MATERIALS AND METHODS: Seventy-two epoxy replicated dies from two prepared maxillary right central incisors acrylic typodont were divided into two groups of different preparation designs (n = 36): Group I, incisal butt-joint, and Group P, incisal overlap. Each group was further subdivided into two equal groups according to ceramic material (n = 18): Group E, IPS e.max CAD, and Group T, Tessera advanced lithium disilicate (ALD) CAD-CAM blocks. The replica technique was used to assess the internal fit using a stereomicroscope at 45× magnification. Laminate veneers were cemented to their corresponding epoxy dies, then the vertical marginal gap was evaluated before and after thermal cycling. Repeated measures analysis of variance (ANOVA) were used for marginal fit data and 2-way ANOVA for internal fit measurements (α = 0.05).
RESULTS: For internal fit, there were no significant differences between tested groups. For vertical marginal gap results, two-way ANOVA showed that only aging had a significant effect on the vertical marginal gap (p
DESIGN: Randomised trial.
SETTING: University Hospital, Malaysia: April 2016-April 2017.
POPULATION: One hundred and sixty women hospitalised for HG.
METHOD: Women were randomised upon admission to fasting for 12 hours or expedited oral feeding. Standard HG care was instituted.
MAIN OUTCOME MEASURE: Primary outcome was satisfaction score with overall treatment at 24 hours (0-10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrolment, and at 8, 16 and 24 hours.
RESULTS: Satisfaction score, median (interquartile range) 8 (5-9) versus 8 (7-9) (P = 0.08) and 24-hour vomiting episodes were 1 (0-4) versus 1 (0-5) (P = 0.24) for 12-hour fasting versus expedited feeding, respectively. Repeated measures analysis of variance of nausea scores over 24 hours showed no difference (P = 0.11) between trial arms. Participants randomised to 12-hour fasting compared with expedited feeding were less likely to prefer their feeding regimen in future hospitalisation (41% versus 65%, P = 0.001), to recommend to a friend (65% versus 84%, P = 0.01; RR 0.8, 95% CI 0.6-0.9) and to adhere to protocol (85% versus 95%, P = 0.04; RR 0.9, 95% CI 0.8-1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different.
CONCLUSION: Advisory of 12-hour fasting compared with immediate oral feeding resulted in a non-significant difference in satisfaction score but adherence to protocol and fidelity to and recommendation of immediate oral feeding to a friend were lower. The 24-hour nausea scores and vomiting episodes were similar.
TWEETABLE ABSTRACT: Women hospitalised for hyperemesis gravidarum could feed as soon, as much and as often as can be tolerated compared with initial fasting.
MATERIALS AND METHODS: Invasive and local species growth pattern was also estimated using length-weight analysis. Sampling was conducted using cast net and electric shock in each river twice in 12 months. Fish collected were identified, photo captured and measured for their weight and length. The growth pattern was also estimated using length-weight analysis.
RESULTS: A total of 188 fishes were caught, comprises of 8 families and 15 species (ten local species with 119 individuals and five alien species with 69 individuals). Sistomus binotatus was the most dominant local species, whereas Tilapia nilotica was the most dominant alien species. There is no significant difference in composition between local and invasive species occur indicates the raise of alien species in those ecosystems even local species still dominated. The growth pattern for Sistomus binotatus and Clarias batrachus is isometric in the pristine ecosystem but negative isometric in disturbed rivers. Contrary, Tilapia nilotica has isometric for both ecosystems.
CONCLUSION: This study concluded the capability and potential of colonization of alien species in stress ecosystem especially Tilapia nilotica. Thus, there is potential colonization of alien in Malaysia freshwater systems and a threat to local species due to food competition, site preferences and survival ability.
MATERIAL AND METHODS: A total of 58 patients who underwent elective surgery under general anaesthesia were randomised to two ETT groups, the PFT group (n = 29) and the UFR group (n = 29), for OFI in simulated difficult intubation patients using a rigid cervical collar. After successful standardised induction and relaxation, OFI and railroading of selected ETT were subsequently performed by a similarly experienced practitioner. Ease of insertion, degree of manipulation, time to successful intubation, post-intubation complications and haemodynamic changes were recorded for both groups.
RESULTS: he percentage of easy intubation was comparable between both groups with a slightly higher percentage in the UFR group than the PFT group (69.0% vs. 62.0%; P = 0.599). Degree of manipulation was also comparable between the two groups; the percentage of cases in which manipulation was not required was slightly higher in the UFR group than the PFT group (69.0% vs. 62.1%; P = 0.849). Time to successful intubation was also comparable between the groups, although the time was slightly shorter for the UFR group than the PFT group (56.9 s ± 39.7 s vs. 63.9 s ± 36.9 s; P = 0.488). There were also no significant differences in other parameters.
CONCLUSIONS: The Parker flex tip ETT was comparable to the unoflex reinforced ETT for OFI in simulated difficult airway patients.
SETTING: Obstetric unit of a university hospital in Kuala Lumpur, Malaysia.
POPULATION: Women admitted for a planned caesarean under spinal anaesthesia.
METHODS: Participants were randomised to a sandwich meal served immediately on return to the ward or on-demand.
MAIN OUTCOME MEASURES: Primary outcomes were patient satisfaction VAS (visual analog scale of 100 mm) on the feeding regimen and vomiting at 24 hours.
RESULTS: 453 women were initially enrolled, 395 were randomised and available for analysis. Median (full range) patient satisfaction VAS scores were 82 (15-100) versus 84 (0-100) mm, P = 0.88 and vomiting rates were 1/197 (0.5%) versus 2/198 (1.0%), P > 0.99 for immediate compared with on-demand feeding, respectively. The immediate versus on-demand arms first ate at a median of 105 (35-210) versus 165 (45-385) minutes, P
CASE PRESENTATION: A 25-year-old super morbidly obese female (body mass index = 55 kg/meter2) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home.
DISCUSSION: The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status.
CONCLUSION: Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.
Methods: FSMS-DI was used to evaluate the context factors, core control and core assurance activities of five powdered beverage manufacturers with different types of FSMS certification. Manufacturer A is not certified with any FSMS, while manufacturers B, C, D and E are complied with MeSTI, GMP, HACCP and ISO 22000, respectively. For MAS, samples were collected from the selected critical sampling locations of two manufacturers who complied FSMS with the least (manufacturer B) and the most stringent (manufacturer E) requirements. The samples consisted of two different types of powdered beverage products were analysed for total plate count (TPC), Salmonella, Escherichia coli, Staphylococcus aureus, yeast and mould count (YMC). Results: The food safety (FS) output of powdered beverages for manufacturer E was better (overall score of 3) than manufacturer B (overall score of 2-3). Manufacturer E was able to achieve their FS objectives. The FSMS activities of manufacturer C, D and E were better (overall score of 2-3) than manufacturer A and B (overall score of 1-2).
Conclusion: The study demonstrated that FSMS-DI and MAS can be used to differentiate the FSMS performance of powdered beverage manufacturers with different types of FSMS certification. Higher scores of FSMS activities obtained by the manufacturer who complied with stringent FSMS certifications contributed to better microbiological safety performance of powdered beverages.
MATERIAL AND METHODS: A total of 66 adult patients underwent elective surgery under general anaes-thesia, and they were randomized to two groups: the Air-Q (AQ) group (n = 33) and the Ambu AuraGain (AA) group (n = 33). A simulated cervical spine injury was created using a cervical collar, which was applied after the induction of general anaesthesia. Ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, oropharyngeal leak pressure (OLP), Brimacombe score for FO laryngeal view, post-intubation complications and haemodynamic changes were recorded for both groups.
RESULTS: The OLP was significantly higher in the AA group than in the AQ group (34.9 ± 6.4 vs. 28.6 ± 7.8 cm H 2 O; P = 0.001). Otherwise, there were no significant differences in the ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, Brimacombe score for FO laryngeal view, haemodynamic parameters or complication rate between the two groups.
CONCLUSIONS: Air-Q was comparably effective as Ambu AuraGain as a conduit for FO endotracheal intubation in patients with a simulated cervical spine injury; however, Ambu AuraGain has a better seal with significant OLP.
OBJECTIVES: This study investigated the status of Bartonella infection in cats from eight (n = 8) shelters by molecular and serological approaches, profiling the CD4:CD8 ratio and the risk factors associated with Bartonella infection in shelter cats.
METHODS: Bartonella deoxyribonucleic acid (DNA) was detected through polymerase chain reaction (PCR) targeting 16S-23S rRNA internal transcribed spacer gene, followed by DNA sequencing. Bartonella IgM and IgG antibody titre, CD4 and CD8 profiles were detected using indirect immunofluorescence assay and flow cytometric analysis, respectively.
RESULTS: B. henselae was detected through PCR and sequencing in 1.0% (1/101) oral swab and 2.0% (1/50) cat fleas, while another 3/50 cat fleas carried B. clarridgeiae. Only 18/101 cats were seronegative against B. henselae, whereas 30.7% (31/101) cats were positive for both IgM and IgG, 8% (18/101) cats had IgM, and 33.7% (34/101) cats had IgG antibody only. None of the eight shelters sampled had Bartonella antibody-free cats. Although abnormal CD4:CD8 ratio was observed in 48/83 seropositive cats, flea infestation was the only significant risk factor observed in this study.
CONCLUSIONS: The present study provides the first comparison on the Bartonella spp. antigen, antibody status and CD4:CD8 ratio among shelter cats. The high B. henselae seropositivity among shelter cats presumably due to significant flea infestation triggers an alarm of whether the infection could go undetectable and its potential transmission to humans.
METHODS: A total of 74 obese parturients scheduled for elective CS under SA were randomised into two groups; Group A (n = 37) received prophylactic PE infusion starting at 50 μg min-1 and adjusted according to the given algorithm and Group B (n = 37) received 100 μg PE bolus to treat hypotension. The measured parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), the total requirement of PE and neonatal Apgar score.
RESULTS: Six patients were excluded from the analysis due to missing data and only 68 were analysed. Group A showed significantly higher SBP, DBP and MAP than Group B (P < 0.05). The requirement of PE was higher in Group A than Group B [817.7 (265.7) μg versus 360.6 (156.0) μg; P = < 0.05]. Both groups had no difference in terms of the neonatal Apgar score.
CONCLUSION: Prophylactic PE infusion provided better haemodynamic control than therapeutic boluses in obese parturients undergoing CS under SA.
MATERIAL AND METHODS: This is a randomised, double-blinded control trial which randomised samples to moderate NMB (train-of-four count [TOF] of 1 or 2) or deep NMB (post-tetanic count [PTC] of 1 or 2). Surgery began with IAP 8 mmHg but was allowed to increase the pressure if the surgical condition was unfavourable. The surgical condition was rated on a 4-point scale. Post-operative abdominal pain and shoulder tip pain was assessed using a numerical rating scale for pain, with 0 defined as no pain and 10 severe pain at recovery area (time 0), 30 minutes, and 24 hours post-operation.
RESULTS: Seventy patients completed the study. The rate of increasing IAP between the 2 groups ( P = 0.172) is not significant, but deep NMB requires less pressure - mean highest IAP of 10.31 (± 1.39) mmHg, moderate NMB 11.54 (± 1.69) mmHg. The mean surgical space condition score was significantly better in the deep NMB group at 2.4 (± 0.7) compared to moderate NMB at 3.2 (± 0.66), P < 0.005. There was a significantly lower post-operative abdominal pain score in deep NMB but no significant difference in shoulder tip pain score between the 2 groups.
CONCLUSIONS: Deep NMB enables the usage of lower IAP in laparoscopic surgery without interfering with surgical space condition, and it reduces the post-operative abdominal pain score in 24 hours compared to moderate NMB.