A total of 422 Mycobacterium tuberculosis isolates from eight countries were subjected to IS6110 and IS1081 DNA fingerprinting by means of restriction fragment analysis to characterize M. tuberculosis strains from each country. Chinese, Mongolian, Hong Kong, Filipino, and Korean isolates had comparatively more copies of IS6110 (proportion with eight or more copies; 95% +/- 5%), while Thai, Malaysian, and Vietnamese isolates had fewer copies (proportion with eight or more copies, 60% +/- 4%). We found a number of novel IS1081 types in this study. One IS1081 type was present in 56% of Filipino isolates, had a specific 6.6-kb PvuII fragment in its IS6110 DNA fingerprint, and was termed the "Filipino family." The IS1081 types of Thai isolates had interposing characteristics between the characteristics of northeastern Asian and southeastern Asian IS1081 types. A 1.3-kb single-copy IS6110 fragment was found only in Vietnamese M. tuberculosis isolates. Although M. tuberculosis isolates from each country had comparatively similar characteristics depending on the classification factor, each country's isolates showed characteristic DNA fingerprints and differed slightly from the isolates from the other countries in either the mode number of IS6110 copies or the distribution of IS1081 types.
Wounds are inevitable events that can occur daily due to many factors such as; physical, chemical and biological, which can cause tissue, cell and in some events bone damage. The process of wound healing is complicated as it involves many factors; therefore, an effective and safe agent is essential to ensure good healing process. Herbal medicine is considered safe and effective. Flaxseed (Linum usitatissimum) is an effective plant when it comes to wound healing and has been used for decades as a traditional healing agent. The bioactivities of flaxseed extract have been reported to demonstrate many beneficial effects such as antimicrobial, antioxidant and anti-inflammatory effects. It has been shown that flaxseed has positive effects on many types of wounds such as skin wound healing, burns and burn scar healing, bone healing and also has demonstrated positive results in the healing of oral ulceration besides exhibiting anti-bacterial effects in the oral cavity. This review describes the positive effects of flaxseed in multiple types of wound healing. Additionally, it is also aimed to introduce the potential applications of flaxseed in socket healing which involves series of complex changes to both soft and hard tissues in the oral cavity.
Dengue is life-threatening and the paediatric population is highly susceptible to complications. Deterioration can occur rapidly and ability to recognise early warning signs is crucial. This study aims to determine the knowledge and awareness of parents and carers and to predict their ability in recognising life-threatening symptoms and signs of dengue in children and to assess their health-seeking behaviour in dengue emergency. Methods This is a crosssectional study involving parents and carers of children ≤ 12 years old in schools and kindergartens in the Gombak district. Demographic details, knowledge on life-threatening symptoms and signs of dengue and health-seeking behaviour were collected using a self-administered questionnaire and knowledge scoring was done. The questionnaire was pilot tested with a Cronbach alpha of 0.82. The results were analysed using SPSS version 20.0. Results Total respondents were 866 with 44.8% men and 55.2% women. The mean age was 40.3 years (SD ± 5.7). Knowledge score of dengue life threatening features among respondents were good (30.0%) to average (56.8%). Respondents were able to recognise fever (98.5%), petechial rash (97.1%) and bleeding (65.2%) but were less able to recognise abdominal pain (22.3%) and passing less urine (28.2%) as life threatening dengue features. However, the ability to recognise fever is a poor predictor in recognising life threatening dengue in children compared to all other symptoms which were good predictors. A respondent that recognise stomach pain or neck stiffness were five times more likely to recognise life-threatening dengue. Respondents preferred to bring their children to the clinic (50.8%) or hospital (37.8%) themselves Instead of calling for ambulance. Worryingly, some would give antipyretics (3.6%) or wait for improvements (7.8%). Conclusion Concerted efforts by the schools, healthcare professionals and health authorities are required to educate parents and carers to identify life-threatening features of dengue and to improve their health seeking-behaviour.
This study aimed to estimate cost of in-patient medical care due to stroke in a tertiary hospital in Malaysia. A retrospective analysis of stroke patients admitted to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between January 2005 and December 2008 were conducted. Cost evaluation was undertaken from the health provider's perspective using a top-down costing approach. Mean length of stay (LOS) was 6.4 ± 3.1 days and mean cost of care per patient per admission was MYR 3,696.40 ± 1,842.17 or 16% of per capita GDP of the country. Human resources made up the highest cost component (MYR 1,343.90, SD: 669.8 or 36% of the total cost), followed by medications (MYR 867.30, SD:432.40) and laboratory services (MYR 337.90, SD:168.40). LOS and cost of care varied across different stroke severity levels (p<0.01). A regression analysis shown significant influence of stroke severity on cost of care, with the most severe stroke consumed MYR 1,598.10 higher cost than the mild stroke (p<0.001). Cost of medical care during hospital admission due to stroke is substantial. Health promotion and primary prevention activities need to take priority to minimise stroke admission in future.
In this work, we successfully isolated microcrystalline cellulose (MCC) from oil palm empty fruit bunch (OPEFB) fiber-total chlorine free (TCF) pulp using acid hydrolysis method. TCF pulp bleaching carried out using an oxygen-ozone-hydrogen peroxide bleaching sequence. Fourier transform infrared (FT-IR) spectroscopy indicates that acid hydrolysis does not affect the chemical structure of the cellulosic fragments. The morphology of the hydrolyzed MCC was investigated using scanning electron microscopy (SEM), showing a compact structure and a rough surface. Furthermore, atomic force microscopy (AFM) image of the surface indicates the presence of spherical features. X-ray diffraction (XRD) shows that the MCC produced is a cellulose-I polymorph, with 87% crystallinity. The MCC obtained from OPEFB-pulp is shown to have a good thermal stability. The potential for a range of applications such as green nano biocomposites reinforced with this form of MCC and pharmaceutical tableting material is discussed.
This analysis is a case-series to document the outcome of term newborns with hypoxic ischaemic encephalopathy (HIE), enrolled into total body hypothermia therapy, in a tertiary neonatal unit in Malaysia. The method used to achieve total body hypothermia is a novel method using just environmental temperature, without the need of expensive equipment. A total of 17 babies were eligible to be included in this study, from the 1st of January 2010 to the 31st of December 2010. 14 out of 15 babies who had Stage 2 HIE had no neurological deficit at follow-up. All Stage 3 HIE babies passed away. Allowing for the small sample size, we can conclude that total body hypothermia therapy is feasible and is a safe treatment modality for HIE Stage 2 babies in a Malaysian setting, by manipulating environmental temperature to achieve therapeutic hypothermia. Further work is needed to determine the long-term outcome of passive cooling total body hypothermia in Stage 2 HIE babies in Malaysia.
BACKGROUND AND AIMS: Many patients who presented to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with signs and symptoms of urolithiasis had mild hydronephrosis with non visualization of calculus on ultrasound examination. These patients underwent an intravenous urogram (IVU) in order to determine the presence of urolithiasis and most of them had normal IVU. The main aim of this study was to determine the predictive value of urinalysis in this group of patients in determining the need for IVU examinations.
MATERIALS AND METHODS: Retrospectively the ultrasound, urinalysis and intravenous urography reports of 53 patients were reviewed and evaluated.
RESULTS: The positive predictive and negative predictive value of urinalysis was found to be 68% and 96.4%, respectively. CONCLUSIONS; The results indicate that the urinalysis was an excellent negative predictor for IVU. In view of high radiation dose, risk of contrast reaction and contrast induced nephropathy of IVU, we suggest that it should not be performed in patient with non visualization of calculus mild hydronephrosis when the urinalysis is negative for blood.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
We investigate the geographical and historical context of diversification in a complex of mutualistic Crematogaster ants living in Macaranga trees in the equatorial rain forests of Southeast Asia. Using mitochondrial DNA from 433 ant colonies collected from 32 locations spanning Borneo, Malaya and Sumatra, we infer branching relationships, patterns of genetic diversity and population history. We reconstruct a time frame for the ants' diversification and demographic expansions, and identify areas that might have been refugia or centres of diversification. Seventeen operational lineages are identified, most of which can be distinguished by host preference and geographical range. The ants first diversified 16-20 Ma, not long after the onset of the everwet forests in Sundaland, and achieved most of their taxonomic diversity during the Pliocene. Pleistocene demographic expansions are inferred for several of the younger lineages. Phylogenetic relationships suggest a Bornean cradle and major axis of diversification. Taxonomic diversity tends to be associated with mountain ranges; in Borneo, it is greatest in the Crocker Range of Sabah and concentrated also in other parts of the northern northwest coast. Within-lineage genetic diversity in Malaya and Sumatra tends to also coincide with mountain ranges. A series of disjunct and restricted distributions spanning northern northwest Borneo and the major mountain ranges of Malaya and Sumatra, seen in three pairs of sister lineages, further suggests that these regions were rain-forest refuges during drier climatic phases of the Pleistocene. Results are discussed in the context of the history of Sundaland's rain forests.
This retrospective study illustrates our approach to this problem over the years, from performing subclavian flap aortoplasty initially to the more accepted procedure now, which is resection and end-to-end anastomosis. Coarctation of aorta in our population is seen in a varying age groups and are also associated with other cardiac anomalies including both acyanotic and cyanotic congenital cardiac defects. Therefore a wide variety of surgical procedures were performed including resection of the coarcted segment and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty and synthetic tube graft interposition. Subclavian flap aortoplasty is not widely practised anymore in favour of resection with end-to-end anastomosis. Fifty four point four percent of patients had isolated coarctation, 10.5% had associated valvular defects, 28.1% had other simple congenital defects and 7.0% had associated complex cyanotic congenital defects. Perioperative mortality was 5.26% and is correlated with the younger age of patients at time of surgery and severity of cardiac failure at time of presentation. We did not see any difference in mortality for patients with complex congenital disease or between the different surgical procedures. However, we did find that in the early period when resection with end-to-end anastomosis was performed, there was a significantly higher incidence of morbidities.
SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia
A retrospective study was done on 302 patients who had undergone coronary artery bypass grafting (CABG) in Hospital Universiti Kebangsaan Malaysia--46.0% were Chinese, 40.1% were Malays and 11.6% were Indians. Overall and irrespective of race and sex, the prevalence of diabetes mellitus, hypertension and hyperlipidaemia was 45.7%, 78.8% and 89.1% respectively indicating that hyperlipidaemia was the most prevalent risk factor amongst this cohort. The Indians had the highest prevalence of the three risk factors. The Chinese and the Malays most frequently presented with the combination of hypertension and hyperlipidaemia.
This is a case report of a pseudoaneurysm due to Salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in Malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.
A dot enzyme immunoassay (EIA) using 50-kD outer-membrane proteins (OMPs) of Salmonella typhi was compared with the Widal test for the serodiagnosis of typhoid fever in 109 febrile children admitted to a hospital in an endemic area. In the culture-positive typhoid group, the initial dot EIA was positive in 40 of 42 cases and the initial Widal test was positive in 41. In the culture-negative clinical typhoid group, both the dot EIA and the Widal test were positive in 17 of 18 cases. In the nontyphoidal fever group, the dot EIA was negative in all of 49 cases and the Widal test was negative in 44. With culture used as the gold standard, the dot EIA is as sensitive as the Widal test (95% vs. 98%), has a similar high negative predictive value (96% vs. 98%), and is more specific (75% vs. 67%). In addition, the dot EIA offers the advantages of simplicity, speed, early diagnosis, economy, and flexibility (i.e., other diagnostic tests can be conducted simultaneously).
Cement is a common cause of dermatitis. Workers affected are usually those in cement factories and at building construction sites. Cement dermatitis among port-workers is not so commonly reported. This paper describes an outbreak of dermatitis among stevodores at a port handling cement. The cement was imported in bags, and because of breakage, there was much spillage. It was also hot and dusty inside the hatch of the ship, and some of the stevodores worked bare-bodied. Cases of dermatitis began to appear in January 1983 and reached a peak in April 1983, gradually subsiding over the next few months to August 1983. This coincided with the increased tonnage of cement handled at the port. A total of 33 stevodores were reported as having dermatitis over this period. Of the 15 cases examined, 13 had eczema, and in 19 the hands and wrists were affected. However, most of the cases had multiple site involvement, including the arms, legs and abdomen.
Samples of cement showed the presence of water-soluble chromium, varying from 9.9 to 17.8pg/g. As the stevodores were reluctant to go for skin patch-testing, only four were tested, but two did not return for the reading of the results. The other two were found to have a positive reaction to dichromates. The outbreak of dermatitis was probably due to several factors which are discussed.
We present a case of an undifferentiated subtype of non-keratinizing squamous cell carcinoma (NK-SCC) with sarcomatoid features in the nasopharynx in a 69-year-old man who was difficult to diagnose due to spindle-shaped malignant cells. He was admitted because of a right nasal obstruction and right headache, and imaging revealed a heterogeneously enhanced irregularly shaped mass at the nasopharynx. Histopathologically, the tumour was partially organised, and the tumour cells were epithelioid or spindle-shaped. Initially, we erroneously diagnosed the tumour as an angiosarcoma owing to its false-negative immunoreaction for cytokeratins and a mistaken interpretation for CD31. After in situ hybridization for Epstein-Barr virus was positive, a consultation and additional immunostaining (including re-staining for cytokeratin with varying dilutions) were performed, and the diagnosis was revised to NK-SCC with sarcomatoid features. We believe that sarcomatoid features may be observed in nasopharyngeal carcinoma and in this case, immunostaining using various epithelial markers is necessary and careful attention should be paid to the interpretation of immunostaining.
The management of pain during root canal treatment is important. The aim of this systematic review and network meta-analysis was to identify the anaesthetic solution that would provide the best pulpal anaesthesia for inferior alveolar nerve blocks (IANB) treating mandibular teeth with irreversible pulpitis. Two electronic databases (PubMed and Scopus) were searched to identify studies up to October 2018. Randomized clinical trials comparing at least two anaesthetic solutions (lidocaine (lignocaine), articaine, bupivacaine, prilocaine or mepivacaine) used for IANB for treatment of irreversible pulpitis were included. The revised Cochrane risk of bias tool for randomized trials was used to assess the quality of the included studies. Pairwise meta-analysis, network meta-analysis using a random-effects model, and SUCRA ranking were performed. The network meta-analysis estimated the probability of each treatment performing best. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. In total, 11 studies (n = 750) were included in the meta-analysis. The network meta-analysis revealed that only mepivacaine significantly increased the success rate of IANB compared to lidocaine (RR, 1.42 [95% CI 1.04-1.95]). However, no significant differences in the success rate of IANB were observed between mepivacaine and other anaesthetic agents (articaine and bupivacaine). Of all anaesthetic agents, mepivacaine (SUCRA = 0.81) ranked first in increasing the success rate of IANB, followed by prilocaine (SUCRA = 0.62), articaine (SUCRA = 0.54), bupivacaine (SUCRA = 0.41) and lidocaine (SUCRA = 0.13). The overall quality of evidence was very low to moderate. In conclusion, based on the evidence from the randomized clinical trials included in this review, mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine, articaine, bupivacaine and lidocaine. Further, high-quality clinical trials are needed to support the conclusion of this review.
Randomized clinical trials are positioned at the highest level of primary clinical evidence, as they are designed to be unbiased with a reduced risk of systematic error. The Consolidated Standards of Reporting Trials (CONSORT) statement was first developed in 1996 to improve the reporting quality of randomized clinical trials with updates being published subsequently. Recently, the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines were developed exclusively for the field of Endodontics to address the suboptimal quality of randomized clinical trials submitted to Endodontic journals, which result in many being rejected. A principal flaw in submissions is the fact that many authors are unclear on the keys terms that should be used when developing manuscripts for publication. Clearly, authors should be aware of the most common terms used when conducting and reporting randomized clinical trials. Hence, the aim of the current paper is to present a comprehensive glossary of the terminology used in randomized clinical trials in order to assist authors when designing, executing and writing-up randomized clinical trials.