Spontaneous pneumomediastinum is a rare condition in viral pneumonia. However, it can arise spontaneously in COVID-19 patients with no other risk factors. Here we present four cases of spontaneous pneumomediastinum in patients with COVID-19 pneumonia with no other precipitating factors.
The control of dengue outbreak requires a multi-pronged effort by the various government agencies. It requires co-operation of the community in the control activities, strict adherence to existing control procedures and guidelines by health personnel, increased manpower where necessary and strengthening co-operation between various health agencies to prevent delay in instituting control measures.
Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The case fatality rate varied from a high of 10.43% in 1985 when dengue type 3 was the predominant type to a low of 1.29% when dengue type 1 predominated. Severe disease patterns have been observed with dengue 2 and 3 serotypes in the country. The clinical spectrum has also been changing and multisystem involvement with more severe manifestations are being seen. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye's syndrome. Dengue type 3 has been isolated from liver biopsy specimens. Neurological manifestations can very from irritability, convulsions, coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluids recently strongly suggests that dengue viruses can be neurovirulent. Adult respiratory distress syndrome was seen in three children admitted with shock. Deaths were more frequent in children in the early period but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.
Plant tissues, especially durian tissues contain high content of polysaccharides, polyphenols and other secondary metabolites which can co-precipitate with RNA causing problem in further transcriptomic study. In this experiment, three basic chaotic agents, CTAB, SDS and guanidine are used in three basic protocols for RNA isolation. The effectiveness of each method was determined by spectrophotometer, denaturing agarose gels analysis and northern blot hybridization. CTAB combining with additional sodium acetate precipitation step showed highest yield and best quality of isolated RNA which was free from contaminations of polysaccharides, polyphenols and other secondary metabolites. Furthermore, the total RNA from 4-month old durian flesh of clone D24 was successfully used to construct a cDNA library. In conclusion, CTAB method is effective to isolate total RNA on various types of durian tissues for further gene expression analysis.
This study is to examine the use of a Rapid Troponin T test in patients attending the Emergency Room with complaints of chest pain. The results show a strong correlation between time to positive developmentaf the Rapid Trapanin T lest to ELISA Trapanin T. These results indicate the use of a simple to perform bedside assay of Rapid Trapanin T may be used in early risk stratification of patients presenting wilh acute coronary syndromes. KEYWORDS: Rapid Trapanin T, acule coronary syndromes, risk stratification.
The non-destructive feature of optical techniques has gained interests for quality assessment
of various agricultural produce as well as in food processing technology. The principle and
interaction of light with food and agricultural produce provide essential information for quality
assessment which promotes non-destructive inspection methods. This review encompasses the
determination of optical properties associated with the evaluation of the quality of agricultural
produce. The understanding of how light interacts with turbid agricultural produce is also
presented, including light characteristics such as absorption and scattering. A brief overview of
the estimation and application of the optical parameters in food and agricultural processing are
discussed. The problems and implementation of optical parameters as well as its future trend
are also included.
It is said that the backbone of Indian economy is agriculture. The contribution of the agriculture sector to the national GDP (Gross Domestic Products) was 14.6% in the year 2010. To attain a growth rate equivalent to that of industry (viz., about 9%), it is highly mandatory for Indian agriculture to modernize and use automation at various stages of cultivation and post-harvesting techniques. The use of computers in assessing the quality of fruits is one of the major activities in post-harvesting technology. As of now, this assessment is majorly done manually, except for a few fruits. Currently, the fruit quality assessment by machine vision in India is still at research level. Major research has been carried out in countries like China, Malaysia, UK, and Netherlands. To suit the Indian market and psychology of Indian farmers, it is necessary to develop indigenous technology. This paper is the first step toward evaluating the research carried out by the research community all over world for tropical fruits. For the purpose of survey, we have concentrated on the tropical fruits of the state of Maharashtra, while keeping in focus of the review image processing algorithms.
A 65 year old male smoker was diagnosed with squamous cell carcinoma of upper lobe of the right lung complicated with Horner's syndrome and gradually increasing leucocytosis. Alhough the inflammatory biomarker level in serum was low, there was no definite way to determine the cause of the leucocytosis (whether infection or hematologic paraneoplastic syndrome). After empirical antibiotic therapy, his fever subsided but the leucocytosis persisted. It was difficult for us to take a decision regarding the priority of the treatment of infection or the lung cancer. Only after the first cycle chemotherapy, did the leucocytosis rapidly drop down. Normal serum procalcitonin level and quick response to chemotherapy indicated that leucocytosis was a manifestation of paraneoplastic syndrome. Treating the underlying cancer is the first step.
The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children.
Owing to the importance of dendritic cells (DC) in the induction and control of immunity, an understanding of their biology is central to the development of potent immunotherapies for cancer, chronic infections, autoimmune disease, and induction of transplantation tolerance. This review surveys the heterogeneity of DC with regards to their phenotype and developmental origin, and how they initiate, modify and regulate the immune response, with emphasis on their maturation, migration, antigen-presentation and interaction with T cells and other immune cells. Much of this knowledge is obtained through research on murine DC. Research on human DC has been hampered by limitations associated with in vitro assays and limited access to human tissues. New approaches on human DC research are required in order to develop novel strategies for the treatment of microbial infections, the control of graft rejection, and the improvement of DC-based immunotherapeutic protocols for autoimmunity, allergy, and cancer.
We report on our early experiences with the Press Fit Condylar Rotating Platform (PFC-RP) total knee replacement prosthesis at University Malaya Medical Centre. This new prosthesis was introduced to Malaysia in 2001. It combines the rotating platform technology of Low Contact Stress (LCS) and the modularity of Press Fit Condylar (PFC) system. We performed 18 knee replacements using cruciate retaining prosthesis without patellar resurfacing in 10 patients and followed them up over a period of 16-month. A new operative strategy was developed to match the flexion and extension gaps. The pre- and post-operative assessments were made according to the American Knee Society Scores (AKSS). Post-operative pain relief, range of motion, knee score and functional score showed promising early results. The average knee rating improved from 28 to 91 (range 75-94). Average functional assessment improved from 26 to 82 (range 75-90). The radiographic assessments show correction of an average pre-operative varus of 140 to post-operative valgus of 50 (range 4-70). Early infection occurred in two knees. Both responded to aggressive debridement and antibiotics. Stiffness was encountered in one patient. There were no spinouts of the insert. We are satisfied that the implants are performing well at the one-year mark and will continue monitor this cohort.
We studied the factors influencing the mid-term outcomes of tibial plateau fractures treated conservatively (n=21) and surgically (n=27) from December 1994 to December 1997. Joint stability was an important prognostic determinant. In the surgical group, the most important factor was good anatomical reduction. Functional outcomes were comparable between the conservative and surgical groups. We concluded that conservative treatment is a valid option for fractures with minimal displacement and surgical treatment is justified for severely displaced or depressed fractures. Attention must be paid to the recognition and restoration of joint stability and articular surface congruency for a satisfactory outcome.
Post Arthroscopic intra-articular analgesia is a better method to avoid post-operative pain after arthroscopic surgery, thus avoiding the adverse effects of systemic analgesics. In this prospective randomized double blind study conducted on 90 patients, 30 patients in group A received 20 ml of intra-articular saline, 30 patients in Group B received 10 ml of intra-articular saline and 10 ml of 0.25% bupivacaine and 30 patients in Group C received 10 ml of 0.25% bupivacaine, 1 ml (30 mg) of ketorolac and 9 ml of saline intra-articularly. Ambulatory status, duration of analgesia and requirement for supplemented analgesia were compared in these three groups. Patients receiving this intra-articular analgesic combination of bupivacaine and ketorolac required significantly less supplemental postoperative analgesics. This combination significantly prolonged the duration of analgesia. Patients receiving this combination of drugs for intra-articular analgesia ambulated earlier.
The roots of Malaysia's drinking patterns lie in the introduction of most forms of alcohol by Europeans. Although Malaysia today has relatively low per capita alcohol consumption, available studies and interviews with alcohol industry officials point to a small segment of the population that drinks heavily and causes and experiences substantial alcohol related-problems. Indians are over-represented in this sub-population, but studies also reveal substantial drinking problems among Chinese and Malays. Government officials categorize alcohol as an Indian problem. The government devotes little resources to monitoring drinking patterns, use or problems; or to preventing, treating or educating the public about alcohol-related problems. Alcohol-producing transnational corporations own shares of all of Malaysia's major alcohol producers. In the face of high alcohol taxes and a ban on broadcast advertising of alcoholic beverages, these companies market alcohol aggressively, making health claims, targeting heavy drinkers and encouraging heavy drinking, employing indirect advertising, and using women in seductive poses and occupations to attract the mostly male drinking population. Monitoring of the country's alcohol problems is greatly needed in order to establish alcohol consumption more clearly as a national health and safety issue, while stronger controls and greater corporate responsibility are required to control alcohol marketing.
'Amyotrophic dermatomyositis' (ADM) is used to describe a small subgroup of patients with the typical skin rash associated with dermatomyositis but without muscle involvement. Lung involvement in ADM is rare. We report on the management of a patient with ADM associated with pulmonary fibrosis at presentation, and her response to corticosteroid treatment.
An approach to cannulate right internal jugular vein in neutral head position is described for situations where head rotation and extension are contraindicated. Venous puncture was made immediately lateral to the carotid artery at the level of cricoid cartilage and directed caudad. In 40 patients studied, the right internal jugular vein of 97.5% of the patients were successfully located by the finder needle. The mean (SE) number of puncture attempts to locate the vein was 1.3 (0.1) per patient. In 72.5% (29 patients), the veins were located exactly at the predicted point after the first attempt. However the overall success rate for cannulation by the angiocath cannula was 87.5% and short term complication rate was 5.0%. We conclude this technique is a reliable, safe alternative for central venous access, especially in patients where cervical spine movement is contraindicated or restricted.
A new iridoid glucoside with an ether linkage between C-3 and C-10 and a novel nonglycosidic iridoid with an ether linkage between C-3 and C-6 and a lactonic linkage at C-1, named macrophylloside (1) and macrophyllide (2), respectively, were isolated from the leaves of Rothmannia macrophylla, along with six known iridoids. Their structures were established by NMR and MS spectroscopies.