Shigellosis is a foodborne illness caused by the genus Shigella and is an important global health issue. The development of effective techniques for rapid detection of this pathogen is essential for breaking the chain of transmission. Therefore, we have developed a novel loop-mediated isothermal amplification (LAMP) assay targeting the invasion plasmid antigen H (ipaH) gene to rapidly detect Shigella species. This assay could be performed in 90 min at an optimal temperature of 64ºC, with endpoint results visualized directly. Notably, the method was found to be more sensitive than conventional PCR. Indeed, the detection limit for the LAMP assay on pure bacterial cultures was 5.9 x 10(5) CFU/ml, while PCR displayed a limit of 5.9 x 10(7) CFU/ml. In spiked lettuce samples, the sensitivity of the LAMP assay was 3.6 x 10(4) CFU/g, whereas PCR was 3.6 x 10(5) CFU/g. Overall, the assay accurately identified 32 Shigella spp. with one enteroinvasive Escherichia coli displaying positive reaction while the remaining 32 non-Shigella strains tested were negative.
The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.
In the last four years, Malaysia has had three outbreaks of chikungunya virus infection. The first two occurred in Perak in 2006.The third began in Johor in early 2008. The genome of the viruses suggests that on each occasion a different virus was introduced into the population. The first outbreak in Bagan Panchor was due to an Asian genotype virus. The second in the Kinta district of Perak in late 2006 was due to a Central/East African genotype virus. Contact tracing was even able to discover the patient who was the source of the virus from the Indian subcontinent. The third outbreak in Johor was also of a Central/East African strain of virus, but introduced independently. The epidemiology of that outbreak is described in this issue of the MJM.
BACKGROUND: Methotrexate (MTX) is a common and efficacious systemic agent used for the treatment of moderate to severe psoriasis. Nevertheless, its use is associated with the risk of hepatotoxicity. This study was performed to study the association of MTX dose with regards to hepatotoxicity as evidenced by deranged transaminases.
METHODS: This was a retrospective review of patients with psoriasis on MTX from 2000 to 2009 at the outpatient dermatology clinic, University Malaya Medical Centre (UMMC). We analyzed patients' demography, serial laboratory investigations, liver ultrasounds, and liver biopsies of patients on MTX.
RESULTS: Sixty-six of 710 (9.30%) patients with psoriasis were prescribed MTX throughout the 10-year period. Among them 57.6% developed deranged transaminases, with six requiring MTX withdrawal due to hepatotoxicity. The mean cumulative dose of MTX at the detection of liver enzyme derangement was 552.3 ± 596.1 mg.
CONCLUSION: A high proportion of patients on MTX had deranged transaminases. However, the number of serious events was low. We concluded from this study that the use of MTX is relatively safe in patients with moderate to severe psoriasis.
Study site: outpatient dermatology clinic, University Malaya Medical Centre (UMMC
A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.
Study site: Chest clinic, Kelang, Selangor, Malaysia
In a retrospective study, 455 people were found to have been admitted to the Surgical Unit of the Taiping District Hospital, suspected of acute appendicitis in the study period from 1 July to 31 December 1990. However, only 147 (32.3%) were clinically confirmed to have appendicitis and underwent appendicectomy. Out of these, 120 (81.6%) cases were subjected to detailed analysis. The study showed that the commonest age group affected was the 10 to 20 year old. Males were slightly more often affected but there seemed to be an equal distribution among the major races. The diagnostic accuracy, that is the operated cases that were actually acute appendicitis, was 92.5%. The perforation rate was 31.5%. Fifty-five percent of patients developed some post-operative complications, of which the commonest was fever.
Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability.
The prevalence of perceived food allergies exceeds that of true food allergies. Unnecessary food avoidance may increase parental and patient anxiety, reduce quality of life and increase the risk of nutritional deficiency. An oral food challenge (OFC) can provide an objective measure regarding the presence or absence of food allergies in a child. This study reviews the indications for and outcomes of OFCs performed on children.
Sand management is essential for enhancing the production in oil and gas reservoirs. The critical total drawdown (CTD) is used as a reliable indicator of the onset of sand production; hence, its accurate prediction is very important. There are many published CTD prediction correlations in literature. However, the accuracy of most of these models is questionable. Therefore, further improvement in CTD prediction is needed for more effective and successful sand control. This article presents a robust and accurate fuzzy logic (FL) model for predicting the CTD. Literature on 23 wells of the North Adriatic Sea was used to develop the model. The used data were split into 70% training sets and 30% testing sets. Trend analysis was conducted to verify that the developed model follows the correct physical behavior trends of the input parameters. Some statistical analyses were performed to check the model's reliability and accuracy as compared to the published correlations. The results demonstrated that the proposed FL model substantially outperforms the current published correlations and shows higher prediction accuracy. These results were verified using the highest correlation coefficient, the lowest average absolute percent relative error (AAPRE), the lowest maximum error (max. AAPRE), the lowest standard deviation (SD), and the lowest root mean square error (RMSE). Results showed that the lowest AAPRE is 8.6%, whereas the highest correlation coefficient is 0.9947. These values of AAPRE (<10%) indicate that the FL model could predicts the CTD more accurately than other published models (>20% AAPRE). Moreover, further analysis indicated the robustness of the FL model, because it follows the trends of all physical parameters affecting the CTD.
Gait events detection allows clinicians and biomechanics researchers to determine timing of gait events, to estimate duration of stance phase and swing phase and to segment gait data. It also aids biomedical engineers to improve the design of orthoses and FES (functional electrical stimulation) systems. In recent years, researchers have resorted to using gyroscopes to determine heel-strike (HS) and toe-off (TO) events in gait cycles. However, these methods are subjected to significant delays when implemented in real-time gait monitoring devices, orthoses, and FES systems. Therefore, the work presented in this paper proposes a method that addresses these delays, to ensure real-time gait event detection. The proposed algorithm combines the use of heuristics and zero-crossing method to identify HS and TO. Experiments involving: (1) normal walking; (2) walking with knee brace; and (3) walking with ankle brace for overground walking and treadmill walking were designed to verify and validate the identified HS and TO. The performance of the proposed method was compared against the established gait detection algorithms. It was observed that the proposed method produced detection rate that was comparable to earlier reported methods and recorded reduced time delays, at an average of 100 ms.
One of the main areas of behavioural neuroscience is forecasting the human behaviour. Epilepsy is a central nervous system disorder in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behaviour, sensations and sometimes loss of consciousness. An estimated 5% of the world population has epileptic seizure but there is not any method to cure it. More than 30% of people with epilepsy cannot control seizure. Epileptic seizure prediction, refers to forecasting the occurrence of epileptic seizures, is one of the most important but challenging problems in biomedical sciences, across the world. In this research we propose a new methodology which is based on studying the EEG signals using two measures, the Hurst exponent and fractal dimension. In order to validate the proposed method, it is applied to epileptic EEG signals of patients by computing the Hurst exponent and fractal dimension, and then the results are validated versus the reference data. The results of these analyses show that we are able to forecast the onset of a seizure on average of 25.76 seconds before the time of occurrence.
The Medical Department of Sabah, in collaboration with various governmental and non-governmental agencies and 'Surgeons International' conducted a state-wide campaign for the 'Early Detection of Cancer' over a period of 3 months from July 1992. The purpose of the campaign was to educate the population about the early signs and symptoms of common cancers, to remove the myth that cancer was incurable and to impress on the public the need to detect cancer early for a possible cure and a better prognosis.
This work studied the bioremediation of weathered crude oil (WCO) in coastal sediment samples using central composite face centered design (CCFD) under response surface methodology (RSM). Initial oil concentration, biomass, nitrogen and phosphorus concentrations were used as independent variables (factors) and oil removal as dependent variable (response) in a 60 days trial. A statistically significant model for WCO removal was obtained. The coefficient of determination (R(2)=0.9732) and probability value (P<0.0001) demonstrated significance for the regression model. Numerical optimization based on desirability function were carried out for initial oil concentration of 2, 16 and 30 g per kg sediment and 83.13, 78.06 and 69.92 per cent removal were observed respectively, compare to 77.13, 74.17 and 69.87 per cent removal for un-optimized results.
Eight hundred and fifty-six strains of Mycobacterium tuberculosis from previously untreated patients with pulmonary tuberculosis from various states in West Malaysia were studied during the period 1984 to 1987. All the strains were tested for in vitro susceptibility to the anti-tuberculosis drugs isoniazid (INH), streptomycin (SM), rifampicin (RMP) and ethambutol (ETB). One hundred and twenty-one of the isolates (14.18%) were resistant to 1 drug while 17 (1.97%) were resistant to 2 drugs. No strain was found to be resistant to more than 2 drugs. The prevalence of primary resistance to INH was 4.20%, SM was 7.59%, RMP was 0.95% and ETB was 1.44%. In 1.86% of isolates, resistance was noted to both INH and SM, while 0.11% were resistant to both RMP and ETB. There was no significant difference in distribution of resistant bacilli between the sexes (p > 0.01).
Iron deficiency is the commonest cause of anemia worldwide and healthy blood donors are estimated to lose about 236 mg of iron with each donation. The objective of this study was to determine the serum ferritin levels among first time and regular male blood donors, and also to correlate the serum ferritin levels with the number of donations and hemoglobin levels. Hemoglobin levels and serum ferritin were measured in three groups of donors divided into first time donors; (n = 92), donors with 2-4 donations (n = 41), and regular donors (n = 78). The mean hemoglobins in the first time donors, second group and regular blood donor group were 14.95 +/- 1.08, 15.12 +/- 1.44 and 15.56 +/- 1.48, respectively. The serum ferritin level were found to be significantly lower among the regular donors (62.0 +/- 39.78 ng/ml) compared to first time donors (90.7 +/- 66.63) and second group donors (114.12 +/- 66.97). The serum ferritin levels gradually decrease according to the number of donations and there was a significant correlation between frequency of donations and the serum ferritin level (r2 = 0.082). Significant correlation between the number of donations and hemoglobin level r2 = 0.061) was noted. However, there was no significant correlation between hemoglobin and serum ferritin levels (r2 = 0.015). Eleven percent of regular donors had depleted iron stores. This was not noted in donors who donated less than 5 times within 2 years.
INTRODUCTION: Several studies have found higher in-hospital mortality for admissions during weekend or off hours, known as "weekend or off-hour effect". However, data for this on Malaysian populations is limited. This study was conducted to analyze the 3-year mortality trend in a secondary hospital and its relation to time and date of admission.
METHODS: The clinical data of 126,627 patients admitted to Taiping Hospital from 1st January 2008 to 31st December 2010 obtained via patient registry database of hospital was analyzed. This study compared mortality during weekdays with weekends, office hours (0800-1700) with off hours (1701-0759), and subanalysis of office hours with evening (1701-2259) or night hours (2300-0759), adjusted for age and gender.
RESULTS: Although the overall staff-to-patient ratio is improving, analyses showed a statistically significant increased risk of mortality for those patients admitted during weekends (OR = 1.22; 95% confidence interval [CI] = 1.14-1.31) or off hours in a weekday (OR = 1.67; 95% CI = 1.57-1.78). In the comparison between time of admission, there was statistically significant increased risk of mortality for admissions during evening hours (OR = 1.44; 95% CI = 1.28-1.62) and night hours (OR = 1.92; 95% CI = 1.71-2.16). Diseases of cardiovascular and respiratory system remained the top two causes of death over the three years.
CONCLUSION: The risk of mortality is significantly higher as a result of "weekend or off-hour effect". Recognition and intervention addressing these issues will have important implications for the healthcare system setting, hospital staffing and training, quality and timeliness of medical care delivery.
Rapid progress of industrial development, urbanization and traffic has caused air quality reduction that negatively affects human health and environmental sustainability, especially among developed countries. Numerous studies on the development of air quality forecasting model using machine learning have been conducted to control air pollution. As such, there are significant numbers of reviews on the application of machine learning in air quality forecasting. Shallow architectures of machine learning exhibit several limitations and yield lower forecasting accuracy than deep learning architecture. Deep learning is a new technology in computational intelligence; thus, its application in air quality forecasting is still limited. This study aims to investigate the deep learning applications in time series air quality forecasting. Owing to this, literature search is conducted thoroughly from all scientific databases to avoid unnecessary clutter. This study summarizes and discusses different types of deep learning algorithms applied in air quality forecasting, including the theoretical backgrounds, hyperparameters, applications and limitations. Hybrid deep learning with data decomposition, optimization algorithm and spatiotemporal models are also presented to highlight those techniques' effectiveness in tackling the drawbacks of individual deep learning models. It is clearly stated that hybrid deep learning was able to forecast future air quality with higher accuracy than individual models. At the end of the study, some possible research directions are suggested for future model development. The main objective of this review study is to provide a comprehensive literature summary of deep learning applications in time series air quality forecasting that may benefit interested researchers for subsequent research.
The authors made a 3-year retrospective study of cases of tubo-ovarian abscess surgically treated in KK Women's and Children's Hospital. In the period studied (1998 through 2000), there were 36 such cases. A total of 11 patients underwent laparoscopic treatment while 25 patients underwent laparotomy. The study demonstrates the differences in the patient profile and the short term morbidity in each mode of surgical treatment and the changing trends in the surgical treatment of tubo-ovarian abscess.