The abdominal pelvic cavity has always been regarded as one of the most vulnerable regions of the body. Injuries to this part have been known to be very serious. Based on this a retrospective study was performed on postmortem cases with abdominal and pelvic trauma from 1 October 2002 to 31 January 2003 at the Forensic Institute, Hospital Kuala Lumpur to determine the common pattern of abdomino-pelvic injuries, the injury’s relationship to epidemiological and socio-economic factors, risk organ within the abdominopelvic region and relationship between injuries and survival period. A total of 122 cases abdomino-pelvic were obtained stemming from medico legal postmortems procedures. Results indicated that those aged between 21 to 30 years (38.5%) had the highest incidence of this type of injury. Categorization based on gender showed that males (90.2%) dominated most of the cases. Prevalence based on socio-economic status showed that lower socioeconomy class (52.5%) had the highest incident. This was followed by the middle income (39.3%) and finally the higher income group. The most numerous type of trauma was non-penetrating trauma (94.3%). It was also found that victims with low injury severity score (ISS) had a longer survival period as compared to those with high ISS. It was also noted that victims with two or more region injuries either were spot dead or brought dead. The most common combination of injuries was abdomen, pelvic, chest and limb. In most blunt trauma cases majority of victims had one or two organ involvement while penetrating injuries were difficult to asses. The most common organ involved in this type of trauma was liver (72.1%), pelvic bone (47.5%) and spleen (43.4%). In conclusion, abdomino-pelvic injury is a serious condition and should not be overlooked. Proper attention towards their diagnosis and management is important and so any patient of head injury with coma must be considered as having intra-abdominal injury until proven otherwise.
The electrical resistivity and flexural strength of plastic composites reinforced with pineapple leaf particles (PCPLP) is presented. PCPLP were produced using different plastic materials; Polyethylene (PE) and Polypropylene (PP), and different plastic pineapple leaf particle ratios; 50:50 and 70:30. The PCPLP were tested and evaluated with respect to electrical resistivity and flexural strength according to ASTM D257 and D790, respectively. The results indicate that PCPLP made from PP exhibits better electrical resistance than PE, which may be attributed to the better frequency insulation behaviour ofPP. PCPLP using the higher ratio of 70:30 also exhibited better electrical resistance than the lower 50:50 ratio. Cellulose materials inherently influence the electrical resistance of plastic composites, due to their natural propensity to absorb moisture. The PCPLP produced using a ratio of 50:50 for both PP and PE composites exhibited better MOE results than the 70:30 composites, however the converse is true with respect to the MOR. MOE of PCPLP was increased with increasing pineapple leaf particles content due to the greater matrix stiffness of this natural particle with respect to plastic matrix. However, high percentage offiller particles in the matrix (70:30 ratio) has reduced the toughness in the composite structure due to the lost ofphysical contact between high accumulated particles.
This study aimed to compare dexmedetomidine and propofol, in terms of haemodynamic parameters, respiratory rates and offset times, when used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia. This was a prospective, randomised, single-blind study where 88 patients were recruited. Patients were randomised into two groups to receive either dexmedetomidine or propofol infusion. Central neuraxial blockade (spinal, epidural or combined spinal epidural) was performed. After ensuring an adequate block and stable haemodynamic parameters, dexmedetomidine was infused 15 minutes later at 0.4 μg/kg/hr, and propofol, at a target concentration of 2.5 μg/ml. Both drugs were titrated to achieve a bispectral index score of 70 before surgery commenced. Sedation level was monitored using the bispectral index score and assessed by the Observer Assessment of Alertness Scale score. Drug infusion was adjusted to maintain bispectral index scores ranging between 70-80 during surgery. Both groups showed reductions in mean arterial pressure and heart rate from baseline readings throughout the infusion time. However there was no significant reduction in the first 15 minutes from baseline (p > 0.05). Haemodynamic parameters and respiratory rate between both groups were not significantly different (p > 0.05). No patient demonstrated significant respiratory depression or SpO2 ≤ 95%. Offset times were also not significantly different between both groups (p = 0.594). There were no significant differences in haemodynamic parameters, respiratory rates and offset times between dexmedetomidine and propofol used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia.
Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology
To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.
Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems.
Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, metaanalyses, case reports, and review articles.
Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline.
Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.
Objective: To determine the incidence and predictors of early ankle contracture in adults with acquired brain injury. Methods: A prospective cohort study of patients admitted to Neurosurgical Intensive Care Unit (NICU), University Malaya Medical Centre and referred for rehabilitation within a period of 12 months. Adult patients with newly diagnosed acquired brain injury with no prior deformity to lower limbs, Glasgow Coma Scale ≤ 12, no concomitant spinal or lower limb injuries, medical stability at inclusion into the study and agreed to participate for the total duration of assessment (3 months) were recruited. We conducted weekly review of ankle muscle tone and measurement of ankle maximum passive dorsiflexion motion. The end point is reached if ankle contracture developed or completed 3 months post injury assessment. Results: The cohort included 70 patients, of which only 46 patients completed the study. Twenty-eight patients suffered from severe brain injury whilst 18 from moderate brain injury. Out of the 46 patients, 13 (28%) developed ankle contracture at the end of the study period. Abnormal motor pattern was significantly associated with incidence of ankle contracture, which included spasticity (p
Cognitive Impairment is common in late life and may be due to the normal process of ageing, or associated with physical or mental disorder which contributes to a decrease in quality of life, neuropsychiatric symptoms, increased disability and increased healthcare cost. The aim of this study is to determine the prevalence of cognitive impairment among the elderly members in NACSCOM in Day Care Centres within the Klang Valley and its associated socio-demographic factors such as age, gender and educational level. This cross-sectional study was conducted on 101 members of NACSCOM in Day Care Centres of Damansara,Subang Jaya and Setapak using assisted questionnaires as the research tool. The questionnaire comprising of a total of 10 questions based on Elderly Cognitive Assessment Questionnaires (ECAQ), consisted of three parts, memory, orientation and recall. One correctly answered question earned the respondent one mark. The total score for ECAQ is 10 where respondents with scores of 5 and below were identified as having cognitive impairment. Data collected was analyzed using Chi-square test (SPSS version 18). The prevalence of cognitive impairment among the elderly members of NACSCOM in Day Care Centres within the Klang Valley was 4.0%. This study also showed that there was no statistically significant association between cognitive impairment and sociodemographic factors such as age, gender and education. Prevalence of cognitive impairment among the members of NACSCOM in Day Care Centres within the Klang Valley was found to be low. This could be attributed to the fact that members actively participated in activities organized by NACSCOM. The study also did not find any statistically significant association between cognitive impairment and age, gender and education.
Obesity is a well-established risk factor for cardiovascular disease. The objective of
the study was to determine the prevalence of obesity and factors associated among secondary school students aged between 13 to 17 years at Slemani City Centre, Iraq. Methodology: A cross sectional study design was used. The calculated sample size was 1656. Probability proportional to size sampling technique was used to select the sample. A validated pretested questionnaire was used to collect the data. Weight and height were also taken. Data were analyzed using SPSS version 21. Chi-square test was used to determine an association between two categorical variables. Independent t-test was used to compare two means. Multiple logistic regression was used to determine the predictors for obesity. Results: The response rate was 92.54% and the overall mean age of the 1588 respondents was 15.42 (95% CI = 15.35, 15.49) years. The prevalence of overweight and obesity was 20.6% and 11.3% respectively. Variables significantly associated with overweight and obesity (age, monthly family income, education level of parents, body part satisfaction and body size perception) were entered into the logistic regression model. Multiple logistic regression analysis showed that the predictors for overweight and obesity were age, monthly family income, body part dissatisfaction and body size perception. Conclusion: The prevalence of overweight and obesity is high (20.6% and 11.3% respectively). The predictors of obesity among secondary school students aged between 13 to 17 years old at Slemani City Centre Kurdistan Region, Iraq were age, family income and body image dissatisfaction.
Limited studies on prevalence and risk factors of Premature Coronary Artery Disease (PCAD) were done in Malaysia, primarily on lipid profile. This cross sectional study aims to identify any changing patterns in prevalence and risk factors of Premature CAD between 2000 and 2012. From 2000 to 2012 we included 21862 patients who underwent the first Percutaneous Coronary Intervention (PCI). Analysis of risk factors was done to 1660 and 2098 patients from year 2007 and 2012 respectively. Age of less than 45 years was taken as PCAD. Data was collected from PCI database of National Heart Institute (NHI), NHI TrakCare System, and patients’ medical records. PCAD significantly decreased from 18.8% (2000) to 11.6% (2012). Malay ethnicity showed increasing trend over the years from 55.1% to 66.9%. Multiple logistic regression analysis in 2007 showed that smoking had the higher risk (AOR=2.52), followed by male gender (AOR=2.06), family history of PCAD (AOR=1.96), Indian ethnicity, (AOR=1.65), triglycerides level (AOR=1.20) and BMI (AOR=1.06). In 2012, family history of PCAD had the highest risk (AOR=2.00) followed by smoking (AOR=1.91) and BMI (AOR=1.11). There are changes in risk factors patterns of premature CAD between 2007 and 2012. Most of them are preventable at earlier stage.
Two isolates of brown root disease fungi were obtained from diseased roots of sentang (Azadirachta excelsa). Morphological characters from macroscopic and microscopic studies suggested that both isolates were from the same genus namely Phellinus noxius and Phellinus sp. Cloning and sequencing of ITS region were conducted to investigate further the variation between the two species at
molecular level. PCR-amplified ITS regions were cloned in pCR2.1 and sequenced. DNA sequences sized 723bp and 710bp were obtained for Phellinus noxius and Phellinus sp respectively. Comparison between the two sequences showed 98% similarity where three nucleotide substitutions and three insertion/deletion regions were found sized 8bp, 2bp and 3bp respectively.
The present study was carried out to determine the concentrations of selected metal elements (lead, copper, manganese, zinc and iron) in 51 samples of commercial drinking water and tap water available in Malaysia. The results indicated that low metal elements were found in the studied water samples. Lead, manganese, zinc and iron were not detected in some of the studied samples, except copper. The concentrations of the metal elements in the studied samples were well below the maximum permitted concentrations as recommended. Therefore these drinking water are safe for consumption and do not pose adverse effect to the health of consumers due to metal toxicity.
Kajian terdahulu banyak menunjukkan perbezaan dalam dimensi okular mengikut kaum. Walau bagaimanapun hanya terdapat sedikit data mengenai dimensi okular bangsa Melayu di Malaysia yang dilaporkan. Kajian ini bertujuan untuk menetapkan nilai normal dimensi okular bangsa Melayu muda di Malaysia. Seramai 584 orang telah diundang untuk menjadi subjek untuk kajian secara sukarela. Pengukuran yang dilakukan meliputi kelengkungan dan ketebalan tengah kornea, nilai esentrisiti kornea (e), diameter iris horizontal dan vertikal yang kelihatan, saiz pupil dan bukaan palpebral. Subjek dibahagikan kepada 3 kumpulan berikut mengikut umur dan dipadankan mengikut jantina dan umur: Kumpulan 1 (7-12 tahun, n = 188), Kumpulan 2 (13 to 18 tahun, n = 196) and Kumpulan 3 (19 to 24 tahun, n = 200). Pengukuran dilakukan menggunakan topografer kornea (CTK 922 dari Haag Streit, Jerman), pakometer ultrasonik (Corneo-Gage Plus 2 dari Sonogage Incorporated) dan auto refraktometer (Auto-Ref R1 dari Canon, Jepun). Dimensi okular bangsa Melayu yang diukur didapati lebih kecil dari bangsa lain di seluruh dunia. Perbezaan yang signifikan juga didapati untuk semua pengukuran dengan peningkatan umur (p < 0.05). Keputusan kajian ini boleh dijadikan rujukan untuk nilai dimensi okular populasi Melayu muda Malaysia di masa hadapan.
Concentrations of Natural Occurring Radioactive Material (NORM) and terrestrial gamma radiation have been shown to be associated with certain lithology and soil types. An attempt was made to statistically predict and validate environmental gamma radiation dose rates based on limited number of actual field measurements using sodium iodide (NaI(Tl)) detector. Statistical analysis including the correlations between the actual and predicted dose were made based on 32 different lithology and soil type combinations. Results of field measurements, have shown that more than 50% of the predicted data were not significantly different from the actual measured data. The interpolation method in GIS was used to produce an isodose map based on the prediction equation. A correlation of multiple regression on the predicted versus lithology and soils dose rates gave relationships of DP = 0.35 DL + 0.82 DS – 0.02, r2 = 0.736. A predicted isodose map was subsequently plotted base on 4 dose rates classes, ranging from 0.1 – 0.3 μSvhr-1.
Developments of computer technology and image processing have shifted conventional industrial radiography application to industrial digital radiography (IDR) system. In this study, two types of IDR modules for non destructive testing (NDT), namely drum- and laser- type film digitizer with 50 μm pixel pitch have been evaluated for NDT applications. The modulation transfer function (MTF) and noise power spectrum (NPS) measurement were adapted to evaluate the image quality of IDR images. Results shown the averaged MTF for drum- and laser- type film digitizer at 20% modulation were 6.15 cycles/mm and 6.55 cycles/mm respectively. For NPS measurement and calculation, the result obtained shows that drum type film digitizer produced higher noise then laser type film digitizer. The study shows that the laser type film digitizer is the best system to be used for film digitization purposes because the MTF result shows that it modulates better than drum type and has the lowest and stable NPS.
Elliptic curve cryptosystems (ECC) provides better security for each bit key utilized compared to the RSA cryptosystem. For this reason, it is projected to have more practical usage than the RSA. In ECC, scalar multiplication (or point multiplication) is the dominant operation, namely, computing nP from a point P on an elliptic curve, where n is an integer defined as the point resulting from adding P + P + ... + P, n times. However, for practical uses, it is very important to improve the efficiency of the scalar multiplication. Solinas (1997) proposes that the τ-adic Non-Adjacent Form (τ-NAF) is one of the most efficient algorithms used to compute scalar multiplications on Anomalous Binary curves. In this paper, we give a new property (i.e., Theorem 1.2) of τ-NAF(n) representation for every length, l. This is useful for evaluating the maximum and minimum norms occurring among all length-l elements of Z(τ). We also propose a new cryptographic method by using randomization of a multiplier n to nr an element of Z(τ). It is based on τ-NAF. We focused on estimating the length of RTNAF(nr) expansion by using a new method.
Introduction: This cross-sectional study aimed to determine association of age and gender with dental treatment need among first-visit patients at Dental Outpatient Clinic, IIUM Kuantan in 2016.
Materials and Methods: Ethical approval (IREC 762) was obtained from IIUM Human Ethics Committee. List of first-visit patients who attended clinic from 1st January to 31st December 2016 was retrieved to assess patient's age and gender. Dental treatment need was determined according to the normative need which was professionally defined by dental-officer-in-charge. All first-visit patients were included, except those attended Orthodontic department or with old Malaysian identification card or foreign passport. Included patients were classified into six age groups (≤14, 15-19, 20-34, 35-44, 45-64 and ≥ 65). Pearson's chi square test was used for statistical analysis using SPSS Version 20 software.
Results: From a total number of 2,713 patients (age range of 2 to 87), 1,210 (44.6%) were males and 1,503 (55.4%) were females. Age (p<0.001) and gender (p<0.001) were significantly associated with dental treatment need. Paediatric patients (≤14) majorly received paedodontic care (97.5%). Young-age patients (15-19, 20-34 and 35-44) mostly required conservative care (39.5%, 31.2% & 30.6%, respectively) while elder-age patients (45-64 and ≥ 65) have major need for prosthodontics (30.0% & 40.2%, respectively). Females outnumbered males in all age groups, except for the age group of ≥ 65 whereby the situation was the opposite. Females also outnumbered males in all types of treatment need, except for periodontics which was predominated by males.
Conclusion(s): Age and gender have significant associations with treatment need for dental care.
KEYWORDS: treatment need, dental, association, age, gender
Calcium carbonate (CaCO3
) plays a crucial role in influencing the growth of osteoblast. This study was conducted
to compare the performance of alginate/cockle shell powder nanobiocomposite (nCP) bone scaffold developed from
naturally occurring CaCO3 with alginate/calcium carbonate (CC) bone scaffold developed using synthetic CaCO3. The
study compares the performance of the scaffold in supporting the growth of osteoblast through in vitro evaluations as
well as initial biocompatibility observations through in vivo methods. Both scaffolds were developed using the mixture
of 40% alginate solution with either 60% of nano cockle shell powder or synthetic CaCO3 to obtain a three dimensional
scaffold structure. In vitro evaluation on calcium release and ALP enzyme activity was conducted on both scaffolds seeded
with osteoblast on day’s three, five and seven using commercial kits. In vivo observations using histological methods
were further conducted by implanting osteoblast seeded scaffold subcutaneously at the dorsum of 8 albino mice for 21
days. Findings from in vitro studies showed a significant increase (p < 0.05) in the release of calcium and ALP enzyme
activity in nCP scaffolds on day seven compared to days three and five of CC scaffold. Histological observations using
H&E and von Kossa staining showed infiltration and proliferation of osteoblast on both scaffolds as well as early stage
bone tissue formation. Formation of new blood vessels within the scaffolds was also observed in nCP scaffold. Both the
developed scaffolds were noted to support osteoblast growth and new tissue formation with better potentials displayed by
nCP scaffolds comparatively. This study shows that naturally occurring CaCO3 obtained from cockle shells in the form
of nano powder has good potentials to be used as a biomaterial for bone tissue engineering applications.
Objective: ADHD is a complex neurobiological disorder, which required tactful
intervention. Besides pharmacotherapy, there is still limited information in
addressing the efficacy of cognitive behavior therapy (CBT) for treating this
developmental disorder.
Methods: We report a case of late diagnosed of ADHD
whose facing difficulty to cope with her undergraduate degree. She has to repeat
her semester examination due to lack of attention. Denial was seen in both
patient and family in accepting the diagnoses, and posed roadblock for
successful intervention.
Results: Six sessions of CBT were conducted, coupled
with psycho education for both the family and patient. Consultation from the
university’s management helped her to accept and cope with her ADHD
symptoms, i.e. attention and impulsivity. The patient showed improvement
following this intensive bio-psycho-social intervention.
Conclusion: The short
duration of CBT was found suitable to be adapted and implemented in young
adult ADHD.
Introduction: Methylation of promoter region of p16 leading to gene silencing has been implicated ina wide range of malignancies including lymphomas. In diffuse large B cell lymphoma (DLBCL) particularly, a varying percentage of epigenetic inactivation of p16 promoter region was observed ranging from 16 -54%. However, quantitative analysis of p16 promoter methylation in DLBCL has not been extensively studied in Malaysia. Objective: This study aims to quantitatively analyse p16 methylation in DLBCL samples using pyrosequencing technique. Methods: Genomic DNA was extracted from 16 formalin-fixed paraffin-embedded lymphoma tissue blocks from patients diagnosed with DLBCL. Samples were retrieved from Hospital Tengku Ampuan Afzan, Pahang and Hospital Universiti Sains Malaysia, Kelantan. Primers were designed to amplify bisulfite-treated DNA targeting p16 promoter region. Methylation status of 7 CpG sites was determined by pyrosequencing. Results: All the 16 samples studied showed promoter methylation of p16. The range of mean methylation percentage was between 18 to 81%. Conclusion: The present study has successfully measured the level of methylation of p16 in all 7 CpG sites despite the limitation in sample size. Since p16 methylation is a common event in our series of DLBCL cases, it is worth including a larger sample size in future studies to increase the chance of finding a significant correlation with clinical parameters.