The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.
Refractory dermal melasma is resistant to conventional treatment. Platelet rich plasma (PRP) may help to reduce the pigmentation of melasma. We present a case report on the clinical outcome of 2 patients with melasma, given PRP, as an adjunct therapy. PRP was administered at a monthly interval for 2 sessions in combination with a monthly Q-switched Nd Yag laser treatment and topical alpha arbutin application. A modified melasma area and severity index (MASI) was evaluated by two dermatologists who were blinded. At the follow up on the 3rd months, the MASI score was reduced by mean 33.5% for case 1 and 20% for case 2. There were no clinical complications for case 1. However recurrence of melasma was noted in case 2 by a worsening of the MASI score mean to 53% at the sixth months follow up. In conclusion, intradermal PRP injection as an adjunct to the conventional treatment of melasma presented with differing results in two cases.
We conducted a multi-institutional case study to identify the issues associated with the adoption of information and communication technology (ICT) in five private care hospitals in the Kingdom of Saudi Arabia. We conducted interviews with 37 respondents primarily comprising IT professionals.
We found that there were three determinants of behavioural intentions in this case study: organisation objectives, facilitating conditions and social influence where there are no effects of performance expectancy or effort expectancy. In all five cases, none of the moderators (age, gender, experience and voluntariness) in the original united theory of acceptance and use of technology model were considered critically important by IT professionals. In the present paper, all qualitative elements such as themes, patterns and overarching in the data were analysed to reach a conclusion. In addition, the various perspectives of using ICT are discussed.
Background: This paper examined the importance and influence of post-transplantation follow-up visits on the quality-of-life (QoL) of living kidney donors in Malaysia.
Methods: Based on data collected from 80 living kidney donors, the relationship between QoL and the frequency of follow-up visits was examined. QoL was measured using standard SF-8 questions to capture its different dimensions.
Results: Donors in the 1991–1998 donation cohort have low QoL, especially in the domains of physical and vitality, compared with the other two cohorts (1999–2005 and 2006–2012). The mean scores showed that donors who never went for any follow-up activities visits experience low QoL in most of the categories, particularly those related to physical activities, implying the importance of follow-up activities visits in influencing the donors’ QoL. Lower QoL was recorded for respondents that never received post-transplant treatment.
Conclusion: Although this study found no serious post-transplant QoL issues in Malaysia, it is still important to set up a donor registry and provide free and mandatory follow-up visits for all donors in order to adequately monitor their health.
Organ transplantation is a new treatment for end-stage organ failure. However, the total number of transplants performed in Malaysia in 2012 was only 94. Rates of deceased and living donors in Malaysia for 2012 were chronically low (0.55 and 1.87 per million population, respectively). A sample of 350 respondents in mosques, hospitals, and universities in various places in the Klang Valley, Kelantan and Pahang were collected between October and December 2013 to investigate the level of knowledge of health care professionals (HCPs), religious leaders (RLs), and academics (ACAs) and their stand on two issues on brain death. The result on the first issue (procuring organs from brain dead donors for transplantation) revealed that 52.8%, 23.7%, and 23.4% of HCPs, RLs, and ACAs, respectively, were in support of it; 30.2%, 31.8%, and 45.2% were uncertain about it; and 17%, 44.5%, and 31.5% were against it. On the second issue (terminating the life support machine of a brain dead person), 60.4%, 35.7%, and 25% of HCPs, RLs, and ACAs, respectively, were in support of it; 26.4%, 36.4%, and 38.7% were uncertain about it; and 13.2%, 27.7%, and 36.3% were against it. The lack of knowledge on Islam brain death-related issues should be addressed by educational efforts targeting these three groups of professionals. Special emphasis should be paid to educating RLs as they can channel their knowledge and perception to the other groups and to the Muslim public.
The family is an important factor that influences an individual’s decision for organ donation. The number of studies addressing the family’s role in organ donation is limited. It is imperative to explore these studies and offer recommendations that may help in addressing organ shortage. 15 studies with more than 2100 participants were selected for a systematic review. The studies were accessed by searching three databases: MEDLINE, Elsevier, and PsycINFO. This systematic review indicates that knowledge about brain death and the circumstances surrounding organ donation and transplantation are the most important factors that affect a family’s decision regarding organ donation. Educational efforts targeting the family should be initiated, which can then guide the family’s decision on organ donation. We suggest that educational efforts be consistent with other factors such as religious beliefs that influence the family’s decision.
Tendon is a dense connective tissue that connects muscle to bone. Tendon can adapt to mechanical forces passing across it, through a reciprocal relationship between its cellular components (tenocytes and tenoblasts) and the extracellular matrix (ECM). In early development, the formation of scleraxis-expressing tendon progenitor population in the sclerotome is induced by a fibroblast growth factor signal secreted by the myotome. Tendon injury has been defined as a loss of cells or ECM caused by trauma. It represents a failure of cells and matrix adaptation to mechanical loading. Injury initiates attempts of tendon to repair itself, which has been defined as replacement of damaged or lost cells and ECM by new cells or new matrices. Tendon healing generally consists of four different phases: the inflammatory, proliferation, differentiation and remodelling phases. Clinically, tendons are repaired with a variety of surgical techniques, which show various degrees of success. In order to improve the conventional tendon repair methods, current tendon tissue engineering aims to investigate a repair method which can restore tissue defects with living cells, or cell based therapy. Advances in tissue engineering techniques would potentially yield to a cell-based product that could regenerate functional tendon tissue.
Osteoarthritis (OA) affects millions of people worldwide with its irreversible destruction of articular cartilage. Recently, the potential of using chondrogenic differentiated multipotent mesenchymal stromal cells (cMSCs) for OA treatment is being assessed. Preliminary clinical studies have been encouraging. However current studies have also demonstrated that cMSCs are not biochemically and biomechanically identical to native articular chondrocytes (ACs). Thus, there is an urgent need for the implementation of proteomic applications as proteomics involve protein identification, relative quantification of proteins and studies of post-translational modification which reveal novel regulating processes of complex mechanisms such as in chondrogenesis. A comprehensive understanding of chondrogenesis is essential for the establishment of an effective cMSC model to regenerate cartilage. In this article, we will review current proteomic studies on chondrogenesis, focusing on recent findings and the proteomic approaches utilised.
Malaria is a major cause of mortality and morbidity globally. Great efforts have been made in the prevention and the elimination of malaria, especially in controlling the malaria vector, the mosquito. Another promising approach would be the development of malaria vaccines. Malaria vaccine studies can be focused on the pre-erythrocytic-stage antigens and the blood-stage antigens, and on the transmission blocking agents targeting the malaria gametocytes. The blood-stage antigens are the leading candidates in malaria vaccine development, as the blood-stage parasites are responsible for causing symptomatic malaria. Human acquired immunity largely targets on blood-stage antigens. This review focuses on one of the most extensively studied blood-stage antigen, the merozoite surface protein-1 (MSP-1), specifically on its evaluation and immunogenicity in rodents and primate models, and its safety and immunogenicity in human clinical trials.
Autologous chondrocyte implantation (ACI) is a significant technique that has gained widespread use for the treatment of focal articular cartilage damage. Since its inception in 2004, the Tissue Engineering Group (TEG) of the Faculty of Medicine, University Malaya has been dedicated to carrying out extensive research on this cell-based therapy. The objective of this report, comprising one clinical case report, six animal studies and one laboratory study, is to summarise and discuss TEG’s key findings. On the whole, we observed that the ACI technique was effective in regenerating hyaline-like cartilage in treated defects. Autologous chondrocytes and mesenchymal stem cells (MSC) were found to produce comparable tissue repair irrespective of the state of MSC differentiation, and the use of alginate-based scaffolding and oral pharmacotherapy (Glucosamine and Chondroitin Sulphate) was shown to enhance ACI-led tissue repair. ACI is suggested to be an efficient therapeutic option for the treatment of articular cartilage defects of the knee.
MicroRNAs (miRNAs) are short, single-stranded non-coding RNAs that control gene expression by annealing to complementary sequences in mRNAs. They are estimated to regulate at least one third of human transcripts and hence, manipulation of these miRNAs can profoundly affect the proteome and ultimately cellular phenotypes. A substantial amount of work has shed light on the crucial roles of miRNAs in diseases. miRNA expression profiles between normal and diseased tissues have identified miRNA signature patterns that correlate to disease development and progression. This review discusses some of the important miRNAs that are involved in endothelial cell senescence and dysfunction that contribute to the development and progression of cardiovascular diseases.
Antimicrobial peptides (AMPs) have gained increasing attention as a potential candidate in the development of novel antimicrobial agent. Designing AMPs with enhanced antimicrobial activity while reducing the cell toxicity level is desired especially against the antibiotic-resistant microbes. Various approaches towards the design of AMPs have been described and physicochemical properties of AMPs represent the primary factors determining the antimicrobial potency of AMPs. The most common parameters include net charge and hydrophobicity, which greatly influence the antimicrobial activity of AMPs. Moreover, certain amino acids would have critical importance in affecting the antimicrobial activity as well as cell cytotoxicity of AMPS. In this review, net charge, hydrophobicity, and specific amino acid residues were discussed as factors contributing to the antimicrobial activity of AMPs.
Dengue is one of the highest occurring vector-borne diseases. It is caused by dengue viruses 1- 4. Currently, the disease is classified into dengue with or without warning signs and severe dengue based on WHO 2009 dengue classification. As of today, neither specific drugs nor commercial vaccine exist for dengue. The best treatment yet would be support, management and proper medical care. With no pathognomonic features that could differentiate it from other febrile illnesses, clinical diagnosis alone is insufficient. Yet, despite the current advances and existence of various laboratory diagnostic methods of dengue, a consensus singular method has not been established. There are several hypotheses or theories regarding the vaguely understood immunopathogenesis of dengue. Amongst these are the viral factors, host-immune factors and host-genetic factors. In addition to these, the occurrence of asymptomatic dengue has further complicated the disease. However, these individuals provide opportunities in the search for protective factors against dengue.
The plants of the genus Phyllanthus (Euphorbiaceae) are distributed in most tropical and subtropical regions of world. This plant has been long used as a traditional medicine to treat problems such as stomach, intestinal infections, kidney and urinary bladder disturbances, diabetes, and hepatitis B. There has been considerable interest in these plants in recent years. This review discusses the antiviral and anticancer aspects of Phyllanthus species. Scientific studies have demonstrated that extracts and purified isolated compounds (flavonoids, lignans, phenols, and terpenes) obtained from these plants possess antiviral effects against herpes simplex (HSV) and dengue virus infections (DENV). These observations are associated with the disruption of essential proteins needed during viral cycle, thus halting the viral replication. In addition, the Phyllanthus species have also been shown to exert inhibitory effects against selected cancers types. In these studies anti-proliferative, anti-metastatic, anti-angiogenic effects and induced apoptosis of human cancers cell lines were observed. These may be explained by the disruption of multiple survival pathways and differential protein expression. CONLCUSION:As a conclusion, tThe Phyllanthus plant possesses multiple medicinal properties, including antiviral and anticancer activities which may potentially be used as a medicinal source for many disease locally.
Salivary gland swelling is a rare complication of upper endoscopy with less than twelve cases reported in the literature. The swelling is usually transient in nature, with complete resolution in a few hours .While all the major paired salivary glands have been implicated, the exact aetiology remains obscure. In this case report, a sixty one year old female presents with unilateral swelling of the right parotid gland immediately following an upper endoscopy. There was complete resolution of the pneumoparotid with no neurological sequelae.
Organ shortage is a major concern in many countries. The objective of this paper was to investigate the factors that contribute to the low quantity of organ donation in Malaysia. The 1311 respondents in this survey came from the three main ethnic groups in Malaysia (Malay, Chinese and Indian). The survey was based on these components: The reason for not pledging to become a donor; the reason of refusing to become a donor; and whether non-fungible incentive would influence decision. The lack of information and trust were the factors that influenced the respondents to remain apathetic to organ donation. The results denote that people are unlikely to become a donor even if non-fungible incentive were provided to them. Thus, it is important for the government bodies to evaluate the programme and strategies of public education in relation to organ donation.
Initiation of Highly Active Anti-Retroviral Therapy (HAART) depends on clinical or immunological criteria. Clinical criteria include the presence of opportunistic infections, categorized by the WHO as stage 3 and 4. Immunological criteria are based on CD4 cell count. The WHO guidelines have changed frequently. All patients with CD4 cell count less than 200 cells/µl and symptomatic HIV or late disease or severe recurrent HIV illnesses or patients with AIDS or tumor at any CD4 count, should start therapy. WHO guidelines in 2013 recommended initiating HAART at CD4 counts less than 500 cells/µl. HAART is usually initiated when CD4 is less than 200 cell/µl because HIV infected patients present at a late stage. Research on factors responsible for this is sorely needed so that interventions can be targeted at this group.
Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age
MRI can be a distressing and traumatic experience in many patients, especially in those with underlying anxiety and/or claustrophobia. We conducted a study to determine if dexmedetomidine as a sedative agent can alleviate these symptoms. Dexmedetomidine is a potent and highly selective α-2 adrenergic receptor agonist which has sedative and analgesic properties. Eleven adult patients (n=11) with a histroy of anxiety and/or claustrophobia undergoing MRI who expressed their desire for sedation were recruited. Dexmedetomidine was infused at 0.5 to 1.0 μg/kg over 10 minutes prior to scanning. Eight patients (n=8) were able to complete the MRI scan comfortably. The findings suggest that dexmedetomidine provides adequate sedation that can allow patients with anxiety and/or claustrophobia to undergo MRI scanning succesfully in a large poproption of the population with anxiety. This result however is still preliminary and will need to be validated in a more robust clinical study.
Human adipose tissue has been recognized as an alternative source of adult stem cells. The abundance and ease of harvest of adipose tissue has made it suitable for use in regenerative medicine and tissue engineering. Adipose-derived stem cells isolated from human adipose tissue are able to differentiate into several mesenchymal lineages and secrete growth factors that exhibit therapeutic potential. Protein profiles have been established using various isolation methods, which has expanded researchers’ understanding of adipose-derived stem cells in clinical applications. This review highlights the properties, isolation methods, immunophenotype and clinical applications of adipose-derived stem cells.