Background and objective In corneal neovascularization, the peri-corneal vascular structure grows into a normally avascular cornea. This is due to an imbalance between the angiogenic and anti-angiogenic factors that sustain corneal transparency. There are various etiologies of this condition, and they can be divided into infective or non-infective causes, such as inflammation, trauma, or surgical causes. Corneal neovascularization has been shown to improve with the current treatments using steroids and anti-vascular endothelial growth factors. This study aimed to evaluate the effectiveness of topical bevacizumab as an anti-angiogenic agent in patients with corneal neovascularization. Methods This retrospective study included patients who suffered corneal neovascularization of various etiologies and completed six months of topical bevacizumab therapy between 2020 and 2022 at the Universiti Kebangsaan Malaysia Medical Centre. Results A total of 16 patients received treatment with topical bevacizumab over the three-year study period. Based on specified inclusion and exclusion criteria, 12 patients were eligible for inclusion in this study. Eight patients (66%) showed improvement in terms of either 'clock hours' of improvement, morphology, or regression of corneal neovascularization. All infective causes of corneal neovascularization showed improvement on completion of bevacizumab compared to other causes. Conclusion Topical bevacizumab can be one of the treatment choices for corneal neovascularization. As the outcome varies depending on the severity and chronicity of the condition, the attending ophthalmologist should treat each case differently. Although topical bevacizumab is more effective in mild and moderate cases, the indications for its use in chronic cases remain debatable as the results are unfavorable in such cases.
Dislocation or subluxation of the hip is considered as the most common hip problem in patients with Down syndrome. Recommended treatment of chronic dislocation treatment is open reduction combined with femoral and/or pelvis osteotomies. We report a Down syndrome child with chronic hip dislocation who was successfully treated with adductor tenotomy and closed reduction, which has not been reported previously.
A slipped upper femoral epiphysis (SUFE) is a known hip disorder in adolescents in which the proximal femoral epiphysis slips and displaces relative to the metaphysis. We report an obese 12-year-old boy who presented with acute pain in the left hip after a fall. He was otherwise healthy with no prior joint pain. Pelvic radiography was misread twice before a second fall led to a severe SUFE.
Spinal neurofibromas occur sporadically and typically occur in association with neurofibromatosis 1. Patients afflicted with neurofibromatosis 1 usually present with involvement of several nerve roots. This report describes the case of a 14- year-old child with a large intraspinal, but extradural tumour with paraspinal extension, dumbbell neurofibroma of the cervical region extending from the C2 to C4 vertebrae. The lesions were readily detected by MR imaging and were successfully resected in a two-stage surgery. The time interval between the first and second surgery was one month. We provide a brief review of the literature regarding various surgical approaches, emphasising the utility of anterior and posterior approaches.
A retrospective study of nerve injuries with displaced supracondylar fractures of the humerus in children younger than 12 years of age, treated in Hospital Universiti Kebangsaan Malaysia. Our objectives were to determine the incidence of primary and iatrogenic nerve injuries in supracondylar humerus fractures Gartland types II and III and to determine the outcome of nerve recovery. A total of 272 patients with displaced supracondylar humerus fractures who required admission to Hospital Universiti Kebangsaan Malaysia from January 2000 to December 2007 were reviewed. There were 182 boys (67%) and 90 girls (33%). The mean age was 6.0 years, ranging from 1 to 12 years. Of 272 supracondylar fractures, 79 were type II and 193 were type III. Fifty-one (19%) patients had closed reduction, 160 (59%) had closed reduction and percutaneous crossed Kirschner (K) wires, and 61 (22%) had open reduction and crossed K-wires. Associated nerve injuries involving the median, radial, and ulnar nerves were observed in 48 (18%) patients. Nerve injuries were observed in nine (3%) patients upon admission. Thirty-nine (14%) patients developed nerve injuries following treatment. Of these 39 patients, 34 had ulnar, three had radial, and two had median nerve injuries. Nerve exploration was performed in five patients (in four patients following debridement of open fracture and in one because of unacceptable postoperative radiographs, and they subsequently underwent open reduction and exploration). Except for these five patients, the K-wires were not removed earlier nor were the nerves surgically explored in others. The nerve injuries resolved clinically on an average time of 3.5 months (range from 3 weeks to 8 months). Our study found complete resolution of all patients with nerve injuries confirmed by clinical assessment. On the basis of our study, we believe that there is no indication to remove the K-wires immediately or to explore the nerve surgically following a mini-open technique, which reduces the risk of penetrating a nerve during pinning.
Non-uniformly sized activated carbons were derived from doum palm shell, a new precursor, by carbonization in air and activation using KOH, NaOH and ZnCl2. The activated carbon fibres were characterised by X-ray diffraction, N2 adsorption-desorption, scanning electron microscopy, particle size analysis and evaluated for Cd(II) and Pb(II) removal. The 40-50 nm size, less graphitic, mesoporous NaOH activated carbon yielded high adsorption efficiency, pointing largely to the influence surface area. The performance of the KOH based activated carbon was arguably explained for the first time in terms of crystallinity. The efficiencies of the mesoporous ZnCl2-formulated activated carbon diminished due to the presence of larger particles. Batch adsorption of divalent metals revealed dependence on adsorbent dose, agitation time, pH and adsorbate concentrations with high adsorption efficiencies at optimum operating parameters. The equilibrium profiles fitted Langmuir and Freundlich isotherms, and kinetics favoured pseudo-second order model. The study demonstrated the practicability of the removal of alarming levels of cadmium and lead ions from industrial effluents.
Heavy metal pollution, such as lead, can cause contamination of water resources and harm human life. Many techniques have been explored and utilized to overcome this problem, with adsorption technology being the most common strategies for water treatment. In this study, carbon nanofibers, polyacrylonitrile (PAN)/sago lignin (SL) carbon nanofibers (PAN/SL CNF) and PAN/SL activated carbon nanofibers (PAN/SL ACNF), with a diameter approximately 300 nm, were produced by electrospinning blends of polyacrylonitrile and sago lignin followed by thermal and acid treatments and used as adsorbents for the removal of Pb(II) ions from aqueous solutions. The incorporation of biodegradable and renewable SL in PAN/SL blends fibers produces the CNF with a smaller diameter than PAN only but preserves the structure of CNF. The adsorption of Pb(II) ions on PAN/SL ACNF was three times higher than that of PAN/SL CNF. The enhanced removal was due to the nitric acid treatment that resulted in the formation of surface oxygenated functional groups that promoted the Pb(II) ions adsorption. The best-suited adsorption conditions that gave the highest percentage removal of 67%, with an adsorption capacity of 524 mg/g, were 40 mg of adsorbent dosage, 125 ppm of Pb(II) solution, pH 5, and a contact time of 240 min. The adsorption data fitted the Langmuir isotherm and the pseudo-second-order kinetic models, indicating that the adsorption is a monolayer, and is governed by the availability of the adsorption sites. With the adsorption capacity of 588 mg/g, determined via the Langmuir isotherm model, the study demonstrated the potential of PAN/SL ACNFs as the adsorbent for the removal of Pb(II) ions from aqueous solution.
The study and applications of in vivo skin optics have been openly documented as early as the year 1954, or possibly earlier. To date, challenges in analyzing the complexities of this field remain, with wide scopes requiring more scrutiny. Recent advances in spectroscopic research and multivariate analytics allow a closer look into applications potentially for detecting or monitoring diseases. One of the challenges in this field is in establishing a reference for applications which correspond to certain bandwidths. This article reviews the scope on past research on skin spectroscopy, and the clinical aspects which have or may have applications on disease detection or enhancing diagnostics. A summary is supplied on the technicalities surrounding the measurements reported in literature, focused towards the wavelength-dependent applications in themes central to the respective research. Analytics on the topology of the papers' data cited in this work is also provided for a statistical perspective. In short, this paper strives to immediately inform the reader with possible applications via the spectroscopic devices at hand. Graphical Abstract .
Traumatic elbow dislocation in a child is rare, and it is usually associated with fractures. Simultaneous proximal radioulnar joint (PRUJ) translocation with ulnar nerve palsy is even rarer. We report an unusual case of a missed PRUJ translocation with ulnar nerve entrapment in a 10-year-old child. The key to diagnosing the translocation is the position of the proximal radius, which lies medial to the ulna. This was treated by open reduction and release of the entrapped nerve. The ulnar nerve palsy recovered fully at the 1-year follow-up. Although PRUJ translocation with ulnar nerve entrapment is a rare injury, a successful outcome is possible with timely open reduction and release of the ulnar nerve.
Femoral bone fracture is one of the main causes for the failure of hip arthroplasties (HA). Being subjected to abrupt and high impact forces in daily activities may lead to complex loading configuration such as bending and sideway falls. The objective of this study is to predict the risk of femoral bone fractures in total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). A computed tomography (CT) based on finite element analysis was conducted to demonstrate damage formation in a three dimensional model of HAs. The inhomogeneous model of femoral bone was constructed from a 79 year old female patient with hip osteoarthritis complication. Two different femoral components were modeled with titanium alloy and cobalt chromium and inserted into the femoral bones to present THA and RHA models respectively. The analysis included six configurations, which exhibited various loading and boundary conditions, including axial compression, torsion, lateral bending, stance and two types of falling configurations. The applied hip loadings were normalized to body weight (BW) and accumulated from 1 BW to 3 BW. Predictions of damage formation in the femoral models were discussed as the resulting tensile failure as well as the compressive yielding and failure elements. The results indicate that loading directions can forecast the pattern and location of fractures at varying magnitudes of loading. Lateral bending configuration experienced the highest damage formation in both THA and RHA models. Femoral neck and trochanteric regions were in a common location in the RHA model in most configurations, while the predicted fracture locations in THA differed as per the Vancouver classification.
Hemodialysis (HD) and peritoneal dialysis (PD) treatments impact the economic burden and psychological distress faced by end-stage kidney disease (ESKD) patients and their caregivers. This review aimed to discuss the concept of an economic burden and the economic burden of different treatment options, and to highlight research gaps regarding the scarcity of previous studies relating economic burden to psychological well-being. We searched five electronic databases for papers published in 2010-2020. Papers focusing on measures of the economic burden from the government's perspective and diseases other than ESKD were excluded. Out of the 6635 publications identified, 10 publications were included. Three categories of economic burden were identified, namely, direct medical costs, direct non-medical costs, and indirect costs. Direct medical costs required the highest expenditure, whereas the lowest economic burden was for indirect costs. HD patients incurred a higher economic burden than PD patients. Most of the studies were carried out in Asia. The results of the research suggest that the economic burden may affect patients and caregivers, but it is unclear whether the economic burden affects the psychological well-being of the patients and caregivers. Very few studies have assessed the relationship between economic burden and psychological well-being, and further research is needed to gain further insight into the relationship between these two variables.
Introduction: High altitude retinopathy (HAR) is part of high altitude illness (HAI) which includes acute mountain sickness, high altitude cerebral oedema and pulmonary oedema. We present a case of bilateral HAR with right eye central scotoma during Mount Everest expedition. Case description: A 37-year-old lady presented with decreased right eye (OD) vision and central scotoma during ascending to the top of Mount Everest at 5100m. She developed respiratory symptoms with shortness of breath at the same time and warranted her a rapid descend on day eight of her excursion. Ocular examination revealed visual acuity of 6/36 OD and 6/6 left eye (OS). Both pupils were normal without relative afferent pupillary defect. Anterior segment and intraocular pressure were unremarkable. Fundus examination revealed bilateral multiple retinal haemorrhages along vascular arcades, with macula involvement in the right eye only. Otherwise there was no sign of optic disc swelling, vascular sheathing or choroidal involvement. Optical coherence tomography (OCT) of the macula showed hyperreflectivity changes on the right fovea at the level of superficial nerve fiber layer. Diagnosis of bilateral HAR was made and treated conservatively. She was also diag-nosed with HAI with acute pulmonary oedema and pneumonia by the treating physician. The retinal haemorrhages started to resolve after two weeks with full recovery of vision in ten weeks. Conclusion: With increasing popularity of mountaineering, ophthalmologists should be prepared to recognise HAR as part of HAI. Visual impairment depends on the location and extent of the lesions. HAR is self-limiting with good prognosis but can be associated with poten-tially fatal conditions of HAI e.g. pulmonary oedema in our case.
The brain is the most complex organ in the human body. Robust and vigorous daily activities may cause changes to the brain structure. Huffaz, individuals who memorise the Quran undergo intensive memorization training which may lead to structural changes in specific regions of the brain.
Preventive maintenance (PM) planning becomes a crucial issue in the real world of the manufacturing process. It is important in the manufacturing industry to maintain the optimum level of production and minimize its investments. Thus, this paper focuses on multiple jobs with a single production line by considering stochastic machine breakdown time. The aim of this paper is to propose a good integration of production and PM schedule that will minimize total completion time. In this study, a hybrid method, which is a genetic algorithm (GA), is used with the Monte Carlo simulation (MCS) technique to deal with the uncertain behavior of machine breakdown time. A deterministic model is adopted and tested under different levels of complexity. Its performance is evaluated based on the value of average completion time. The result clearly shows that the proposed integrated production with PM schedule can reduce the average completion time by 11.68% compared to the production scheduling with machine breakdown time.
Introduction: The distribution of Staphylococcus aureus and Staphylococcus epidermidis
among Malaysian healthy adults and their capability to produce enzyme hyaluronidase are less
reported. Hyaluronidase degrade hyaluronic acid in animal connective tissue and facilitate
bacterial spreading in host body. This study aims to identify the distribution of both
Staphylococci species in healthy subject, the hyaluronidase producer among the isolates and
the association of the latter with site of isolation (palm skin and anterior nares) and gender of
the host. Methods: A total of 108 swab samples were collected from anterior nares and palm
of 54 healthy subjects. The bacteria were identified through microscopic and biochemical tests,
before screened for hyaluronidase production using hyaluronic acid diffusion rapid plate
method. Results: Total of 139 bacterial isolates were identified; 68 isolates are S. aureus, 63
S. epidermidis and 8 other bacterial species. Staphylococcus aureus was highly isolated from
palm (57%) than anterior nares (47%). On the contrary for S. epidermidis was highly isolated
from anterior nares (53%) than from palm skin (43%). Equal proportion was found for both
species in male and female subject. A total of 77 (59%) isolates produced hyaluronidase; 55%
are S. aureus and 45% are S. epidermidis. Hyaluronidase-producer isolates are equally found
between anterior nares (56%) and palm skin (61%) or male (57%) and female subject (60%)
regardless of Staphylococcal species. No significant value was recorded for any analysis.
Conclusion: Capability of commensal S. aureus and S. epidermidis isolated from healthy
subject to produce hyaluronidase may indicate their potential as opportunistic pathogen
whenever the opportunity arises in any way.
local herb known as neem (semambu) or its scientific name Azadirachta indica has been used extensively in traditional treatment due to its medicinal properties. Neem leaves have been used traditionally for treating several epidermal dysfunctions, such as eczema, psoriasis, and acne. Neem is rich in antioxidants and helps to boost immune response in tissues of affected skin area. It also consists of bioactive compounds for antibacterial, antifungal, and anticancer activities. In this study, neem leaves extract was used in producing herbal neem soap as a remedy for curing skin problems. The herbal neem soap was made by blending 36.4% palm oil, 9.1% coconut oil, 27.3% sodium hydroxide, 9.1% neem oil extract, and 18.2% neem aqueous extract which formed a pale yellow soap base. The results of the selected physical and chemical properties of this study show that the moisture content of the soap was 4.02% with 10.60 pH value, 57.40% total fatty matter, and 0.44% free caustic alkali. The results imply that herbal neem soap is suitable for human skin and can be a therapeutic alternative to skin problems.
Introduction: Rabies is a highly fatal disease that is mostly caused by a dog bite. The Dog Bite Prevention KAP scale is a 30-item scale that is designed to measure children’s level of safety knowledge on dog’s behaviour, precautionary behaviour around dogs, perceived vulnerability towards dogs and help-seeking behaviour following a dog bite. Therefore, this study aimed to determine the test-retest reliability and validity of outcome measures
Methods: This questionnaire was administered to samples of school student aged from 13 years to 14 years at a secondary school located in Bau District, Sarawak. They were purposively selected for a baseline interview (Time 1) anda ten-day follow-up (Time 2). This study was conducted within four months, which were from 10 April to 31 August 2018. Descriptive analysis, content analysis, Cronbach’s alpha, intra-class correlation and exploratory factor analysis were performed in thisstudy.Results: A total of 64 boys and 114 girls were involved in the study, whereby 79.2%, 10.1%, 7.9%, 2.2% and 0.6% of them were of Bidayuh ethnic, Chinese, Iban, Malays and other ethnic, respectively. The Cronbach's alpha was 0.796. The test-retest intra-class correlation was adequate, with 0.84 for perceived vulnerability towards dogs and 0.81 for precautionary behaviour around dogs. Principal components analysis with varimax rotation resulted in two factors, which explained 39% of the variance (perceived vulnerability towards dogs) and 49% of the variance (precautionary behaviour around dogs)
Conclusion: The questionnaire is a valid and reliable tool for a dog-bite prevention survey
Different disease risk for diabetic nephropathy (DN) may be partly due to the diverse genetic susceptibility of the disease. This systematic review aimed to identify the genetic variants with a substantial effect on DN and to evaluate the genetic models used in the reviewed studies. We searched the ScienceDirect and PubMed databases for all eligible studies comparing genetic variants in patients with and without DN from 2005-2016. We included a total of 14 studies and identified 13 genes with 17 related variants. The OR was from 2.9 to 9.95. The genes were involved in the pathogenesis of DN via the hemodynamic (ACE, AGT, AGTR1), metabolic (ACACB, MTHFR, PPARGC1A) and inflammatory (TNF-, TGFβ1, eNOS, CCR5, HSP70-1, MPO, OPN gene promoter) pathways. The results of these studies were presented according to pre-specified genetic models: basic, additive, dominant and recessive. No genetic model selection was biologically justified. We identified 17 genetic variants that were significantly associated with DN and were determined using different genetic models. To reduce error, further replication with the best genetic model should be carried out to determine the role of these variants in DN.
ABSTRACT
Objective: To evaluate the effectiveness of hypnosis 1) to reduce dental anxiety in periodontal patients, and
2) to increase periodontal patients’ compliance through the reduction of dental anxiety. Methods: This was a
randomized control trial of 22 patients (13 males, 9 females; 40.14 ± 19.59 years) who underwent non-surgical
periodontal therapy in the Postgraduate and Undergraduate Clinics. Patients were divided into the case, H,
(hypnosis; n=11) and controlled, N, (no hypnosis; n=11) groups, where patients’ dental anxiety level was assessed
twice for both groups using IDAF-4C+ during the first visit and the second visit. The compliance was evaluated
during the follow-up visit. Results: The result showed statistically significant differences (p < 0.05) in the H
group during the second visit indicating a reduction in dental anxiety as compared to N group. However, there
were no statistically significant differences (p > 0.05) in the pattern of reduction of blood pressure between both
case and control groups. Based on the heart rate, patients were found to be more relaxed with hypnotherapy
at the beginning of the treatment but halfway through, patients without hypnotherapy had a more significant
reduction in heart rate level. Conclusion: Hypnotic suggestions were found to help reduce patient’s fear and
anxiety. However, the compliance of the patients with or without hypnotherapy proved to have a similar outcome.