The objectives of the study are to use immobilized acclimated biomass and immobilized biomass-powdered activated carbon (PAC) as a novel approach in the bioregeneration of granular activated carbon (GAC) loaded with phenol and o-cresol, respectively, and to compare the efficiency and rate of the bioregeneration of the phenolic compound-loaded GAC using immobilized and suspended biomasses under varying GAC dosages. Bioregeneration of GAC loaded with phenol and o-cresol, respectively, was conducted in batch system using the sequential adsorption and biodegradation approach. The results showed that the bioregeneration efficiency of GAC loaded with phenol or o-cresol was basically the same irrespective of whether the immobilized or suspended biomass was used. Nonetheless, the duration for bioregeneration was longer under immobilized biomass. The beneficial effect of immobilized PAC-biomass for bioregeneration is the enhancement of the removal rate of the phenolic compounds via adsorption and the shortening of the bioregeneration duration.
A structural study of epoxidized natural rubber (ENR-50) and its cyclic dithiocarbonate derivative was carried out using NMR spectroscopy techniques. The overlapping (1)H-NMR signals of ENR-50 at δ 1.56, 1.68-1.70, 2.06, 2.15-2.17 ppm were successfully assigned. In this work, the C=S and quaternary carbon of cyclic dithiocarbonate. All other (1)H- and (13)C-NMR chemical shifts of the derivative remain unchanged with respect to the ENR-50.
This was a prospective observational study done to evaluate the role of a repeat head CT in patients with mild traumatic brain injury. The aim was to evaluate wether the repeat head CT were useful in providing information that leads to any neurosurgical intervention. 279 adult patients with a mild head injury (GCS 13-15) were enrolled, and these comprised of patients with an initial traumatic intracranial haemorrhage not warranting any surgical intervention. All patients were subjected to a repeat head CT within 48 hours of admission and these showed no change or improvements of the brain lesion in 217 patients (79.2%) and worsening in 62 patients (20.8%). In thirty-one patients, surgical intervention was done following the repeat head CT. All of these patients had a clinical deterioration prior to the repeat head CT. Even if a repeat head CT had not been ordered on these patients, they would have had a repeat head CT due to deteriorating neurological status. When the 62 patients with a worsening repeat head CT were compared with the 217 patients with an improved or unchanged repeat head CT, they were found to have older age, lower GCS on admission, presenting symptoms of headache, higher incidence of multiple traumatic intracranial pathology and lower haemoglobin level on admission. On stepwise multiple logistic regression analysis, three factors were found to independently predict a worse repeat head CT (Table IV). This includes age of 65 years or older, GCS score of less than 15 and multiple traumatic intracranial lesion on initial head CT. As a conclusion, we recommend that, in patients with a MTBI and a normal neurological examination, a repeat cranial CT is not indicated, as it resulted in no change in management or neurosurgical intervention. Close monitoring is warranted in a subset of patients with risk factors for a worsening repeat head CT.
Keywords: Computed tomography, brain injury, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
Cryptocaryoniasis (also known as marine white spot disease) is mediated by Cryptocaryon irritans. This obligate ectoparasitic protozoan infects virtually all marine teleosts, which includes Lates calcarifer, a highly valuable aquaculture species. Little is known about L. calcarifer-C. irritans interactions. This study was undertaken to gain an informative snapshot of the L. calcarifer transcriptomic response over the course of C. irritans infection. An in-house fabricated cDNA microarray slides containing 3872 probes from L. calcarifer liver and spleen cDNA libraries were used as a tool to investigate the response of L. calcarifer to C. irritans infection. Juvenile fish were infected with parasites for four days, and total RNA was extracted from liver tissue, which was harvested daily. We compared the transcriptomes of C. irritans-infected liver to uninfected liver over an infection period of four days; the comparison was used to identify the genes with altered expression levels in response to C. irritans infection. The greatest number of infection-modulated genes was recorded at 2 and 3 days post-infection. These genes were mainly associated with the immune response and were associated in particular with the acute phase response. Acute phase proteins such as hepcidin, C-type lectin and serum amyloid A are among the highly modulated genes. Our results indicate that an induced acute phase response in L. calcarifer toward C. irritans infection is similar to the responses observed in bacterial infections of teleosts. This response demonstrates the importance of first line defenses in teleost innate immune responses against ectoparasite infection.
The Langat River in Malaysia has been experiencing anthropogenic input from urban, rural and industrial activities for many years. Sewage contamination, possibly originating from the greater than three million inhabitants of the Langat River Basin, were examined. Sediment samples from 22 stations (SL01-SL22) along the Langat River were collected, extracted and analysed by GC-MS. Six different sterols were identified and quantified. The highest sterol concentration was found at station SL02 (618.29 ng/g dry weight), which situated in the Balak River whereas the other sediment samples ranged between 11.60 and 446.52 ng/g dry weight. Sterol ratios were used to identify sources, occurrence and partitioning of faecal matter in sediments and majority of the ratios clearly demonstrated that sewage contamination was occurring at most stations in the Langat River. A multivariate statistical analysis was used in conjunction with a combination of biomarkers to better understand the data that clearly separated the compounds. Most sediments of the Langat River were found to contain low to mid-range sewage contamination with some containing 'significant' levels of contamination. This is the first report on sewage pollution in the Langat River based on a combination of biomarker and multivariate statistical approaches that will establish a new standard for sewage detection using faecal sterols.
A capillary electrophoretic method for the separation of the enantiomers of both ofloxacin and ornidazole is described. Several parameters affecting the separation were studied, including the type and concentration of chiral selector, buffer pH, voltage and temperature. Good chiral separation of the racemic mixtures was achieved in less than 16 min with resolution factors Rs=5.45 and 6.28 for ofloxacin and ornidazole enantiomers, respectively. Separation was conducted using a bare fused-silica capillary and a background electrolyte (BGE) of 50 mM H(3)PO(4)-1 M tris solution; pH 1.85; containing 30 mg mL(-1) of sulfated-beta-cyclodextrin (S-beta-CD). The separation was carried out in reversed polarity mode at 25 degrees C, 18 kV, detection wavelength at 230 nm and using hydrodynamic injection for 15 s. Acceptable validation criteria for selectivity, linearity, precision, and accuracy were studied. The limits of detection (LOD) and limits of quantitation (LOQ) of the enantiomers (ofloxacin enantiomer 1 (OF-E1), ofloxacin enantiomer 2 (OF-E2), ornidazole enantiomer 1 (OR-E1) and ornidazole enantiomer 2 (OR-E2)) were (0.52, 0.46, 0.54, 0.89) and (1.59, 1.40, 3.07, 2.70) microg mL(-1), respectively. The proposed method was successfully applied to the assay of enantiomers of both ofloxacin and ornidazole in pharmaceutical formulations. The computational calculations for the enantiomeric inclusion complexes rationalized the reasons for the different migration times between the ofloxacin and ornidazole enantiomers.
β2-Microglobulin (β(2)M) is the light chain of major histocompatibility class I (MHC I) that binds non-covalently with the α heavy chain. Both proteins attach to the antigen peptide, presenting a complex to the T cell to be destroyed via the immune mechanism.
Teleconsultation in Neurosurgery was introduced in Malaysia in 2006 with the aims of enhancing quality services in the field of Neurosurgery. The present teleconsultation system is equipped with user friendly features which allow physicians to send and neurosurgeons to gain access to patient data in a swift and effective manner. In the past, teleconsultation in neurosurgery was tied with teleradiology, however we have now developed a multimodality system to cater specifically for neurosurgery. In Malaysia, the teleconsultation service is gaining momentum as evidenced by the large volume of cases channeled through this system. 944 cases within a span of 4 months were recorded on the system. 54.5% of the cases were trauma, 33.2% stroke, 6.1% intracranial tumours, 2% of cases were of spinal pathology, 2% pediatric anomalies and 2.2% intracranial infections. 50.2% of the referrals were after regular working hours reflecting the need for dedicated teleneurosurgery consultative services and the ability to review referrals outside of hospitals. Only 36% of cases needed emergency transfers and 9.9% of the cases were managed remotely at distant hospitals. Another 9.4% of the cases were either transferred electively or brought to the clinic for consultation. The above findings emphasise the importance of teleconsultation as a means to provide wide medical coverage within the region.
Cryptocaryon irritans is a parasitic ciliate that causes cryptocaryonosis (white spot disease) in marine fish. Diagnosis of cryptocaryonosis often depends on the appearance of white spots on the surface of the fish, which are usually visible only during later stages of the disease. Identifying suitable biomarkers of this parasite would aid the development of diagnostic tools and control strategies for C. irritans. The C. irritans genome is virtually unexplored; therefore, we generated and analyzed expressed sequence tags (ESTs) of the parasite to identify genes that encode for surface proteins, excretory/secretory proteins and repeat-containing proteins.
Tramadol is metabolized by the highly polymorphic enzyme cytochrome P450 (CYP)2D6. Patients with different CYP2D6 genotypes may respond differently to tramadol in terms of pain relief and adverse events. In this study, we compare the pharmacokinetics and effects of tramadol in Malaysian patients with different genotypes to establish the pharmacokinetic-pharmacodynamic relationship of tramadol.
There is a dire need to have complementary form of disaster training which is cost effective, relatively easy to conduct, comprehensive, effective and acceptable. This will complement field drills training. A classroom-based training and simulation module was built by combining multiple tools: Powerpoint lectures, simulations utilising the Kuala Lumpur International Airport (KLIA) schematic module into 'floortop' model and video show of previous disaster drill. 76 participants made up of medical responders, categorised as Level 1 (specialists and doctors), Level 2 (paramedics), Level 3 (assistant paramedics) and Level 4 (health attendants and drivers) were trained using this module. A pre-test with validated questions on current airport disaster plans was carried out before the training. At the end of training, participants answered similar questions as post-test. Participants also answered questionnaire for assessment of training's acceptance. There was a mean rise from 47.3 (18.8%) to 84.0 (18.7%) in post-test (p<0.05). For Levels 1, 2, 3 and 4 the scores were 94.8 (6.3)%, 90.1 (11)%, 80.3 (20.1)% and 65 (23.4)% respectively. Nevertheless Level 4 group gained most increase in knowledge rise from baseline pre-test score (51.4%). Feedback from the questionnaire showed that the training module was highly acceptable. A classroom-based training can be enhanced with favourable results. The use of classroom training and simulation effectively improves the knowledge of disaster plan significantly on the back of its low cost, relatively-easy to conduct, fun and holistic nature. All Levels of participants (from specialists to drivers) can be grouped together for training. Classroom training and simulation can overcome the problem of "dead-document" phenomenon or "paper-plan syndrome".
Moving bed sequencing batch reactors (MBSBRs) packed with 8% (v/v) of 8-, 27- and 64-mL polyurethane (PU) foam cubes, respectively, were investigated for simultaneous 4-chlorophenol (4-CP) and nitrogen removal at increasing 4-CP concentration. When the 4-CP concentration exceeded 300 mg L(-1), the MBSBR with 27-mL foam cubes was observed to outperform the other MBSBRs in removing 4-CP and nitrogen. The reasons were: (1) there were more biomass in inner layer of the 27-mL cubes, compared to that of the 8-mL cubes, which was more shielded from the inhibitory effect of 4-CP and (2) the 27-mL cubes were more mobile than the 64-mL cubes. Although increasing 4-CP concentration to 600 mg L(-1) resulted in incomplete removal of 4-CP in the MBSBRs, results of the batch reactor with 27-mL foam cubes showed that complete 4-CP removal within the REACT period could be achieved by increasing the packing volume to 20%.
We describe a case of a giant thrombosed intrasellar internal carotid artery aneurysm initially diagnosed as pituitary macroadenoma. The differentiating neuroimaging features were discussed.
Although the kinetic behaviour of tramadol has been described, the present study is the first to our knowledge, to report specifically on the population pharmacokinetic modelling of tramadol hydrochloride.
Cryptocaryon irritans causes Cyptocaryonosis or white spot disease in a wide range of marine fish including Lates calcarifer (Asian seabass). However, the immune response of this fish to the parasite is still poorly understood. In this study, quantitative polymerase chain reaction (qPCR) was performed to assess the expression profile of immune-related genes in L. calcarifer infected by C. irritans. A total of 21 immune-related genes encoding various functions in the fish immune system were utilized for the qPCR analysis. The experiment was initiated with the infection of juvenile fish by exposure to theronts from 200 C. irritans cysts, and non-infected juvenile fish were used as controls. Spleen, liver, gills and kidney tissues were harvested at three days post-infection from control and infected fish. In addition, organs were also harvested on day-10 post-infection from fish that had been allowed to recover from day-4 up to day-10 post-infection. L. calcarifer exhibited pathological changes on day-3 post-infection with the characteristic presence of white spots on the entire fish body, excessive mucus production and formation of a flap over the fish eye. High quality total RNA was extracted from all tissues and qPCR was performed. The qPCR analysis on the cohort of 21 immune-related genes of the various organs harvested on day-3 post-infection demonstrated that most genes were induced significantly (p
Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.
Randomized control trials (RCTs) are considered as most rigors way of determining the cause-effect relationship of a treatment and outcome. Activation of rennin angiotensin aldosterone system (RAAS) is an important contributor to hypertension in hemodialysis patients. The prevalence of hypertension in hemodialysis patients varies from 60% to 80% and hypertension management alone with conventional hemodialysis is insufficient. Hence, the current review was aimed to investigate the effect of RAAS inhibitors in managing hypertension among hemodialysis patients in a randomized control trial. Using PUBMED and EMBASE databases, randomized control trial with primary or secondary outcomes related to the effect of RAAS inhibitors on blood pressure among hemodialysis patients were included for analysis. The current review also assessed the quality of reporting of RCT. A total of eight RCT met inclusion criteria for current review. According to modified jaded scale, one (12.5%) study scored four points for quality reporting, whereas two (25%) studies scored one point that was the least score. The mean score for all included studies was 2.25. Six (75%) of the eight RCT included, involved ARB in hypertension management among hemodialysis patients, whereas two (25%) studies involved angiotensin-converting enzyme (ACE) inhibitors. Of the siz RCT involving ARB, two (33.3%) RCT also included ACE inhibitors comparison group. Altogether six (75%) studies report a reduction in blood pressure with the use of RAAS inhibitors compared to control group; however, of the six studies, two (33.3%) reported that the reduction in blood pressure was not significant. Whereas, two (25%) studies reported no reduction in blood pressure compared to the control group. The findings from current review do not indicate a clear pattern for a role of RAAS inhibitors for hypertension control among hemodialysis patients.
Methadone is widely being used for opioid substitution therapy. However, the administration of methadone to opioid dependent individual is frequently accompanied by withdrawal syndrome and chemical dependency develops. Other than that, it is also difficult to retain patients in the treatment programme making their retention rates are decreasing over time. This article is written to higlights the potential use of prophetic medicines, Nigella sativa, as a supplement for opioid dependent receiving methadone. It focuses on the potential role of N. sativa and its major active compound, Thymoquinone (TQ) as a calcium channel blocking agent to reduce withdrawal syndrome and opioid dependency.
In this study, iron impregnated activated carbon (FeAC) was synthesized following an oxidation and iron impregnation of activated carbon (AC). Both the AC and FeAC were characterized by pHZPC and FTIR spectroscopy. The removal of Methylene Blue (MB) by AC and FeAC was examined under various experimental conditions. The FeAC showed up to 95% (higher than AC) MB removal in the pH range of 7-10. Although the reaction kinetics was pseudo-second order, the overall rate was controlled by a number of processes such as film diffusion, pore diffusion and intraparticle diffusion. The activation energy values for the MB uptake by AC and FeAC (21.79 and 14.82 kJ/mol, respectively) revealed a physisorption process. In the regeneration study, FeAC has shown consistently ≥ 90% MB removal even up to 10 repeated cycles. The reusable characteristic of the spent FeAC improved the practical use of activated carbon and can be a breakthrough for continuous flow system applications where it can work effectively without any significant reduction in its performance.