The National Clinical Practice Guideline in Tuberculosis (TB) was designed to improve the quality of tuberculosis care. However, it remains unknown whether primary care doctors adhere to it well. This audit aims to assess the quality of care in the process of TB contact tracing in a primary care setting. Methods: Data on TB contact tracing from 1st February 2013 to 15th February 2013 was obtained retrospectively from all medical records of diagnosed pulmonary TB in a public primary care clinic. All patients who fulfilled the inclusion and exclusion criteria were included in the study. Results: A total of 102 medical records of adult TB contacts were recruited. The median age of the TB contact was 34 (IQR=10) years and 65 % were male. Seventy two percent of the adult TB contact had a TBIS 10C3 form created, and 95% of the medical records were fully documented. History taking and physical examination were recorded on 97% and 99% of patients respectively during the first follow-up at the polyclinic. Eighty five percent and 100% of the patients had a chest-x-ray and sputum direct smear for acid-fast bacilli done respectively. The turn-up rate for the first, second, third and fourth visit was 100% to 32%, 10% and 2% respectively. Conclusion: The quality of care for adult TB contacts tracing in this clinical audit was found to be suboptimal. There is a difference between the current national guidelines and practice in the clinic. Certain measures to improve the quality of care for adult TB contact tracing
are urgently needed.
Indium antimonide nanowires were synthesized by electrochemical deposition using anodic aluminum oxide template in the presence of gold film as conductive layers. Field emission scanning electron microscopy and energy dispersive X-ray spectrometry measurements were carried out to investigate the effect of adhesive insulated tape covered below the conductive layer. Results showed that the anodic aluminum oxide template covered with insulating tapes had better morphology with less presence of overgrown rough film on the topside of the anodic aluminum oxide template and it exhibited a smoother nanowire sidewall as compared to the uncovered ones. Additionally, the unique properties of anodic aluminum oxide were controllable pore diameter with a narrow size distribution at some intervals. It was evident from the energy dispersive X-ray spectrum that the nanowires synthesized from the covered template condition exhibited better InSb composition and stoichiometric ratio compared to the uncovered template condition.
Aripiprazole (ARP), a quinolinone derivative, is an atypical antipsychotic drug that is used in the treatment of schizophrenia. ARP has an extensive distribution and more than 99% of the ARP and dehydro-ARP, the main active metabolite, is bound to plasma proteins. However, information regarding the protein binding of ARP is limited. In this study, we report on a systematic study of the protein binding of ARP. The interaction of ARP and structurally related compounds with human serum albumin (HSA) was examined using equilibrium dialysis, circular dichroism (CD) spectroscopy, fluorescent probe displacement, and an X-ray crystallographic analysis. The binding affinities (nK) for ARP and its main metabolite, dehydro-ARP with HSA were found to be significantly higher than other structurally related compounds. The results of equilibrium dialysis experiments and CD spectral data indicated that the chloro-group linked to the phenylpiperazine ring in the ARP molecule plays a major role in the binding of these ligands to HSA. Furthermore, fluorescent probe displacement results indicated that ARP appears to bind at the site II pocket in subdomain III. A detailed CD spectral analysis suggests that the chloro-group linked to the phenylpiperazine ring may control the geometry of the ARP molecule when binding in the site II binding pocket. X-ray crystallographic analysis of the ARP-HSA complex revealed that the distance between the chlorine atom at the 3-positon of dichlorophenyl-piperazine on ARP and the sulfur atom of Cys392 in HSA was 3.4-3.6 Å. A similar halogen bond interaction has also been observed in the HSA structure complexed with diazepam, which also contains a chloro-group. Thus, the mechanism responsible for the binding of ARP to a protein elucidated here should be relevant for assessing the pharmacokinetics and pharmacodynamics of ARP in various clinical situations and for designing new drugs.
Assessing the repeat rate is crucial to reduce unnecessary dose to the patient by identifying the major cause for repeating the x-rays exposure to the patient and apply corrective measures. To analyse the repeat rate of routine lower limb projections in direct digital radiography (DR) from general radiology department of Pantai Klang Hospital. 26 months retrospective repeated radiograph was acquired from Picture Archiving and Communication System (PACS) at Hospital Pantai Klang. The retrieved radiographs were grouped based on the reason for the i radiographs being rejected which are incorrect positioning, incorrect collimation, patient movement, incorrect exposure factors, artefact, and other reasons. Total repeated radiographs retrieved for basic lower limbs projections were 13616. Knee was the highest repeted examination and the lowest repeat rate was tibia fibula. (repeat rate: knee = 1.04%, tibia fibula = 0.57%). incorrect positioning is the major causes for repeat exposure for all examinations type, followed by incorrect collimation, other categories, centring ray error, incorrect exposure factors and artifact.
Catalytic hydrogenation of carbon dioxide (CO2) to methanol is an attractive way to recycle and utilize CO2. A series of Cu/ZnO/Al2O3/ZrO2 catalysts (CZAZ) containing different molar ratios of Cu/Zn were prepared by the co-precipitation method. The catalysts were characterized by temperature-programmed reduction (TPR), field emission scanning electron microscopy-energy dispersive x-ray analysis (FESEM-EDX) and X-ray diffraction (XRD). Higher surface area, SABET values (42.6-59.9 m2/g) were recorded at low (1) and high (5) Cu/Zn ratios with the minimum value of 35.71 m2/g was found for a Cu/Zn of 3. The reducibility of the metal oxides formed after calcination of catalyst samples was also affected due to change in metal-support interaction. At a reaction temperature of 443 K, total gas pressure of 3.0 MPa and 0.1 g/mL of the CZAZ catalyst, the selectivity to methanol decreased as the Cu/Zn molar ratio increased, and the maximum selectivity of 93.9 was achieved at Cu/Zn molar ratio of 0.33. With a reaction time of 3h, the best performing catalyst was CZAZ75 with Cu/Zn molar ratio of 5 giving methanol yield of 6.4%.
Introduction: Various medium and high tube potentials were utilized to conduct chest x-rays. There
are advantages and disadvantages with regards to image quality and radiation dose when using
medium and high kilovoltage (kVp) technique. However, radiographers have misconstrued
understanding pertaining to the choice of tube potential as well as grid usage when performing chest radiography. Methods: The experimental study was conducted using the PBU-50 phantom by exposing it with medium kVp utilizing grid and non-grid as well as high kVp with grid. All images obtained were evaluated using the modified evaluation criteria for PA chest established by the Commission of European Communities, 1996 whilst the dose area product (DAP) was determined using the Dose Area Product (DAP) meter. The value obtained from the DAP meter was converted to entrance surface dose (ESD) usingCALDOSE_X5.0 software and mathematical formula. Results: The Wilcoxon Signed-Rank Test indicated a significant difference in ESD when using medium and high kVp; Z= -2.666, p
This descriptive cross sectional study was conducted to assess patient's satisfaction by evaluating the waiting time experienced by 27 (54%) inpatients and 23 (46%) outpatients who sought treatment at a private hospital in Selangor from 15th of May 2006 until 3rd of]une 2006. Majority of the patients (78%) were in the range between Z 1 - 40 years old and well»educated. Almost half (48%) were in the human resources employment category, 20% were in administration and marketing and 10% were professionals. Majority of them earned from RM1000-1999 (34%) and RMZ000-3999 (32%). Almost all of them (96%) agreed that the medical care that they had been receiving in the hospital was just about perfect. 98% agreed that the doctors treated them in a very friendly and courteous manner and 96% rated the care given by nurses as g0od/ excellent. 88% to 92% said that their communication with the doctors, nurses and other staff were good/ excellent. 80% waited less than 15 minutes at the registration counter, 52% waited less than 15 minutes to see the doctor and 44% waited less than 15 minutes at other places such as pharmacy and x-ray. Overall, 94% rated the level of services in the hospital as good/ excellent, Almost all (90%) would like to recommend the hospital to their friends and relatives. Our study demonstrated that the majority of the patients were satisfied with the doctors, nurses and environment of the private hospital. The average waiting time of patient before being attended to by a doctor was less than 30 minutes.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
In medical imaging practice, the act of removing any clothes from the region of interest is justified as to prevent the presence of artefacts on radiographs. However, by doing so, the ‘aurah’ of the patients, especially for the Muslims, are not observed and can be considered as violating their privacy if they are not well-informed beforehand. Previous studies have proved that radiographs with the presence of some fabric materials on the region of interest are radiographically acceptable. Therefore, the aims of this study are to tackle the issue of exposing one’s ‘aurah’ for a knee x-ray examination to take place and also to add insufficiency from the previous studies.
This is a novel study of the depth of penetration of bonding agents (BA) by using a
miniaturised CT-scan, XMT.The Linear Attenuation Coefficient describes the fraction of a beam of
x-rays or gamma rays that is absorbed or scattered per unit thickness of the absorber. The higher
the LAC, the more opaque the image is. (Copied from article).
Ameloblastoma is a slow growing benign tumour of the jaw and patients usually present late after the tumour achieved considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and characteristic findings on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumour are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.
The study was conducted to create specific formulae for stature estimation of adult male population in Malaysia based on measurements of femur, tibia and fibula lengths using radiographic method. A number of thirty two Malaysians from hospitals involved as subjects in this study. The subjects were Malays (14), Chinese (8) and Indians (10) from 25-45 years old. The standing height of the subject was recorded before femur, tibia and fibula were scanned with an x-ray
machine. The bones length was measured on the x-ray film in centimetres (cm) and analysed using Statistical Package for Social Sciences (SPSS) version 19.0 for Windows. The results showed a significant relationship (p < 0.05) between stature and measurements of length of femur, tibia and fibula. Stature of Malays and Indians were significant (p < 0.05) with measurements of length of femur, tibia and fibula but insignificant in Chinese. Simple Linear Regression Analysis was used to derive regression equation for single bone and Multiple Linear Regression Analysis was used to derive regression equation for combination of femur, tibia and fibula. Six formulae for stature estimation of adult male population in Malaysia were derived. The formulae consist of three formulae for single bone, a formulae for combination bones with unknown race, a formulae for combination bones of Malays population and a formulae for combination bones of Indians population. Formulae for combination bones had the highest correlation coefficient compared to the formula using a single bone. Standard error was found to be high in all the formulae due to small sample size. Extension for this study is essential to provide Malaysia with accurate formulae.
Cephalometric analyses using computer software have more advantages than manual analyses. However, the software should be evaluated for the accuracy and reproducibility before it can be used. The aims of the present study were: 1) to compare the differences in accuracy and precision between utilizing scanned images and soft copy images with the software 2) to assess the reproducibility of software and manual cephalometric analyses. Fifteen cephalograms were selected randomly from the Record Unit, Hospital Universiti Sains Malaysia. All films had 10 fiducial points marked and were scanned at 75 dots per inch (dpi) and 300 dpi. Manual and digital measurements were compared to obtain magnification factors. Seven digital x-ray images of a caliper were taken. The mean differences were measured between the fixed caliper measurement and digital measurements. Subsequently, 37 cephalograms were traced manually and digitally with Computer-Assisted Simulation System for Orthognathic Surgery (CASSOS) software to assess its accuracy and reproducibility after applying the obtained magnification factor. Steiner analysis was utilized and T tests were used to evaluate the mean difference. P
This is a case of a 62-year-old Indian man who was diagnosed with a rare type of lung
neuroendocrine tumour (NET) of atypical carcinoid (AC) subtype which comprises only 0.1%–
0.2% of pulmonary neoplasms. He initially presented to a private hospital in May 2018 with a
6-month history of chronic productive cough and haemoptysis. Chest X-Ray (CXR), CT scan,
bronchoscopy, biopsy and broncho-alveolar lavage were conducted. At this stage, imaging and
histopathological investigations were negative for malignancy. Diagnosis of bronchiectasis was
made and he was treated with antibiotic and tranexamic acid. Due to financial difficulties, his
care was transferred to a university respiratory clinic in June 2018. His condition was monitored
with CXR at every visit and treatment with tranexamic acid was continued for 6 months.
However, due to persistent haemoptysis, he presented to the university primary care clinic in
Dec 2018. Investigations were repeated in January 2019 where his CXR showed increased
opacity of the left retrocardiac region and CT scan revealed a left lower lobe endobronchial
mass causing collapse with mediastinal lymphadenopathy suggestive of malignancy.
Bronchoscopy, biopsy and histopathology confirmed the presence of NET. Although the Ki-67
index was low, the mitotic count, presence of necrosis and evidence of liver metastases
favoured the diagnosis of AC. A positron emission tomography Ga-68 DONATOC scan showed
evidence of somatostatin receptor avid known primary malignancy in the lungs with suspicions
of liver metastasis. He was subsequently referred to the oncology team and chemotherapy was
initiated. This case highlights the challenge in diagnosis and management of patients with AC.
Physicians ought to be vigilant and have a high index of suspicion in patients who present with
persistent symptoms on multiple visits. Early diagnosis of NET would prevent metastasis and
provide better prognosis. Continuous follow-up shared care between primary care and
secondary care physicians is also essential to provide ongoing psychosocial support for
patients with NET, especially those with metastatic disease
Pencirian enzim ekstraselular protease daripada bakteria Alkalophilic Bacillus lehensis G1 dari Malaysia telah dikaji. Enzim protease yang dirembeskan diuji pada agar susu skim 2%. Keputusan menunjukkan protease ekstraselular mampu mengekalkan aktiviti sehingga suhu 60°C di dalam julat pH yang luas iaitu 3 hingga 11 dengan suhu optimum pada 40°C dan pH optimum pada 7.0. Aktiviti enzim juga diperhatikan akan meningkat dengan penambahan beberapa ion iaitu Mn2+, Fe2+, Cu2+, Mg2+ dan Co2+. Manakala aktiviti protease didapati sedikit direncat dengan kehadiran ion Ca2+, K+ dan Ni2+ dengan baki aktiviti sebanyak 85%, 81% dan 75%. Protease ekstraselular juga didapati serasi dengan beberapa cecair detergen komersial dari Malaysia, yang menunjukkan protease ini boleh dimanfaatkan sebagai pembersih kotoran pada pakaian. Selain itu, potensi kegunaan protease yang dihasilkan oleh B. lehensis G1 ke atas penguraian gelatin dari filem X-ray yang telah digunakan juga telah dilakukan di dalam kajian ini.
Novel germanium (Ge)-doped silica glass fibres tailor-made in Malaysia are fast gaining recognition as potential media for thermoluminescence (TL) dosimetry, with active research ongoing into exploitation of their various beneficial characteristics. Investigation is made herein of the capability of these media for use in diagnostic imaging dosimetry, specifically at the radiation dose levels typically obtained in conduct of Computed Tomography (CT). As a first step within such efforts, there is need to investigate the performance of the fibres using tightly defined spectra, use being made of a Philips constant potential industrial x-ray facility, Model MG165, located at the Malaysian Nuclear Agency Secondary Standards Dosimetry Lab (SSDL). Standard radiation beam qualities (termed RQT) have been established for CT, in accord with IEC 61267: 2003 and IAEA Technical Reports Series No. 457: 2007. A calibrated ionisation chamber has also been utilised, forming a component part of the SSDL equipment. The fabricated fibres used in this study are 2.3 mol% flat fibre (FF) of dimensions 643 × 356 μm2 and 2.3 mol% cylindrical fibre (CF) of 481 μm diameter, while the commercial fibre used is 4 mol% with core diameter of 50 μm. The dopant concentrations are nominal preform values. The fibres have been irradiated to doses of 20, 30 and 40 milligray (mGy) for each of the beam qualities RQT 8, RQT 9 and RQT 10. For x-rays generated at constant potential values from 100 to 150 kV, a discernible energy-dependent response is seen, comparisons being made with that of lithium fluoride (LiF) thermoluminescence dosimeters (TLD-100). TL yield versus dose has also been investigated for x-ray doses from 2 to 40 mGy, all exhibiting linearity. Compared to TLD-100, greater sensitivity is observed for the fibres.
Langerhans cell histiocytosis (LCH) is a clonal histiocytic disorder. The variable clinical manifestations from isolated bone lesion to multisystem disease can cause difficulties and delay in diagnosis. We report a 2 years and 8 months-old girl who presented with a 2 weeks history of persistent fever and weight loss associated with progressive abdominal distension. Physical examination revealed pallor, bilateral proptosis, seaborrheic dermatitis over the scalp and hepatosplenomegaly. Skull X-ray demonstrated multiple lytic lesions at the base and the skull vault. Bone marrow morphology showed numerous abnormal Langerhans cells (LCs) and foamy macrophages. The trephine immunohistochemistry (IHC) stains for CD1a, S-100 and CD68 were inconclusive. The diagnosis of multisystem Langerhans cell histiocytosis (MS-LCH) in this patient was based on the clinical presentation, radiological and morphological analysis. She subsequently received chemotherapy and currently she is on maintenance therapy with a good clinical response. LCH is a rare disease and although the IHC was inconclusive, the correlation of clinical, radiological and morphological data are essential for the diagnosis.
Treating tuberculosis (TB) remains a public health challenge in many developing countries. Treatment success rate in Malaysia is on declining pattern from 78% in 2000 to 48% in 2006. This study will determine factors associated with unsuccessful treatment among pulmonary TB patients. A retrospective cohort study was conducted on notified and treated pulmonary TB cases in Kota Bharu district Kelantan between January 2006 and December 2007. To identify the associated factors, univariate comparison and multiple logistic regressions were performed. Among the 765 patients identified, 472 (61.7%) cases fulfilled the criteria and were analyzed. There were 316 males and 156 females and their mean (SD) age was 45 (17.9) years. In univariable analysis, age, gender, educational level, employment status, family incomes as well as coexistence of extra-pulmonary TB, smoking, co-morbid disease (diabetes mellitus), HIV status, sputum cultures, chest X-ray findings and duration of delay for diagnosis were all found to have significant relationship with unsuccessful pulmonary TB treatment outcome. After adjusted for the confounders, the significant predictors for unsuccessful tuberculosis treatment were age (Adj. OR 1.09; 95% CI: 1.03-1.15), HIV positive (Adj. OR 23.04; 95% CI: 3.01-176.22) and advanced chest X-ray findings (Adj. OR 6.51; 95% CI: 1.50-28.23). A large proportion of unsuccessfully treated cases could be identified at entry
by screening for age, chest X-rays and HIV status and specially targeted measures could be taken. The use of directly observed treatment short-course (DOTS) should be given more focus and priority among this high risk group of patients.
The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 - 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.
Adenokarsinoma paru-paru miliari adalah sangat jarang dan agresif. Adenokarsinoma paru-paru biasanya menunjukkan sifat ketulan pada peparu yang berkaitan dengan kerosakan paru-paru dan efusi pleura. Adenokarsinoma ini jarang jarang berpunca daripada tapak selain daripada tapak primer, tidak seperti kanser-kanser lain contohnya kanser tiroid, koriokarsinoma dan sarcoma. Kami membentangkan di sini kes seorang suri rumah berusia 50 tahun yang mengadu batuk-batuk, hilang selera makan dan sukar untuk bernafas selama 1 bulan. Perawat perubatan primer telah merawat beliau sebagai jangkitan kuman pada paru-paru. Disebabkan keadaan yang tidak pulih dan semakin melarat, beliau dibawa ke Jabatan Kecemasan. Oksigen beliau dikesan sebanyak 93% atas udara bilik. Berdasarkan sejarah pesakit dan penemuan X-ray paru-paru, rawatan untuk tuberculosis miliari telah di beri walaupun ujian Mantoux dan kahak negatif. Berikutan peningkatan tanda-tanda dan intubasi, bronkoskopi kemudian mendedahkan diagnosis adenokarsinoma paru-paru. Sebagai pelajaran, penampilan miliari radiografi tidak dikelirukan kepada tuberkulosis sahaja, kerana sebab-sebab berbahaya yang lain perlu disiasat. Bronkoskop dengan analisis histopatologi diperlukan, terutamanya jika Mantoux dan sputum adalah negatif.
We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Keywords: emphysema, haemopneumothorax, thoracostomy, thorax