α following zinc treatment. As it was evident from an up-regulation of its specific target gene CA9 that encodes carbonic anhydrase IX, the stabilized HIF-1α translocated to the nucleus and was transcriptionally active. Hence, we conclude that zinc causes normoxic accumulation of transcriptionally active HIF-1α by interfering with its post-translational regulation.
In this study, a disposable and simple electrochemical immunosensor was fabricated for the detection of carcinoembryonic antigen. In this method, silver nanoparticles (AgNPs) were mixed with reduced graphene oxide (rGO) to modify the surface of screen-printed carbon electrode (SPE). Initially, AgNPs-rGO modified-SPEs were fabricated by using simple electrochemical deposition method. Then the carcinoembryonic antigen (CEA) was immobilized between the primary antibody and horseradish peroxidase (HRP)-conjugated secondary antibody onto AgNPs-rGO modified-SPEs to fabricate a sandwich-type electrochemical immunosensor. The proposed method could detect the CEA with a linear range of 0.05-0.50µgmL-1 and a detection limit down to 0.035µgmL-1 as compared to its non-sandwich counterpart, which yielded a linear range of 0.05-0.40µgmL-1, with a detection limit of 0.042µgmL-1. The immunosensor showed good performance in the detection of carcinoembryonic antigen, exhibiting a simple, rapid and low-cost. The immunosensor showed a higher sensitivity than an enzymeless sensor.
A 10 year-old Iban girl presented with severe odynophagia for 4 days and subcutaneous emphysema. Clinically, her neck was tender with crepitus. Lateral neck radiograph showed multiple linear radiolucent shadows at retropharyngeal space. Flexible nasopharyngolaryngoscope revealed a tunnel behind upper oesophagus with slough and there was pooling of saliva at pyriform sinus. Feeding via nasogastric tube was started and empirical treatment for fungal and bacterial infection was commenced. Subsequent computed tomography of neck and thorax showed a 15-long blind tract at subglottic region posterior to oesophagus (prevertebral region), extending to superior mediastinum just before carina at T3/T4 level, represent abscess. Hourly suctioning of the remaining abscess in the blind tract with 10ml-syringe was done.
Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with advanced cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients and their families. In Malaysian culture, families play a significant part in providing care to the dying. Connecting with families in patient care is therefore important. This paper reports a focused literature review evaluating studies on the care of the families of terminally ill people in palliative care environments in Malaysia.
Embryonal rhabdomyosarcoma is an exceedingly rare tumor in adult. We report an embryonal rhabdomyosarcoma of the ethmoid in a 59-year-old Iban lady who presented with proptosis and complete ptosis of her left eye for two months. Imaging investigations showed left ethmoidal and left orbital soft tissue mass with extradura and dura involvement. The patient was planned for chemotherapy. Unfortunately, in such an advanced disease, she succumbed before treatment.
This study was revealed the potential of Peperomia pellucida leaf extract as an immunostimulator agent in controlling motile aeromonad septicemia due to Aeromonas hydrophila in red hybrid tilapia, Oreochromis sp.