The presenting features of 236 thyrotoxic patients seen in the thyroid clinic were reviewed. 18.65% of these patterns had one or more dermatological complaints at presentation. There was no specific difference in this group of patients when compared with the general hyperthyroid population with regard to age, race, sex, duration of hyperthyroidism or biochemical indices of thyrotoxicosis. The two major complaints were itching and alopecia. The prevalence of pruritus at 6.4% in our series was identical to that of other workers, but we had a much lower occurrence of alopecia at 2.6%. The diagnosis of thyrotoxicosis was delayed in two patients in whom the only major complaint was pruritus. These symptoms cleared quickly when these patients became euthyroid. However there were other patients who noted hair loss with anti-thyroid medications. The incidence of vitiligo, eczema, onycholysis in our series was much lower those quoted in the Western literature The occurrence of pretibial myoxoedema in our series is similar to that of other workers from this region. The other miscellaneous manifestations include urticaria, xanthelasma and systemic lupus erythematosis. In conclusion we feel the cutaneous manifestations of hyperthyroidism are common in our patients.
Scrub typhus is an endemic problem in Malaysia. Yet its diagnosis appears to depend heavily on the Wetl-Felix test as the more sophisticated diagnostic procedures are not available routinely. We therefore reviewed our experience with scrub typhus patients treated at the Melaka General Hospital from 1983 to April 1986, to identify those clinical features which are diagnostic of this rickettsial illness. Based on the clinical presentation of our patients and the dramatic response of scrub typhus to Doxycycline, we propose a clinical approach to diagnosis until more specific and cheap diagnostic procedures become available in our laboratories. Otherwise, this rickettsial illness will continue to be under-recognised.
Membrane fouling during the filtration process is a perennial issue and could lead to reduced separation efficiency. In this work, poly(citric acid)-grafted graphene oxide (PGO) was incorporated into a matrix of single-layer hollow fibre (SLHF) and dual-layer hollow fibrr (DLHF) membranes, respectively, aiming to improve membrane antifouling properties during water treatment. Different loadings of PGO ranging from 0 to 1 wt% were first introduced into the SLHF to identify the best PGO loading for the DLHF preparation with its outer layer modified by nanomaterials. The findings showed that at the optimized PGO loading of 0.7 wt%, the resultant SLHF membrane could achieve higher water permeability and bovine serum albumin rejection compared to the neat SLHF membrane. This is due to the improved surface hydrophilicity and increased structural porosity upon incorporation of optimized PGO loading. When 0.7 wt% PGO was introduced only to the outer layer of DLHF, the cross-sectional matrix of the membrane was altered, forming microvoids and spongy-like structures (more porous). Nevertheless, the BSA rejection of the membrane was improved to 97.7% owing to an inner selectivity layer produced from a different dope solution (without the PGO). The DLHF membrane also demonstrated significantly higher antifouling properties than the neat SLHF membrane. Its flux recovery rate is 85%, i.e. 37% better than that of a neat membrane. By incorporating hydrophilic PGO into the membrane, the interaction of the hydrophobic foulants with the membrane surface is greatly reduced.
Dialyzers have been commercially used for hemodialysis application since the 1950s, but progress in improving their efficiencies has never stopped over the decades. This article aims to provide an up-to-date review on the commercial developments and recent laboratory research of dialyzers for hemodialysis application and to discuss the technical aspects of dialyzer development, including hollow fiber membrane materials, dialyzer design, sterilization processes and flow simulation. The technical challenges of dialyzers are also highlighted in this review, which discusses the research areas that need to be prioritized to further improve the properties of dialyzers, such as flux, biocompatibility, flow distribution and urea clearance rate. We hope this review article can provide insights to researchers in developing/designing an ideal dialyzer that can bring the best hemodialysis treatment outcomes to kidney disease patients.
The development of wearable artificial kidney demands an efficient dialysate recovery, which relies upon the adsorption process. This study proposes a solution to solve the problem of competitive adsorption between the uremic toxins by employing two adsorptive components in a membrane separation process. Dual-layer hollow fiber (DLHF) membranes, which are composed of a polysulfone (PSf)/activated carbon (AC) inner layer and a PSf/poly(methyl methacrylate) (PMMA) outer layer, were prepared for co-adsorptive removal of creatinine and urea from aqueous solution. The DLHF membranes were characterized in terms of morphological, physicochemical, water transport, and creatinine adsorption properties. The membrane was then subjected to an ultrafiltration adsorption study for performance evaluation. The incorporation of AC in membrane, as confirmed by microscopic and surface analyses, has improved the pure water flux up to 25.2 L/(m2 h). A membrane with optimum AC loading (9 wt %) demonstrated the highest maximum creatinine adsorption capacity (86.2 mg/g) based on the Langmuir adsorption isotherm model. In the ultrafiltration adsorption experiment, the membrane removed creatinine and urea with a combined average percent removal of 29.3%. Moreover, the membrane exhibited creatinine and urea uptake recoveries of 98.8 and 81.2%, respectively. The combined action of PMMA and AC in the PSf DLHF membrane has made the adsorption of multiple uremic toxins possible during dialysate recovery.
Membrane technology is a sustainable method to remove pollutants from petroleum wastewater. However, the presence of hydrophobic oil molecules and inorganic constituents can cause membrane fouling. Biomass derived biopolymers are promising renewable materials for membrane modification. In this study, fouling resistant biopolymer N-phthaloylchitosan (CS)- based polythersulfone (PES) mixed matrix membranes (MMMs) incorporated with nanocrystalline cellulose (NCC) was fabricated via phase inversion method and applied for produced water (PW) treatment. The morphological and Fourier-transform infrared spectroscopy (FTIR) analyses of the as-prepared NCC evidenced the formation of fibrous sheet-like structure and the presence of hydrophilic group. The membrane morphology and AFM analysis showed that the NCC altered the surface and cross-sectional morphology of the CS-PES MMMs. The tensile strength of NCC-CS-PES MMMs was also enhanced. 0.5 wt% NCC-CS-PES MMMs displayed a water permeability of 1.11 × 10-7 m/s.kPa with the lowest contact angle value of 61°. It affirmed that its hydrophilicity increased through the synergetic interaction between CS biopolymer and NCC. The effect of process variables such as transmembrane pressure (TMP) and synthetic produced water (PW) concentration were evaluated for both neat PES and NCC-CS-PES MMMs membranes. 0.5 wt% NCC-CS-PES MMMs exhibited the highest PW rejection of 98% when treating 50 mgL-1 of synthetic PW at a transmembrane pressure (TMP) of 200 kPa. The effect of nano silica and sodium chloride on the long-term PW filtration of NCC-CS-PES MMMs was also investigated.