Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being a pluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
There is a strong need to reduce costs of hospital and advocating health economics in countries like the United States of America. The rising cost of healthcare globally especially in the United States of America has interestingly outraged the temper of many citizens about the Obamacare and Trumpcare. The issue about high cost in healthcare is the failure for people globally to recognize that healthcare facility is a 24-hour round-the-clock service. It therefore involves doubling of the utility bills, tripling the manpower due to shifts and rest, wear-and-tear of basic electrical devices is short-lived, breakdown period of huge machine is consistently due to overloaded usages in the government hospitals and poor knowledge of the maintenance programme. Low birth weights (LBW) is a public health concern because it has a well-known predisposition to increased risk for perinatal infections, respiratory distress and ultimately mortality. There is also a higher risk of poor health outcomes throughout the life course of the LBW newborns that includes Type 2 diabetes, high blood pressure, neurodevelopmental disabilities and cardiovascular diseases. The World Health Organization and United Nations Child’s Fund estimate the prevalence of low birth weights in the world ranges from 3% to 32%. Albania in the year 2000 recorded prevalence of low birth weight of 3% whereas Yemen recorded a low birth weight of 32% in 1997. In 2015, the US national vital statistics pointed out that 83.9% of preterm birth (PTB) are LBW. This indicates that prevention of PTB will lead to a decrease in the incidence of LBW.
Mast cells (MCs) play a crucial role in the pathogenesis of allergic diseases due to their hypersensitive reaction to non-harmful substances that elicit an allergic response. As such, by interrupting certain signalling proteins within the signalling pathway of a MC, an allergic response may be avoided or inhibited. Compounds that attenuate the release of mediators from MCs are known as MC stabilizers. These drugs are clinically used to prevent MC effector responses towards common allergens. Although commonly prescribed clinical MC stabilizers such as disodium cromoglycate and ketotifen fumarate were used in the preventative treatment of various allergic diseases, there still remains a need of advancement towards the discovery of new MC stabilizing drugs that are able to target specific signalling molecules in order to provide better treatment option against these diseases. Among these newly discovered potential MC stabilizers, much efforts have been given to the inhibition of vital upstream signalling molecules such as spleen tyrosine kinase as well as surface receptors such as the high-affinity IgE receptor (FcεRI) and stem cell factor receptor (KIT). A recent study also reported that linker for activation of T cells (LAT) may also be an excellent molecular target for inhibiting MC degranulation. Although in most cases the exact mode of action of these molecules is yet to be elucidated, all these compounds have shown MC inhibition. Therefore, they might have potential therapeutic use in the treatment of allergies and allergy related diseases where MCs are majorly involved. Thus, this mini review will focus on summarising the potential signalling molecules or receptors that have been targeted to inhibit MC degranulation, particularly those located in the upstream signalling pathway.
Compliance to delivery of orthodontic appliances within specified times and factors which influenced compliance by dental technicians in Selangor was evaluated. This is a prospective 8-month study of 18 trainee/ trained technicians from 4 main government dental laboratories in Kajang, Klang, Tanjong Karang and Shah Alam. Delivery times specified by orthodontists were 1 day for plastic retainer, 3 days acrylic retainer, 5 days active plates (URA), 10 days functional appliances (FA), 10 days transpalatal arch (TPA) and 10 days for quadhelix. Punctual delivery was recorded as ‘compliant’. Compliance was compared between appliances, clinics, technicians, orthodontists and seniority of technicians. The sample comprised appliances from 365 patients; 38 (10.4%) Tanjong.Karang, 114 (31.2%) Kajang, 191 (52.3%) Klang and 22 (6.0%) Shah Alam. The majority of appliances were retainers (66.3%), followed by URA (13.4%), functionals (9.3%), TPA (9.0%) and quadhelix (1.9%). Mean compliance for all appliances in Selangor was 55%. Plastic retainers had highest compliance (77.8%), followed by acrylic retainers (59.9%), quadhelix (57.1%), FA (47.1%), TPA (45.5%) and URA (24.5%). Senior technicians (>3 years in service) were more compliant than juniors (
This was a cross-sectional study which attempts to assess the effectiveness of the 18-hour lactation management course organised by Klang District Health Office for its health staff. The course was conducted for three days from 19 to 21 September, 2006 with a total of 18 hours, comprising 15 hours of lectures and three hours of supervised clinical experience. There were a total of 46 participants for the course. The pre- and post-test scores of the participants from the course were used for analysis. This study showed that the mean pre-test versus mean post-test scores were 12.63 and 19.87. The difference in the mean score was statistically significant (p < 0.001, 95%CI -8.285, -6.193). The difference was significant for the staff nurse, community nurse and assistant nurse but not for doctors. In conclusion, the 18-hour duration lactation management course was effective at improving the knowledge and skills on breastfeeding management for the health staff.
Steroids remain an important component of maintenance immunosuppression after renal transplantation. Their anti-inflammatory action is partly due to the sequestration of CD4+ lymphocytes in the reticuloendothelial system. Steroids bind to intracellular receptors and the resulting steroid-receptor complex alters the transcription of cytokines by binding to glucocorticoid response elements on DNA. Transcription factors whose actions are altered by glucocorticoids include activating protein-1 (AP-1) and nuclear factor-B (NF-B). The main cytokines whose production by antigen-presenting cells is inhibited by steroids are interleukin-1 (IL-1), required for helper T-cell activation, and IL-6, required for B-cell activation. Other pro-inflammatory cytokines such as interferon gamma and tumour necrosis factor are also inhibited. This multiplicity of immunosuppressive actions is not fully replicated by other immunosuppressants. However, there are concerns about the long-term side effects of steroids. This review will examine the attempts at steroid withdrawal or steroid avoidance in renal transplant patients.
We report a case of a broken K-wire migrating to the cervical spine from the right clavicle in a 9-year-old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K-wiring. One K-wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K-wire was removed percutaneously under image intensification. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age of 18 or 19 years meaning that almost all closed fractures of the clavicle in children can be treated nonoperatively.
Objective: A rare case of induced hypomania was reported. Method: Patient was a 78-year-old Indian female with squamous cell carcinoma of the nasal septum, childhood bronchial asthma and underlying bipolar disorder. Her bipolar disorder is currently in remission. She developed hypomanic symptoms after one week of initiation of montelukast sodium for treatment of acute exacerbation of bronchial asthma. Result: Her hypomanic symptoms improved after stopping usage of montelukast sodium. Conclusion: Montelukast sodium likely had induced hypomania in this patient.
The world’s biodiversity is not distributed uniformly throughout the globe. Some areas such as the tropical rainforests, seas and coral reefs teem with the varieties of life whereas others such as some deserts and polar regions are almost devoid of them (Gaston, 2000). Malaysia, with her tropical jungles and seas, is rich with biodiversity. She is fortunate to have had eminent pioneers such as Ridley (1967), Corner (1972), Soepadmo (1972) and Whitmore (1983) to study her flora and Medway (1968) and Lim (1991) to study her fauna taxonomy. Other pioneers in Malaysian biology included Berry, Dhaliwal and Mohsin. These pioneers are then ably followed by workers such as Latiff, Kiew, Go, Khoo, Davidson, Saberi, Omar, Jambari, Idris, Zekri, Teo, Marziah, Tan, Mukherjee, Shapor, Yusoff, Azmi and many others studying the various subdisciplines of biology. In addition to the more obvious large plants and animals, microorganisms and aquatic organisms had not been neglected either. Workers such as Nawawi, Verghese, Ho and Faridah are known
for their work on fungi while Fatimah, Phang, Japar and Anton had studied algae, seaweeds, diatoms and seagrasses. However, some of these workers have now either retired or are soon going to attain retirement age and the worrying part is that there are not many younger
workers keen to pursue research in taxonomy and biosystematics, a prerequisite to further studies in ecology, genetics, biotechnology which in turn are prerequisites for rational conservation, management and sustainable utilization of our rich biological resources. With each passing day species are becoming extinct sometimes without us even knowing that they had ever existed. Even in a developed country such as the USA, one third of her plant and animal species are at risk of extinction (McCann, 2000). Hence, taxonomic and biosystematic studies of our plants, animals and microbes whether terrestrial or aquatic, freshwater and marine, should be priority areas. So should studies on their reproductive biology, life cycles, physiology, feeding habits, migration patterns, predators and their sensitivities to environmental changes.
In various biological studies, for example those in population genetics, conservation biology, forensic science, gene mapping, breed, strain and population characterization and identification, marker assisted selection and the identification of cryptic species complexes, codominant genetic markers play important roles. The information that can be gained from them are far superior than those from dominant markers like random amplified polymorphic DNA (RAPD), amplified fragment length polymorphisms (AFLP), direct amplification of length polymorphisms (DALP) and randomly amplified microsatellites (RAM) or inter simple sequence repeats (ISSR).
Bismuth chromium solid solutions, with a general formula Bi6-xCr2Oδ, where -1 ≤ x ≤ 2, were successfully synthesized via the conventional solid state method. The phases of the synthesized samples were determined by X-ray diffraction (XRD) analysis. The properties of single-phase compounds were characterized by using differential thermal analysis (DTA), thermal gravimetric analysis (TGA), AC impedance spectroscopy, and inductively coupled plasma-atomic emission spectroscopy (ICP-AES). The occurrence of phase transitions was confirmed by DTA and TGA, where a thermal event was observed by DTA at around 800oC. In addition, TGA studies also showed that there was a weight loss at around 800oC. Elemental analysis of Bi6Cr2O15 and its solid solutions by ICP-AES showed a good agreement between the expected value and the experimental value on the compositions, with no evidence of any systematic deviation from stoichiometric. Electrical properties of Bi6Cr2O15 and its solid solutions were investigated by using AC impedance spectroscopy from 300oC to 650oC. Ionic conductivity increased with the increasing temperature and bismuth content, and the best ionic conductivity was observed for Bi7Cr2O16.5. The activation energy (Ea) of Bi6Cr2O15 and its solid solutions were in the range of 1.22-1.32 eV.
The peels of pomelo contribute 30% of the fruit weight and yet it has been dump without recognizing the possible nutritional value of the peels. Study has been carried out to identify flavonoid content of the peels and analysed the activity of the flavonoid towards inhibition of lipid peroxidation. Optimization of flavonoid extraction was conducted using aqueous solvent (methanol and ethanol), extraction time (1-3 h) and extraction temperature (50°C-80°) via water bath extraction. The total content of flavonoids was quantitatively determined by using coloration methods with chromogenic system of NaNO2–Al (NO3)3–NaOH and and it was found that the extraction at 65ºC for 2 h in aqueous ethanol was the optimized condition for maximum flavonoids i.e. 190.42mg/L. A spectrophometric analysis was performed to evaluate flavonoid activity towards lipid peroxidation in the fish tissue. There was reduction in Peroxide value (PV) indicated the inhibition of lipid peroxidation in fish treated with pomelo peel as evidence of concurrency of positive flavonoid activity.
Extract of mengkudu was heated using a bench-top tube heat exchanger at 30, 50, 70 and 90 o C for 0, 5, 10 and 15 min residence time. The treated mengkudu extract was then measured for pH, L * , a * , b * color parameters, clarity, viscosity and total polyphenol content. Results show that heating using temperature of 30 to 90 o C for 5 to 15 mins significantly (p
Objectives: 1) To establish the incidence of rotavirus infection in paediatric patients admitted to a private hospital in Malaysia with a diagnosis of community-acquired acute gastroenteritis. 2) To determine whether patients with rotaviral acute gastroenteritis have greater disease severity. Design Retrospective cross-sectional study. Setting An urban private hospital in Malaysia. Participants All paediatric patients with a discharge diagnosis of acute gastroenteritis (AGE) admitted to the hospital between September 2005 and March 2006. A total of 261 patients were included in the study. Results Rotavirus infection contributed to 54% of paediatric hospital admissions with discharge diagnoses of acute gastroenteritis. 74% of children with rotavirus infection were aged 5 years and below. This study demonstrated that patients with rotaviral gastroenteritis had greater disease severity, as measured by two indicators. Firstly, the average length of hospital stay was longer in patients who were rotavirus positive (5.14 days) compared to those who were rotavirus negative (4.81 days). These results were statistically significant (p
Channa striatus (“haruan”) fish destined for fillet preparation was subjected to two freezing treatments, freezing with distilled water (FW) or freezing directly without distilled water (DF). Fish that was freshly processed without freezing served as control (C). Fillet yield (%) was in the range 33.8% to 35.3% and the highest yield was recorded in FW samples. Whole Fillet Powder (WFP) was prepared from the fillets through low temperature vacuum oven drying (50°C) and its composition and physicochemical properties were assessed. There was no significant difference in moisture and protein contents of all samples (p > 0.05). All WFP were generally dark in colour with whiteness indices ranging from 55.23 - 63.98. The redness (a*) values were 4.33, 11.12, 8.83 whilst the yellowness (b*) were 19.31, 23.04, 21.20 for C, WFP-FW and WFP-DF respectively. WFPs were generally high in histidine, arginine, threonine and tyrosine when compared to egg whites and these (except histidine) and other amino acids (serine, glycine, methionine and phenylalanine) were significantly higher (p < 0.05) in WFP-FW compared to other samples. Overall, freezing treatments affected the composition and physicochemical properties of WFPs.
Diagnosis by histopathology remams as one of the most important investigative methods used to establish a definitive diagnosis of a lesion or disease state. The provision of oral tissue diagnostic services is therefore an essential function of an Oral Pathology unit. A review of the English language literature disclosed that much of the documented information on the patterns of oral diagnostic services were from the United States, Canada and the United Kingdom. This paper provides an overview of such surveys carried out in these countries.
An audit of broken/lost removable appliances was carried out. This study aimed to measure the occurrence of broken/lost appliances over a period of 6 months. It also assessed whether there was any difference in the occurrence rate between patients who paid for treatment and those who received it free of charge. The results indicated that the total number of broken/lost removable appliances was 183, from a total of 472 appliances issued. For paying patients, 59 of 177 patients had at least one broken/lost appliance, giving an occurrence rate of 33.3%. For nonpaying patients, 60 of 112 patients had at least one broken/lost appliance, giving an occurrence rate of 53.6%.
A cross-sectional study was undertaken to evaluate if outpatient administration of in-travenous iron sucrose complex (Venofer) was a sensible option in treating iron defi-ciency anaemia during pregnancy and puerperium. A total of 120 patients with iron deficiency anaemia were recruited from the Obstetric Day Care Clinic at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over 18 months from March 2003 to August 2004. The main outcome measures were haemoglobin increment, patients’ compliance, adverse effects and saving from hospitalization fees. The pre-treatment haemoglobin (Hb) level was 8.5+0.85g/dl for the antenatal patient and 7.6+0.80 g/dl in the post-partum group. The mean post-treatment haemoglobin increment at day four-teenth was 3.52+0.75g/dl. One patient developed skin rash while another had low-grade pyrexia. Seven patients experienced mild metallic taste. There were no serious side effects or anaphylactic reactions. Ten patients (8.3%) did not complete their ther-apy - eight delivered before completion of treatment; another two defaulted following delivery. The average number of Venofer used was seven ampoules i.e. 700mg per person, most of them required three sessions to complete the course. Outpatient treatment allows each patient to save hospitalization fees of RM45 per day, which to-talled up to RM135 for a 3-days ward stay. An estimation of RM16,200 hospitalization fees for the 120 patients was avoided during the study period. In conclusion, outpatient treatment of anaemia in pregnancy and post-partum period using Venofer was safe and feasible, with high patient compliant and cost-savings from hospitalization fees.
Study site: Obstetric Day Care Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia