Individuals respond differently to drugs and sometimes the effects are unpredictable. Differences in DNA that alter the expression or function of proteins targeted by drugs can contribute significantly to the variation in the individuals responses. The use of pharmacogenomics is to identify genetic polymorphisms that predispose patients to adverse drug effects that, although they may occur in only a small subset of the people treated with a new medication, are sufficiently toxic to jeopardise further development of the drug for all patients. Given the potential value of knowing all the possible factors that influence the effects of new agents, it is likely that pharmacogenomics will have an increasingly important role in drug discovery and development. This article briefly reviews concepts that underlie the emerging fields of pharmacogenetics and pharmacogenomics, with an emphasis on the pharmacogenetics of drug metabolism. Although only a few examples will be provided to illustrate concepts and to demonstrate the potential contribution of pharmacogenetics to medical practice, it is now clear that virtually every pathway of drug metabolism will eventually be found to have genetic variation.
Different modalities of turbinate reduction procedures are available for treatment of vasomotor rhinitis not responding to appropriate medical therapy. Amongst these, conventional inferior turbinectomy (non-endoscopic) is the most widely performed procedure. With the advent of nasal endoscopes, inferior turbinoplasty has been gaining popularity worldwide. The purpose of this study was to compare the post-operative complaints and hospital stay of conventional versus endoscopic inferior turbinate reduction techniques performed non-randomly on 15 and 21 patients of vasomotor rhinitis respectively from January 1998 to December 1999 at Hospital Universiti Kebangsaan Malaysia (HUKM). A total of 36 patients (22 males and 14 females) with a mean age of 30.6 years underwent turbinate reduction procedures during this period with a post-operative follow up ranging from 3 months to 6.7 months (mean 3.8 months). There was a significant difference between the conventional and the endoscopic technique with regards to nasal discomfort (p = 0.05) and dry throat (p = 0.02) which was less severe when performed endoscopically. The average hospital stay in hours by the endoscopic technique was almost half compared to the conventional technique. Due to the improved visualisation and minimal post-operative complaints and reduced hospital stay, the technique of endoscopic inferior turbinoplasty is currently the procedure of choice at our center. In septoplasty when endoscopic instrument is not needed, the standard turbinate reduction procedure is still performed. The availability of pre and post-operative acoustic rhinomanometric evaluation will be helpful as an objective measurement of nasal symptoms in the near future.
The strong international demand for admission into medical schools make medical education a "seller's market", and increasingly a global market. Teaching of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) has two primary goals. Firstly, a firm grasp of basic principles, recognition and treatment of common disorders, initial management of ORL-HNS emergencies and indications for specialist referral. Secondly, to provide sufficient exposure to the specialty to assist in career planning. Good communicative skills for optimal patient care are essential in the selection criteria of medical students. Proficiency in English is essential to obtain a disproportion share of opportunities in the new economy. The examination evaluation needs to be standardized between the various medical schools and the recommended lecturer-student ratio is maintained. The Joint National Evaluating Board has a very essential role to play in the maintenance of medical educational standards in Malaysia.
Sirtuins are evolutionary conserved NAD+ dependent acetyl-lysine deacetylases and ADP ribosyltransferases dual-function enzymes involved in the regulation of metabolism and lifespan. Sirtuins represent a promising new class of III NAD dependent histone deacetylases that regulate a number of physiological processes, originally identified in yeast. Sirtuins regulate various normal and abnormal cellular and metabolic processes, including tumorgenesis, neurodegeneration and processes associated with type 2 diabetes and obesity. Several age-related diseases such as Alzheimer's disease and longevity have also been linked to the functions of sirtuins. Because of these associations, the identification of small molecules sirtuin modulators has been of significant interest.
Multiple variations of the right renal and testicular vessels were found during routine dissection in a 65-year-old male cadaver. The cadaver was healthy and did not have any other anomalies. The variations found were: presence of three right renal arteries, origin of the right inferior suprarenal artery from the middle right renal artery, two right renal veins, origin of the right testicular artery from the inferior right renal artery and the termination of the right testicular vein into the right renal vein. A sound knowledge of vascular variations in relation to the right kidney and right suprarenal gland is important in kidney transplantation and suprarenal surgery.
Management of severe tracheal anomalies remains a clinical challenge. Tissue engineering offers new hope in trachea reconstruction surgery. However to date no optimal technique achieved in the formation of human or animal trachea. The main problem lies on the biomaterial used and the complex city of forming trachea in vivo. This study was aimed at creating tissue-engineered trachea cartilage from easily accessible human and animal nasal septum cartilage using internal scaffold and biodegradable human and animal fibrin.
Down syndrome may be associated with many complications. Among the malignancies associated with Down syndrome, leukaemia is the most common. This is a case report of a patient with Down syndrome associated with both a retroperitoneal teratoma and a Morgagni hernia.
The first case of COVID-19 was reported in Malaysia on the 25 January 2020. By the 20 January 2021, the cumulative numbers reported confirmed cases of COVID-19 had reached 169,379 including 630 deaths. Malaysia has been hit by three waves of COVID-19. This article reports on the three waves, the current situation and some of the possible factors associated. It outlines the need to reassess the overall situation, re-strategize the approach in order to contain the spread. The first COVID-19 wave lasted from 25 January to 16 February 2020, the second wave occurred between the 27 February 2020 and the 30 June 2020. The current third wave began on 8th September 2020.The sudden surge of cases in the third wave was mainly due to the two largest contributors, namely the Benteng Lahad Datu cluster in Sabah state and Kedah's Tembok cluster. The current situation is critical. The daily confirmed cases of COVID-19 continue to soar. The challengers faced by healthcare workers and other front liners is tremendous. Non-communicable diseases such as cardiovascular diseases, diabetes and cancer are the leading cause of death in Malaysia. A paradigm shift in the approach is required to ensure the sustainability of the normal healthcare services provided by the government especially for the lower income groups. There is also a need to expedite the tabling of Tobacco Control Bill in coming parliament session which is long overdue. H.E. the King of Malaysia has called on all Malaysians to put aside political, racial and religious differences and show the spirit of loyalty, humanitarianism and steadfastness in fighting the COVID-19 pandemic.
This study examined the prevalence of hepatitis B and C markers in 55 paediatric oncology patients who had completed treatment at the Hospital Universiti Sains Malaysia in Kota Baru. All these children had received blood products and had been treated between 1985-1996. Forty seven per cent of patients were positive for hepatitis B or C. Twenty nine per cent were positive for hepatitis C and twenty two per cent were HBsAg positive. Two children were positive for both and none were HIV positive. Four children had an elevated ALT level and one child had jaundice and hepatomegaly. Some children were marker-positive despite immunization and screening of blood.
There appears to be a general tendency towards under-usage of analgesics not only in children but also in adults. The aim of this study was to describe the pattern of analgesic usage in adults and children admitted for major intra-abdominal surgery. All patients who had intra-abdominal surgery at University Science Malaysia Hospital (USM Hospital) from 1st January to 31st March 1995 were included in the study. Children were patients of 12 years and below and adults were patients above 12 years of age. Data including age, sex, weight, type of analgesics used, the number of patients who had analgesics ordered and administered post-operatively were obtained from the patients' medical record. A total of 48 children and 67 adults were studied. Narcotic analgesics were the most common analgesics ordered both in adults (95.5%) and in children (97%). Post-operative analgesics were ordered significantly more often for adults 67 (100%) than for children 33 (69%) (p < 0.0001). In adults, 70% of patients who had analgesics ordered post-operatively had their analgesics administered, but in children only 39.4% of patients had their analgesics administered (p < 0.001). The most common route of administration was intramuscular in both adults (95.5%) and children (88%). Analgesics were more likely to be administered in the intensive care units (100%) than in the surgical wards (60%) (p = 0.049). Elective or emergency surgery and the time of day when surgery was performed did not affect the frequency of analgesics ordered or administered. In summary, children in this hospital had less analgesics ordered and administered following intra-abdominal surgery compared to adults. The results of this study imply that increased attention should be given to relieve postoperative pain with analgesic drugs in children.
Studies on persistence, mobility and the effect of repeated application of permethrin on its half-life were carried out under field conditions. The half-life of permethrin in the top 20 cm of the soil increased from 11.5 to 23.6 days as the application rates increased from 35 to 140 g ha(-1). Induced by heavier rainfall, more residues moved downward in trial 2 than in trial 1. Repeated applications enhanced degradation rates and mobility of permethrin in the soil. The residue level in the 0-5-cm layer was reduced at day 28 after 17 consecutive applications to a level lower than after 5 applications. The half-life of permethrin was reduced from 15.9 days to 11.2 days after 5 and 17 applications, respectively. The residue reached the 15-20 cm layer much earlier (approximately 3 days after treatment) in soil that received 17 applications as compared to those with two applications.
The adsorption, desorption, and mobility of permethrin in six tropical soils was determined under laboratory and greenhouse conditions. The six soils were selected from vegetable growing areas in Malaysia. Soil organic matter (OM) was positively correlated (r2 = 0.97) with the adsorption of permethrin. The two soils, namely, Teringkap 1 and Lating series with the highest OM (3.2 and 2.9%) released 32.5 and 30.8% of the adsorbed permethrin after four consecutive repetitions of the desorption process, respectively, compared to approximately 75.4% of the Gunung Berinchang soil with the lowest OM (1.0%) under the same conditions. The mobility of permethrin down the soil column was inversely correlated to the organic matter content of the soil. Permethrin residue penetrated only to the 10-15 cm zone in the Teringkap 1 soil with 3.2% OM but penetrated to a depth of more than 20 cm in the other soils. The Berinchang series soil with the lowest OM (1.0%) yielded leachate with 14.8% permethrin, the highest level in leachates from all the soils tested. Therefore, the possibility for permethrin to contaminate underground water may be greater in the presence of low organic matter content, which subsequently allows a higher percentage of permethrin to move downwards through the soil column.
The purpose of this study was to investigate the potential risk of pretilachlor, thiobencarb, and propanil pollutants in the water system of the rice fields of the Muda area. The study included two areas that used different irrigation systems namely non-recycled (N-RCL) and recycled (RCL) water. Regular water sampling was carried out at the drainage canals during the weeding period from September to October 2006 in the main season of 2006/2007 and April-May 2007 in off season of 2007. The herbicides were extracted by the solid-phase extraction method and identified using a GC-ECD. Results showed that the procedure for identification of the three herbicides was acceptable based on the recovery test values, which ranged from 84.1% to 96.9%. A wide distribution pattern where more than 79% of the water samples contained the herbicide pollutants was observed at both the areas where N-RCL and RCL water was supplied for the two seasons. During September to October 2006, high weedicide residue concentration was observed at the N-RCL area and it ranged from 0.05 to 1.00 μg/L for pretilachlor and propanil and 10-25 μg/L for thiobencarb. In the case of the area with RCL water, the weedicide residue ranged from 1 to 5 μg/L for pretilachlor and propanil and 10-25 μg/L for thiobencarb. The highest residue level reached was 25-50, 50-100, and 100-200 μg/L for pretilachlor, propanil, and thiobencarb, respectively. During April to May 2007, high residue concentration frequently occurred at the area supplied with N-RCL irrigation water and it ranged from 0.05 to 1.00, 10 to 25, and 25 to 50 μg/L for pretilachlor, propanil, and thiobencarb, respectively. The highest residue level reached was 25-50 μg/L for pretilachlor and 100-200 μg/L for propanil and thiobencarb. There was an accelerated increase in the concentration of the herbicide residues, with the maximum levels reached at the early period of weedicide application, followed by a sharp decrease after the rice fields were completely covered with the rice crop. During the main season of 2006/2007, the concentration of propanil residue gradually rose, although that of the other herbicides declined.
The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.