Objective: Lacunar infarct is a small infarct in the distal distribution of deep
penetrating vessels. A silent stroke is not associated with outward symptoms.
The objective of this report is to highlight a case of a silent young stroke
presenting with peduncular hallucinosis.
Methods: This gentleman was
thoroughly investigated and was found to have a lacunar infarct of the Pons
and Occipital Lobe. A further referral to Neurology thereafter; for an in
depth investigation into the cause of this silent young stroke.
Treatment with low dose antipsychotic resolved the complaints; while the
episode being transient.
Conclusion: Organic psychosis is responsive to
antidopaminergic agents, via action on the Ponto-Geniculo-Occipital
Modern medicine, specifically assisted reproductive technology (ART), has overtaken the law in many jurisdictions around the world. New technologies and practices open a Pandora's Box of ethical, religious, social and legal questions, and may present a variety of significant legal problems to the courts and legislators. Surrogate motherhood and pregnancy through ART have both attracted controversy. Some groups condemn ART and want it banned while its supporters acknowledge there is a need for legislative guidelines and regulations. A proposed statute, the Assisted Reproductive Technique Services Act, aimed at regulating reproductive technologies, including surrogacy arrangements, will be introduced in the Malaysian parliament, probably in 2012, and the Assisted Reproductive Technology (Regulation) Bill 2010 is already before the Indian parliament. This paper will discuss several of the potential socio-legal issues surrounding ART in the light of the complex situation, with a comparative analysis of the Malaysian, USA, UK and Indian positions.
High uncertainties in aerosol radiative forcing (ARF) arise from inaccurate estimation for aerosol optical depth (AOD) as an input parameter into Santa Barbara Discrete Ordinate Radiative Transfer (SBDART) model. Influence of AOD in ARF at the top of atmosphere (TOA) and surface over Kuching from 2011 until 2015 was investigated using Moderate Resolution Imaging Spectroradiometer (MODIS). Multi plane regression technique was used to retrieve AOD from MODIS (AODMODIS) by using different statistics (mean and standard deviation (MODISµ±σ) and relative absolute error (MODISRAE) for accuracy assessment in spatial averaging and compared with Aerosol Robotic Network (AERONET). The relationship between AODMODIS and AOD from AERONET (AODAERONET) showed R2 value for MODISµ±σ and MODISRAE is 0.906 and 0.932, respectively. AODMODIS over Kuching tends to underestimate AOD during low variations and overestimate AOD when aerosol loading is higher. The retrieval of AODMODIS was used as an input parameter into SBDART for ARF estimation and compared with ARF from AERONET. When using AODMODIS from MODISµ±σ, the ARF at TOA was between -5.95 Wm-2 and 0.89 Wm-2 and at the surface was from -389.7 Wm-2 and -31.4 Wm-2 while for MODISRAE, ARF value at the surface was from -392.3 Wm-2 and -27.3 Wm-2 while at TOA was between -5.89 Wm-2 and 0.98 Wm-2. Average ARF value within the atmosphere for both MODISµ±σ and MODISRAE were 151.6 Wm-2 and 130.4 Wm-2, respectively. There is a poor relationship between the SBDART and AERONET for MODISµ±σ, where R2 is 0.33, while strong relationship is observed for MODISRAE with R2 value at 0.724.
Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
Keywords: bradyarrythmia, bradycardia, elderly, hyperkalaemia, polypharmacy
Octenyl succinic anhydride (OSA) modified sago starch was prepared in order to improve the emulsification properties of native starch. In the present study, the major factors affecting esterification were investigated with respect to OSA concentration, pH and reaction time using response surface methodology (RSM) based on central composite rotatable design (CCRD) to obtain the highest value of degree of substitution (DS). Results shown that the optimum conditions for OSA concentration, pH and reaction time were 5.00%, pH 7.20 and 9.65 h, respectively. At optimum condition, the esterification of sago starch with OSA resulted in DS value of 0.0120. The DS increased linearly with the increase in amount of OSA, whilst pH and reaction time show a curvature trend on the value of DS. The value of DS was found to be significantly affected by all the three variables. The experimental values under optimum condition were in good consistent with the predicted values (0.0131), which suggested that the optimisation by RSM is more efficient process than conventional optimisation.
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
AIMS: To examine the relationships between nurses' empowerment, job satisfaction and organizational commitment in culturally and developmentally different societies.
BACKGROUND: Employment and retention of sufficient and well-committed nursing staff are essential for providing safe and effective health care. In light of this, nursing leaders have been searching for ways to re-engineer the healthcare system particularly by providing an environment that is conducive to staff empowerment, job satisfaction and commitment.
METHODS: This is a descriptive correlational survey of 556 registered nurses (RNs) in two teaching hospitals in England and Malaysia.
RESULTS: Although the Malaysian nurses felt more empowered and committed to their organization, the English nurses were more satisfied with their job.
CONCLUSION: The differences between these two groups of nurses show that empowerment does not generate the same results in all countries, and reflects empirical evidence from most cross cultural studies on empowerment.
IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management should always take into consideration cultural differences in empowerment, job satisfaction and commitment of nursing staff while formulating staff policies.
We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.
A study on the feasibility of using gel electrophoresis technique in grading the agarwood oil
quality was investigated. Prior to electrophoresis, the emulsified agarwood oil droplets were
screened by a diffuse layer of ions that have equal absolute charge to that of the droplets surface
charge in aqueous phase. The condition was obtained by varying the concentrations of nonionic
surfactant; Tween 80 until the critical aggregation concentration (CAC) value of 0.0167%
(v/v) was achieved. The prepared droplets suspended in the aqueous within nano-metre size and
had ability to migrate through the agarose gel with its own specific electrophoretic mobility.
However, due to the limitation of gel pore size, only large oil droplets (>200 nm) indicated
visible bands. Overall, a novel work for grading the emulsified agarwood oil droplet with its
own electrical properties was feasible.
Legionella pneumophila are intracellular pathogens, associated with human disease, attributed to the presence and absence of certain virulent genes. In this study, virulent gene loci (lvh and rtxA regions) associated with human disease were determined. Thirty-three cooling tower water isolates, isolated between 2004 to 2006, were analyzed for the presence of these genes by PCR method. Results showed that 19 of 33 (57.5%) of the L. pneumophila serogroup 1 isolates have both the genes. Six (18.2%) of the isolates have only the lvh gene and 2 (6.1%) of the isolates have only the rtxA gene. However, both genes were absent in 6 (18.2%) of the L. pneumophila isolates. The result of our study provides some insight into the presence of the disease causing L. pneumophila serogroup 1 in the environment. Molecular epidemiological studies will provide better understanding of the prevalence of the disease in Malaysia.
Two solid biopolymer electrolytes (SBEs) systems of carboxymethyl cellulose doped ammonium chloride (CMC-AC) and propylene carbonate plasticized (CMC-AC-PC) were prepared via solution casting technique. The ionic conductivity of SBEs were analyzed using electrical impedance spectroscopy (EIS) in the frequency range of 50 Hz-1 MHz at ambient temperature (303K). The highest ionic conductivity of CMC-AC SBE is 1.43 × 10(-3)S/cm for 16 wt.% of AC while the highest conductivity of plasticized SBE system is 1.01 × 10(-2)S/cm when added with 8 wt.% of PC. TGA/DSC showed that the addition of PC had increased the decomposition temperature compared of CMC-AC SBE. Fourier transform infrared (FTIR) spectra showed the occurrence of complexation between the SBE components and it is proved successfully executed by Gaussian software. X-ray diffraction (XRD) indicated that amorphous nature of SBEs. It is believed that the PC is one of the most promising plasticizer to enhance the ionic conductivity and performance for SBE system.
We sought to review the current practice of sedation and analgesia in intensive care units (ICUs) in Malaysian public hospitals. A questionnaire survey was designed and sent by mail to 40 public hospitals with ICU facility in Malaysia. The anaesthesiologists in charge of ICU were asked to complete the questionnaire. Thirty seven questionnaires were returned (92.5% response rate). Only 35% respondents routinely assess the degree of sedation. The Ramsay scale was used prevalently. A written protocol for sedation was available in only 14 centers (38%). Although 36 centers (95%) routinely adjust the degree of sedation according to patient's clinical progress, only 10 centers (14%) interrupt sedation on a daily basis. Most respondents agreed that the selection of agents for sedation depends on familiarity (97%), pharmacology (97%), the expected duration for sedation (92%), patient's clinical diagnosis (89%) and cost (73%). Midazolam (89%) and morphine (86%) were the most commonly used agents for sedation and analgesia, respectively. Only 14% respondents still frequently use neuromuscular blocking agents, mostly in head injury patients. Our survey showed similarity in the choice of sedative and analgesic agents in ICUs in Malaysian public hospitals comparable to international practice. Nevertheless, the standard of practice could still be improved by implementing the practice of sedation score assessment and daily interruption of sedative infusion as well as having a written protocol for sedation and analgesia.
In this prospective, randomized controlled trial, changes in endotracheal tube cuff pressure were studied in 60 patients undergoing elective surgery under general anaesthesia with nitrous oxide and oxygen. The cuffs were inflated with either air or distilled water. The mean pressure in the air-filled cuffs increased steadily throughout the procedure, reaching 47.5 +/- 7.3 cmH2O at one hour compared with 31.6 +/- 2.4 cmH2O mean pressure in the water-filled cuffs. The pressure and the rate of rise in cuff pressure were significantly lower (P<0.05) in the water-filled cuffs throughout the hour of study. When an endotracheal tube cuff is distended with water, the rise in cuff pressure during nitrous oxide anaesthesia is lower than that of an air-filled cuff.
In the last few decades, co-trimoxazole (SXT), an antibacterial combination of trimethoprim and sulfamethoxazole, has been used for treatment of upper respiratory tract infection due to Haemophilus influenzae. The usage of this antibiotic has become less important due to emergence of SXT-resistant strains worldwide. Most reports associate SXT resistance to the presence of variants of dihydrofolate reductase (DHFR) dfrA genes which are responsible for trimethoprim resistance; while the sulfamethoxazole (SMX) resistance are due to sulfonamide (SUL) genes sul1 and sul2 and/or mutation in the chromosomal (folP) gene encoding dihydropteroate synthetase (DHPS). This study aims to detect and analyse the genes that are involved in SXT resistance in H. influenzae strains that were isolated in Malaysia. Primers targeting for variants of dfrA, fol and sul genes were used to amplify the genes in nine SXT-resistant strains. The products of amplification were sequenced and multiple alignments of the assembled sequences of the local strains were compared to the sequences of other H. influenzae strains in the Genbank. Of the five variants of the dhfA genes, dfrA1 was detected in three out of the nine strains. In contrast to intermediate strains, at least one variant of folP genes was detected in the resistant strains. Multiple nucleotide alignment of this gene revealed that strain H152 was genetically different from the others due to a 15-bp nucleotide insert in folP gene. The sequence of the insert was similar to the insert in folP of H. influenzae strain A12, a strain isolated in United Kingdom. None of the strains had sul1 gene but sul2 gene was detected in four strains. Preliminary study on the limited number of samples shows that the TMP resistance was attributed to mainly to dfrA1 and the SMX was due to folP genes. Presence of sul2 in addition to folP in seven strains apparently had increased their level of resistance. A strain that lacked sul1 or sul2 gene, its resistance to sulfonamide was attributed to a 15-bp DNA insert in the folP gene.
Taxonomic status of fanged frogs from the Peninsular Malaysia, previously assigned to Limnonectes kuhlii, is assessed using genetic and morphological approaches. Phylogenetic relationships inferred from sequences of the mitochondrial and nuclear genes revealed that the fanged frogs from the Peninsula form a monophyletic group and are clearly divergent from other species previously, or even now, assigned to L. kuhlii from Mainland Southeast Asia. In both mtDNA and nuDNA phylogeny, the Malay Peninsula clade diverges into two lineages, one from north (Larut Hill, Perak, and Hulu Terengganu, Terengganu) and another from south (Genting Highlands, Pahang, and Gombak, Selangor). These lineages are separated by large genetic distances, comparable with those observed between some other species of L. kuhlii-like frogs. Although the two lineages are very similar morphologically, they are distinguishable in several morphological traits and are considered heterospecific. We therefore describe them as L. utara sp. nov. and L. selatan sp. nov. These new species differ from all other species of kuhlii-like frogs from Mainland Southeast Asia by the surface of tibia, which is densely covered by large warts.
Epilepsy is one of the most common chronic disorders affecting individuals of all ages. A greater understanding of pathogenesis in epilepsy will likely provide the basis fundamental for development of new antiepileptic therapies that aim to prevent the epileptogenesis process or modify the progression of epilepsy in addition to treatment of epilepsy symptomatically. Therefore, several investigations have embarked on advancing knowledge of the mechanism underlying epileptogenesis, understanding in mechanism of pharmacoresistance and discovering antiepileptogenic or disease-modifying therapy. Animal models play a crucial and significant role in providing additional insight into mechanism of epileptogenesis. With the help of these models, epileptogenesis process has been demonstrated to be involved in various molecular and biological pathways or processes. Hence, this article will discuss the known and postulated mechanisms of epileptogenesis and challenges in using the animal models.
Acute melioidosis may present as localised or septicaemic infections and can be fatal if left untreated. Burkholderia pseudomallei resistant to antibiotics used for the treatment of melioidosis had been reported. The aim of this study was to determine the in vitro antibiotic susceptibility patterns of Burkholderia pseudomallei isolated in Malaysia to a panel of antibiotics used for the treatment of melioidosis and also to potential alternative antibiotics such as tigecycline, ampicillin/sulbactam, and piperacillin/tazobactam. A total of 170 Burkholderia pseudomallei isolates were subjected to minimum inhibitory concentration determination using E-test method to eleven antibiotics. All isolates were sensitive to meropenem and piperacillin/tazobactam. For ceftazidime, imipenem, amoxicillin/clavulanic acid, and doxycycline resistance was observed in 1 isolate (0.6%) for each of the antibiotics. Trimethoprim/sulfamethoxazole resistance was observed in 17 (10%) isolates. For other antibiotics, ampicillin/sulbactam, chloramphenicol, tigecycline, and ciprofloxacin resistance were observed in 1 (0.6%), 6 (3.5%), 60 (35.3%) and 98 (57.7%) isolates respectively. One isolate B170/06 exhibited resistance to 4 antibiotics, namely, ciprofloxacin, chloramphenicol, trimethoprim/sulfamethoxazole, and tigecycline. In conclusion, the Malaysian isolates were highly susceptible to the current antibiotics used in the treatment of melioidosis in Malaysia. Multiple resistances to the antibiotics used in the maintenance therapy are the cause for a concern.