Between April 1998 and December 1999, thirty patients with Idiopathic Scoliosis were operated with Multisegmented Hook-Rod System. These patients were operated at the mean age of 16 years and were followed up for a mean of 22.3 months (range 13-34 months). Seven patients had anterior release to increase the curve flexibility followed by second stage posterior instrumentation on the same day. The average operating time for a posterior instrumentation alone and anterior release combined with posterior instrumentation were 270 minutes and 522 minutes respectively. The average blood loss was 2.2 litres for posterior instrumentation alone and 3.3 litres for single day anterior release and posterior surgery. The mean preoperative Cobb's angle was 70 degrees. The mean immediate postoperative and final follow up Cobb's angles were 38 and 42 degrees, which represented an average coronal plane correction of 46.7% and 40.0% respectively. The mean preoperative apical vertebral rotation was 25 degrees, which improved to 15 degrees after the operation. At final follow up, the mean apical vertebra rotation was 20 degrees, which represented a mean apical vertebral rotation correction of 20%. Complications of the procedure included one transient neurological deficit, one infection, one graft site infection and one case of screw cut out. We were able to obtain satisfactory correction of idiopathic scoliosis with the Multisegmented Hook-Rod System.
Birth defects are one of the leading causes of paediatric disability and mortality in developed and developing countries. Data on birth defects from population-based studies originating from developing countries are lacking. One of the objectives of this study was to determine the epidemiology of major birth defects in births during the perinatal period in Kinta district, Perak, Malaysia over a 14-month period, using a population-based birth defect register. There were 253 babies with major birth defects in 17,720 births, giving an incidence of 14.3/1000 births, a birth prevalence of 1 in 70. There were 80 babies with multiple birth defects and 173 with isolated birth defects. The exact syndromic diagnosis of the babies with multiple birth defects could not be identified in 18 (22.5%) babies. The main organ systems involved in the isolated birth defects were cardiovascular (13.8%), cleft lip and palate (11.9%), clubfeet (9.1%), central nervous system (CNS) (including neural tube defects) (7.9%), musculoskeletal (5.5%) and gastrointestinal systems (4.7%), and hydrops fetalis (4.3%). The babies with major birth defects were associated with lower birth weights, premature deliveries, higher Caesarean section rates, prolonged hospitalization and increased specialist care. Among the cohort of babies with major birth defects, the mortality rate was 25.2% during the perinatal period. Mothers with affected babies were associated with advanced maternal age, birth defects themselves or their relatives but not in their other offspring, and significantly higher rates of previous abortions. The consanguinity rate of 2.4% was twice that of the control population. It is concluded that a birth defects register is needed to monitor these developments and future interventional trials are needed to reduce birth defects in Malaysia.
Objective: To describe the association between childhood adversity and depression in adult depressed patients in a Malaysian population.
Methods: Fifty-two patients, who met the criteria for major depressive disorder or dysthymia according to the Structured Clinical Interview based on the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders, were used as cases and compared with 52 controls matched for age and sex. Cases and controls were assessed using a sexual and physical abuse questionnaire and a Parental Bonding Instrument.
Results: There was a positive relationship between childhood abuse in general and childhood physical abuse with adult depressive disorder in particular. Nearly a quarter (23%) of depressed patients reported being abused in childhood compared with none in the control group. There was no significant association between childhood loss and depression in adulthood. Low level of parental care during childhood was significantly correlated with adult depressive disorder.
Conclusion: Clinicians should assiduously seek a history of childhood adversities in adult patients with depression. This information can influence clinical management by way of implementing secondary preventive measures. In all depressed patients, mental health professionals also need to look out for their poor attachment with parents during childhood. This may enable interventions directed at parenting skills and improved attachment relationships with their own children. These types of interventions together
with pharmacotherapy may provide the optimal approach to the management of depression in adults and help prevent the cycle of depression perpetuating itself in the next generation.
Key words: Child abuse; Depression; Maternal behavior
This paper explores the migration of adaptive filtering with swarm intelligence/evolutionary techniques employed in the field of electroencephalogram/event-related potential noise cancellation or extraction. A new approach is proposed in the form of controlled search space to stabilize the randomness of swarm intelligence techniques especially for the EEG signal. Swarm-based algorithms such as Particles Swarm Optimization, Artificial Bee Colony, and Cuckoo Optimization Algorithm with their variants are implemented to design optimized adaptive noise canceler. The proposed controlled search space technique is tested on each of the swarm intelligence techniques and is found to be more accurate and powerful. Adaptive noise canceler with traditional algorithms such as least-mean-square, normalized least-mean-square, and recursive least-mean-square algorithms are also implemented to compare the results. ERP signals such as simulated visual evoked potential, real visual evoked potential, and real sensorimotor evoked potential are used, due to their physiological importance in various EEG studies. Average computational time and shape measures of evolutionary techniques are observed 8.21E-01 sec and 1.73E-01, respectively. Though, traditional algorithms take negligible time consumption, but are unable to offer good shape preservation of ERP, noticed as average computational time and shape measure difference, 1.41E-02 sec and 2.60E+00, respectively.
We study a fuzzy fractional differential equation (FFDE) and present its solution using Zadeh's extension principle. The proposed study extends the case of fuzzy differential equations of integer order. We also propose a numerical method to approximate the solution of FFDEs. To solve nonlinear problems, the proposed numerical method is then incorporated into an unconstrained optimisation technique. Several numerical examples are provided.
Treatment for articular cartilage damage is quite challenging as it shows limited repair and regeneration following injury. Non-operative and classical surgical techniques are inefficient in restoring normal anatomy and function of cartilage in osteoarthritis (OA). Thus, investigating new and effective strategies for OA are necessary to establish feasible therapeutic solutions. The emergence of the new discipline of regenerative medicine, having cell-based therapy as its primary focus, may enable us to achieve repair and restore the damaged articular cartilage. This review describes progress and development of employing mesenchymal stromal cell (MSC)-based therapy as a promising alternative for OA treatment. The objective of this review is to first, discuss how in vitro MSC chondrogenic differentiation mimics in vivo embryonic cartilage development, secondly, to describe various chondrogenic differentiation strategies followed by pre-clinical and clinical studies demonstrating their feasibility and efficacy. However, several challenges need to be tackled before this research can be translated to the clinics. In particular, better understanding of the post-transplanted cell behaviour and learning to enhance their potency in the disease microenvironment is essential. Final objective is to underscore the importance of isolation, storage, cell shipment, route of administration, optimum dosage and control batch to batch variations to realise the full potential of MSCs in OA clinical trials.
A method of transpedicular bone grafting using contrast impregnated bone to improve the visualization of bone graft on the image intensifier is reported. A - 36-year old man who had sustained traumatic burst fracture of T12 vertebra, with Load-Sharing Classification (LSC) score of 8, was treated with posterior short segment fusion from T11 to L1 with transpedicular bone graft of T12 vertebra. We were able to correct the kyphotic end plate angle (EPA) from 19º to 1.4º. Anterior bone graft augmentation was achieved with contrast enhaced transpedicular bone grafts. At six months follow up, CT scan showed good bony integration of the anterior column with EPA of 4.5º and two years later, radiographs showed EPA of 7.6 º.
Snake envenomation is listed as Category A Neglected Tropical Diseases (NTD) by World Health Organization, indicates a severe public health problem. The global figures for envenomation cases are estimated to be more than 1.8 million annually. Even if the affected victims survive the envenomation, they might suffer from permanent morbidity due to local envenomation. One of the most prominent local envenomation is dermonecrosis. Dermonecrosis is a pathophysiological outcome of envenomation that often causes disability in the victims due to surgical amputations, deformities, contracture, and chronic ulceration. The key venom toxins associated with this local symptom are mainly attributed to substantial levels of enzymatic and non-enzymatic toxins as well as their possible synergistic actions. Despite so, the severity of the local tissue damage is based on macroscopic observation of the bite areas. Furthermore, limited knowledge is known about the key biomarkers involved in the pathogenesis of dermonecrosis. The current immunotherapy with antivenom is also ineffective against dermonecrosis. These local effects eventually end up as sequelae. There is also a global shortage of toxins-targeted therapeutics attributed to inadequate knowledge of the actual molecular mechanisms of cytotoxicity. This chapter discusses the characterization of secretory phenotypes of dermonecrosis as an advanced tool to indicate its severity and pathogenesis in envenomation. Altogether, the secretory phenotypes of envenomed cells and tissues represent the precise characteristics of dermonecrosis caused by venom toxins.
Amplikasi isoterma berpengantara gelung (LAMP) merupakan teknik amplifikasi gen
yang menghasilkan produk akhir iaitu mendapan keruh magnesium pirofosfat yang
boleh dianalisis dengan hanya menggunakan mata kasar. Penggunaan pewarna
interkalat yang sesuai adalah penting kerana ia boleh meningkatkan sensitiviti dan
mengurangkan keputusan positif palsu dan negatif palsu untuk pengesanan. Kajian
ini bertujuan untuk membandingkan prestasi tiga pewarna interkalat yang berbeza;
SYBR Green I, SYBR Safe dan pewarna berasaskan calcein di dalam asai LAMP
HPV-16 melalui visualisasi oleh mata kasar, elektroforesis gel dan mesin masanyata
turbidimeter. Reaksi LAMP dilakukan menggunakan amplifikasi kit Loopamp
DNA berisipadu sebanyak 25 μl. Campuran reaksi dieram pada suhu 60�C selama
60 minit dan ditamatkan menggunakan suhu 80�C selama 5 minit dalam mesin
masa-nyata turbidimeter. Untuk pengesanan menggunakan mata kasar, SYBR
Green I dan SYBR Safe telah dicairkan dalam 1:10 DMSO dan telah ditambah ke
dalam tiub yang mengandungi campuran reaksi selepas proses amplifikasi berlaku
manakala calcein ditambah sebelum proses amplifikasi. Sensitiviti asai telah disiasat
menggunakan pencairan DNA HPV-16 yang berkepekatan bermula dari 101
salinan/
μl to 108
salinan/μl. Ketiga-tiga pewarna mempamerkan keputusan yang sama
dari segi sensitiviti dengan had pengesanan adalah 103
salinan/μl. Penambahan
calcein di dalam asai menunjukkan masa pengesanan bertambah selama 10 minit
dengan menggunakan mesin nyata-masa turbidimeter. Prestasi ketiga-tiga pewarna
interkalat untuk pengesanan mata kasar adalah setanding dan boleh digunakan
untuk aplikasi pemeriksaan titik akhir dalam asai HPV-16, manakala dengan mesin nyata-masa turb
Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was free of pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known
Rajakumar MK, Suleiman AB, Lee CH, Cheah M, Yeoh PH
Citation: Rajakumar MK, Abu Bakar Suleiman, Lee CH, Cheah M, Yeoh PH. The Future of The Health Services in Malaysia. A Report of a Committee of Council of the Malaysian Medical Association. Kuala Lumpur: Malaysian Medical Association, 1980
The synthesis of high quality graphene via economic way is highly desirable for practical applications. In this study, graphene flake was successfully synthesized on Cu/MgO catalyst derived from recovered Cu via etching in ammonium persulfate solution. Recovered Cu acted as efficient active metal in Cu/MgO catalyst with good crystal structure and composition according to XRD and XRF results. FESEM, EDX, HRTEM, Raman spectroscopy and SAED analysis were carried out on the synthesized graphene. The formation of single, bilayer and few layer of graphene from Cu/MgO catalyst derived from recovered Cu was feasible.
This paper involves the obtained results of an "Elective Program" project which was carried out by Phase I Medical Students of the 1998-1999 academic year at the Faculty of Medicine (FOM), University of Malaya (UM). A questionnaire was designed to survey the attitudes of teachers at FOM-UM, the subject of choice of a 4-student group who were supervised by a faculty member. Students obtained a list of faculty members (teachers) of all academic departments from the Dean's Office and rehearsed their interviewing skills prior to collecting the data of the questionnaire, within a 1-week period. Respondents were 146 out of 275 in total (53%), which included all academic ranks and clinical and non-clinical teachers. Results showed that respondents were well qualified, have enough teaching experience and teach in a variety of forms. All teachers liked to teach and were motivated; however, 15% felt unhappy about their teaching and 6% did not think that their teaching was effective. The nlajority (96%) of teachers liked their teaching to be evaluated and many revealed several means to assist and 111otivate students. Teachers felt that there was room for improvenlent in the aspect of student-teacher interactions. Results of this project revealed that FOM-UM is well endowed by qualified, motivated and caring teachers who wish for better interactions with their students. I
This literature review focuses on the implementation of biomedical ethics in Malaysia based on the government and institutional settings. Insights of the development of biomedical ethics and the responsible entities, particularly the clinical trials that become the emerging field of interest by the government to boost the biomedical research in Malaysia are provided. Some issues and their implications for research and ethical review process in Malaysia are also elucidated. The review indicates the advancement of policies by the government in implementing the biomedical ethics with some affairs that should be a matter to be concerned.
Keywords: Biomedical, ethics, implementation, standards, research ethic committee, good laboratory practice.
The whole-body fluorodeoxyglucose F18 (18F-FDG) and gallium-68 (Ga-68 DOTATATE) are the most common radiopharmaceutical use in PET/CT imaging for cancer staging. Although radiopharmaceutical for PET/CT examination has been acknowledged for its safety and efficacy, the internal dosimetry and effective dose (ED) from the examinations are rarely discussed. Hence, this study aimed to evaluate radiation ED for whole-body radiopharmaceuticals PET/CT concerning patients’ gender and their weight. A total of 82 oncology patients (44 males and 38 females) were collected retrospectively from Institut Kanser Negara, Putrajaya. Data, such as 18F-FDG and Ga-68 DOTATATE activity and patient demography (weight, height, age), were recorded and analyzed. Effective doses from both internal and external exposure were calculated using the coefficient
provided by the International Commission on Radiological Protection (ICRP) report. The total ED of 18F-FDG for male patients was 20.2 ± 8.6 mSv and for female patients were 19.0 ± 8.2 mSv while total whole-body ED for Ga-68 DOTATATE for male patients was 18.5 ± 7.0 mSv and 17.0 ± 5.6 mSv for female patients. The ratio for ED between male and female were 1:1 for both examinations ranged from 12.0 – 23 mSv. From this study, it indicated that the ED of Ga-68 DOTATATE was far lower when compared to the ED of 18F-FDG by a factor of 0.7. Therefore, it is crucial to optimize the PET/CT protocol dose in order to uphold the dose as low as reasonably achievable (ALARA).
Introduction: The purpose of this study was to evaluate inter-session repeatability, inter-examiner
reproducibility and inter-device agreement of corneal power measurements from manual keratometer,
autokeratometer, topographer, Pentacam high resolution and IOLMaster. Methods: Two sets of mean
corneal power measurements (n=40) were compared for inter-session repeatability and inter-examiner
reproducibility in each instrument. Repeatability and reproducibility were evaluated by within-subject
standard deviation (Sw), coefficient of variation (COV) and intraclass correlation coefficient (ICC). A oneway
repeated measures analysis of variance was conducted to compare differences in the corneal power
between each instrument pair. The Bland and Altman analysis and Pearson’s correlation were employed to
assess agreement and determine strength of relationship between measurements. Results: There were no
significant differences in mean corneal power measurements between 2 different visits (p > 0.05). The Sw
and COV values between 2 visits were lower than 0.09 D and 0.20 % respectively. The ICCs were stronger
than 0.99 in all instruments. For reproducibility of each instrument, differences of the measurements
between 2 different examiners were also insignificant (p > 0.05). The Sw and COV values between 2
examiners were lower than 0.11 D and 0.23 % respectively. The ICCs were 0.99 and above in all instruments.
The 95% limit of agreement between instruments ranged from -0.29 to 1.13 D and the r-values were stronger
than 0.84. Conclusion: The corneal power measurements using these 5 instruments were repeatable and
reproducible. These instruments can also be used interchangeably, however the topographer should be used
with caution.
Introduction: The purpose of this study was to derive a modified equation for contact lens method (CLM) in
calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who
underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of
postoperative corneal power using the standard CLM and newly-derived contact lens modified method
(CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod
equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive
change. Results: The mean postoperative corneal power using standard CLM was significantly higher than
HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were
within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and
HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean
postoperative corneal power of CLMmod showed that there was no statistical significant difference compared
to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod
results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results.
Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser
refractive surgery corneal power. In near future, this modified equation can be used as an alternative
equation to calculate postoperative corneal power when the preoperative data is unavailable.
Angiotensin I-converting enzyme (ACE) plays an important role in reducing blood pressure and
gives an anti-hypertensive effect. Inhibition of ACE mainly results in an overall antihypertensive
effect. The objectives of this study were to determine the ACE inhibition activity in edible bird
nest hydrolysates and the effect of different hydrolysis time of 30, 60, 90, 120, 180 and 240
minutes. Edible bird nest protein was hydrolysed by enzymatic hydrolysis with alcalase and
papain to obtain ACE inhibitory peptides. The results suggested that 60 minutes of hydrolysis
time using alcalase contributed to the best ACE inhibitory activity (IC50 = 0.02mg protein/ml)
which shows edible bird nest protein hydrolysate to be a potent ACE inhibitor that may be used
to decrease blood pressure.
The aimed of this study is to estimate the entrance surface dose (ESD) of routine chest X-ray (CXR) examination and to compare the direct and indirect measurement. This study also extended to relate with the patients body thickness and established lifetime attributable risk (LAR) of the examinations. A total of 101 CXR examinations in posteroanterior (PA) projections were selected
as subjects and data, such as patient habitus and scanning acquisition parameters were recorded. The mean ESD value obtained from the TLD-100 and the software calculation was 0.31 mGy and 0.17 mGy, respectively. The percentage deviation obtained ranged from 25.5% to 61.3%. In comparison with the national diagnostic reference level (DRL), the mean values of ESD obtained from this study were lower by a factor of 3. Furthermore, it was observed that the mean absorbed dose of the adrenals, kidneys, lungs, oesophagus, and heart walls were lower as compared to the ESD value. The examinations were only associated with very low risk of cancer incidence and mortality. Hence, the results of this study suggested a need for standardisations of the personnel training to perform X-ray examinations according to ALARA principles.