The aim of the study was to determine the characteristics and pattern of the betel/tobacco quid chewing habit in the estate Indian community. The study was conducted in 6 randomly selected estates. It involved oral mucosal examination and an interview to solicit personal data as well as history and details of oral habits. Of a total of 618 subjects studied, 19.3 % (n= 119; 89 females and 30 males) were betel !tobacco quid chewers. The youngest age of onset of betel quid chewing is 10 years. The mean frequency of chewing quid is 4.3 times/day and the mean duration of chewing is 8.1 minutes. Initiation to the habit occur at a young age and a major role is played by family and friends in initiation to the habit. Practises of adding tobacco and lime appear to have adverse effects and are associated with higher occurrences of precancer lesions in this study (p
Elevated temperature affects marine benthic algae by reducing growth and limits the transport of electron or carbon fixation which may reduce the ability of the cell to use light. This resulting excess light energy may cause photoinhibition. In this study, the photosystem II of the benthic microalgal communities from Casey, eastern Antarctic were relatively unaffected by significant changes in temperatures up to 8ºC, along with high PAR level (450 μmol photons m–2 s–1). Similarly, the community was able to photosynthesize as the temperature was reduced to –5ºC. Recovery from saturating and photoinhibiting irradiances was not significantly influenced by temperatures at both –5ºC and 8ºC. These responses were consistent with those recorded by past experiments on Antarctic benthic diatoms and temperate diatoms which showed that climate change did not have a significant impact on the ability of benthic microalgae to recover from photoinhibitory temperature stress.
Congenital partial aplasia of the atlas with a posterior arch remnant is rare. It may be found as an incidental radiological finding or patients can present with neurological signs and symptoms after head or neck trauma. A 36-year-old female presented with a 3-day history of right sided neck pain radiating down the right arm. Radiographs of the cervical spine showed a radiolucent area in the region of the posterior arch of the atlas. Computed tomography subsequently revealed partial absence of the posterior arch of the atlas with a defect at the anterior ring. Her clinical condition subsequently improved with rest, analgesia and physiotherapy. This case report illustrates a situation where congenital defect of the posterior arch of the atlas was revealed in a patient with neck pain. Awareness of the existence of this condition will help clinicians avoid misdiagnosis and excessive investigations.
Beta (β)- thalassaemia is a public health problem in Malaysia. The carrier rate is estimated to be 4.5% by micro-mapping studies particularly among Malays who comprise 53.5% of the population in Malaysia. The common diagnostic method in Malaysia for mutation detection is by amplification refractory mutation system (ARMS). It allows single mutation detection in each reaction but is labour intensive and time consuming when many mutations need to be identified. The purpose of this study was to develop a diagnostic tool for effective mutation detection of beta thalassaemia in Malay patients and compare its efficacy with ARMS-PCR, the current method in use. Methods: Reverse dot blot hybridization (RDBH) technique was incorporated in the development of two strip assays [RDBH-Strip M(6) and RDBH-Strip C(6)] to identify common beta thalassaemia mutations in the Malays. The panels of selected mutations were based on the mutation frequencies in Malaysia reported in previous studies. RDBH-Strip M(6) was applied as step 1 and RDBH-Strip C(6) was applied as step 2 for unidentified mutations. The strips were validated with the gold standard method, ARMS- PCR. Results: One hundred and thirty seven Malay patients with 274 alleles were studied. In Step 1 mutation detection, 238 alleles (86.9%) were identified in 119 of patients by RDBH-Strip M(6). Step 2 resulted in a further detection of 20 alleles in another 10 patients by RDBH-Strip C(6). The combination of both strips resulted in the identification of 258 alleles in 129 (94.6%) of 137 Malay patients. The strip assays were 100% sensitive and specific when compared with ARMS-PCR method. Conclusion: Two strip assays utilising the RDBH technique were developed to identify common β-thalassaemia mutations in Malays. The RDBH Strip M(6) identified 86.9% of the mutations and the RDBH-Strip C (6) detected further 7.3% alleles. This two step strategy was found to be rapid and cost effective for the direct diagnosis of β-thalassaemia mutations in the Malays. The remaining unidentified mutations would require DNA sequencing. It can serve as a specific molecular diagnostic tool for effective diagnosis of
β-thalassaemia mutations in this ethnic group.
The controversy on malignant transformation of oral lichen planus has always intrigued researchers. We present a case of lichenoid lesion and squamous cell carcinoma of the tongue, occurring in a middle aged Indian lady. The diagnosis and timing of these lesions is discussed.
Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
The purpose of this study was to determine the adsorption coefficient (Koc) of chlorpyrifos in clay soil by measuring the Freundlich adsorption coefficient (Kads(f)) and desorption coefficient (1/n value) of chlorpyrifos. It was found that the Freundlich adsorption coefficient (Kads(f)) and the linear regression (r 2 ) of the Freundlich adsorption isotherm for chlorpyrifos in the clay soil were 52.6 L/kg and 0.5344, respectively. Adsoprtion equilibrium time was achieved within 24 hours for clay soil. This adsoprtion equilibrium time was used to determine the effect of concentration on adsorption. The adsorption coefficient (Koc) of clay soil was found to be 2783 L/kg with an initial concentration solution of 1 µg/g, soil-solution ratio (1:5) at 30 o C when the equilibrium between the soil matrix and solution was 24 hours. The Kdes decreased over four repetitions of the desorption process. The chlorpyrifos residues may be strongly adsorbed onto the surface of clay.
The purpose of this study is to explore and understand the exercise maintenance in women with breast cancer survivors adopting Guolin Qigong using the Social Cognitive Theory related constructs. A qualitative approach using in-depth interviews were employed in this study. 22 participants of the Malaysia Guolin Qigong Association from five regions in Peninsular Malaysia were purposely selected to participate in this study. Data was collected through a series of audiotapes during the interview sessions. They were asked on how do they maintain in their Guolin Qigong exercise. Three themes related to the Social Cognitive Theory constructs emerged from the data collected. (i) Personal Factors; (ii) Environmental Factors and (iii) Tailored Program. The belief in Guolin Qigong or in an exercise program is crucial in helping one to maintain with the exercise program and this findings is consistent with literature that those responded favourably to an exercise will have greater positive attitudes to exercise maintenance. To keep these women maintain the exercise it is important that these women have friends who understand them better to share their experiences related to their disease. It has been suggested that connecting to other survivors contributes to the survivors' positive well-being and to deal with their everyday living. Lastly, the type of exercise should be tailored to the physical condition of these women to keep them sustain the exercise. This theory can be used by the health practitioners to develop more effective interventions for increasing exercise maintenance in sedentary cancer survivors by taking into special attention personal factors particularly one's beliefs and inner motivation. Having to embark and engage into an exercise program of their preferred choice will help one to maintain an exercise program.
Adenovirus vector is the most common used vector in clinical gene therapy. The development of adenovirus from the first generation until the helper-dependent adenovirus vector has greatly reduced toxicity and immunogenicity. The helper-dependent adenovirus can also prolong transgene expression. Tissue- or disease-specific approach has been used to improve the specificity of adenoviral vector for cancer gene therapy. This review summarizes some adenoviral gene therapy and targeting approaches available for human cancer as well as animal cancer.
Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop.
This paper looks at electrical power generation from solar concentrator using thermoelectric generator. An experiment was conducted on a concentrator thermoelectric generator (CTEG) utilising solar thermal energy. The CTEG used a parabolic dish as concentrator with thermoelectric device installed at the focal point to convert thermal energy to generate electricity. The investigation covered the cooling effect of the cold side of the thermoelectric generator using natural and forced convection cooling for optimum output. Forced convection cooling with a fan provided 69% more power output from the CTEG system as the temperature difference across the TEG was greater than the system cooled by natural convection. The outcome of this project showed maximum power output was obtained for the CTEG system cooled by forced convection cooling.
Introduction: Many tasks seem daunting for a new medical graduate who is starting houseman
posting; as educators, we must ask ourselves whether our graduates are ready to face emergency
situations as the first responders during a crisis. Exploration of undergraduate students’ perceptions
highlights needs in some areas, including acute care, practical skills and prescribing. Armed with basic
resuscitation skills, students could face emergencies with more confidence and skill. Method: Seven
cohorts of final-year students completed a one-and-a-half day cardiac life support course and were
assessed using megacode and pre- and post-course multiple choice questions. Results: The pre- and
post-test analysis using paired sample T-test demonstrated significant performance improvement
(p
This study was conducted to investigate the effects of dietary inclusion of Spirulina platensis on growth performance and hematological parameters of juvenile Asian sea bass (Lates calcarifer) reared in a freshwater culture system. Five experimental diets were prepared by replacing fish meal protein with the microalga at replacement levels of 5% (SP5), 10% (SP10), 20% (SP20) and 30% (SP30), and the substitution effect was compared with a control diet (Con) in which fish meal was the sole protein. Fish were stocked in net cages placed in a 150-ton tank with a stocking density of 20 fish per cage. After 8 weeks of feeding trial, the fish did not show any significant differences in growth performance but numerically higher weight gain and specific growth rate were achieved in the fish stock fed diet SP10 compared to other treatments. Feed conversion ratio and survival rate of fish were significantly affected by the inclusion of Spirulina in the diets. Except for crude ash content, whole-body proximate composition of the experimental fish was also significantly influenced by the diets. Regarding the effects of diets on blood parameters, only hematocrit, hemaglobin, HDL-c and AST were significantly affected by the inclusion of Spirulina in the diets. This study demonstrated that Spirulina could replace up to 10% of FM protein in practical diets of juvenile Asian sea bass without negative effects on growth performance. However, replacement of fish meal with Spirulina meal at 5% might be considered for commercial use considering a significant decrease in survival above this value.
The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially
useful for local research on hypoglycaemia. However, it requires adaptation and
validation in local settings. This study reports the process and results of cross-cultural
adaptation and linguistic validation of HypoSRQ for Malay and English versions in
our local setting. The HypoSRQ underwent forward and backward translation and
adaptation with support from professional translators and a clinical psychologist.
Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes
mellitus from varying sociodemographic backgrounds. Discussion was done
together with the original developers of the HypoSRQ to decide on the best version
for local use. The finalised versions were proofread and formatted with the help
of Health Psychology Research. Cognitive debriefing for Malay version involved 7
patients and for the English version5 patients. Direct literal translation into Malay
language was unsuitable due to technical terms which were difficult for laypersons
to understand. Amendments were made based on findings from the cognitive
debriefing process. Participants found the questionnaire fairly easy to understand.
The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by
local participants. These tools may undergo psychometric evaluation for future
use in local settings.
This report describes the complications of obstructive urolithiasis in the lower urinary tract causing urinary bladder rupture in a Jamnapari buck. A 3-year-old Jamnapari buck was presented with the complaint of stranguria, subsequent anuria and a progressively distended abdomen for the past three days. Upon physical examination, body temperature, pulse rate and respiration rate were increased. Uroliths could be felt within the urethra in the ventral abdomen region. A urolith was removed via amputationof the urethral process, but the patency of the urethra could not be established. Transabdominal ultrasound revealed anechoic areas around the bladder, and the bladder was relatively small for a urinary obstructed goat. The bladder wall was thickened and shadow of sludge was observed within the bladder. Abdominocentesis was done and fluid analysis revealed that it was a haemorrhagic effusion. Blood results revealed renal disease, liver disease, muscle injury and haemoconcentration. Retrograde cystourethrogram revealed no urolithswithinthe urethra but there was leakage of the contrast agent from the bladder into the peritoneal cavity. The final diagnosis was complete blockage of the lower urinary tract leading to bladder rupture. Exploratory laparotomy was done and emergency cystorraphy was planned. Due to the poor condition of the urinary bladder with presence of septic peritonitis, the goat was euthanised.
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).
Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.
Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.
Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.
Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
Keywords: intubation, laceration, trachea
Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumour is a benign vascular proliferation that mimics other malignant vascular tumour. To date, this is the fourth case of Masson’s tumour at urethra being reported in the literature. A 65-year-old female Para 2, presented with post-menopausal bleeding. Examination revealed a 4x3x3 cm growth surrounding the urethral meatus. She underwent examination under anaesthesia and excision of the periurethral mass. Histopathological examination confirmed Masson’s tumour. Diagnosis and management of this uncommon tumour at a rare location was discussed.
Keywords: angiosarcoma, endothelial hyperplasia, Masson’s tumour, urethral neoplasm, vascular neoplasm