Conjoined twins in a triplet pregnancy is an extremely rare occurrence. We present here, a 27-year-old multigravida with gestational diabetes and a conjoined twins in a triplet pregnancy.
The aim of this study, is to determine whether the fine characteristics of the fetal heart sounds could be used to identify intrauterine growth retarded fetuses. A preliminary evaluation, was conducted to compare these characteristics between intrauterine growth retarded fetuses and normal fetuses in the antenatal period after 36 weeks of gestation. Altogether, 7 IUGR fetuses were compared with 12 normal fetuses. An instrument named the Fetal Frequency Phonocardiogram was designed for this purpose. When connected to a personal computer and with a software programme specially written, the fetal heart sound characteristics were analysed. After detailed analysis, there were 3 significant differences between IUGR and normal fetuses, all of which gave a p-value of < 0.01. The frequency of the first heart sound was significantly higher in the IUGR fetuses compared to normal fetuses. The ratio of the amplitude of the first heart sound over the second heart sound was higher in the IUGR group. Finally, the ratio of the time between the first and second heart sound over the cardiac cycle was shorter in the IUGR fetuses. Fetal heart sound analysis, may provide a simple non-invasive method of detecting and monitoring fetuses at risk in the antenatal period.
Vomiting, drowsiness, metabolic acidosis, polymorphonuclear leucocytosis, and encephalopathy developed in thirteen infants within hours of ingestion of margosa oil. Liver biopsy of one infant and necropsy examination of ICR strain mice after experimentally induced margosa-oil poisoning demonstrated pronounced fatty infiltration of the liver and proximal renal tubules as well as cerebral oedema. Electron microscopy demonstrated mitochondrial damage. These findings indicate that margosa oil may be involved in the aetiology of Reye's syndrome among Indians in Malaysia.
The main strategy for lowering blood cholesterol levels is through the inhibition of the NADPH-dependent HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-CoA reductase). The enzyme catalyses the reduction of HMG-CoA to mevalonate and this process is inhibited by statins that form the bulk of the therapeutic agents to treat high cholesterol since the 1970s. Newer drugs that are safer than statins are constantly being developed. The inhibition of candidate drugs to HMG-CoA reductase remains the mainstay of drug development research. The determination of the enzyme activity is important for the correct assessment of potency of the enzyme as well as determining the inhibition of potential therapeutic agents from the plant and microbial extracts. Also, this chapter covers the use of the popular four-parameter logistics model that can yield accurate estimation of the IC50 values of therapeutic agents and their 95% confidence intervals.
The purpose of this study was to determine if the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score is able to predict the outcome of febrile neutropenia in patients with underlying hematological malignancy and to look at the other possible predictors of outcome. A retrospective study of 116 episodes of febrile neutropenia in patients who were admitted to the hematology ward of a local medical center in Malaysia between January 1st 2004 and January 31st 2005. Patient characteristics and the MASCC score were compared with outcome. The MASCC score predicted the outcome of febrile neutropenic episodes with a positive predictive value of 82.9%, a sensitivity of 93%, and specificity of 67%. Other predictors of a favorable outcome were those patients who had lymphomas versus leukemias, duration of neutropenia of less than 7 days, low burden of illness characterized by the absence of an infective focus and absence of lower respiratory tract infection, a serum albumin of >25 g/l, and the absence of gram-negative bacteremia on univariate analysis but only serum albumin level, low burden of illness, and presence of respiratory infection were significantly associated with unfavorable outcome after multivariate analysis. The MASCC score is a useful predictor of outcome in patients with febrile neutropenia with underlying hematological malignancies. This scoring system may be adapted for use in local settings to guide the clinical management of patients with this condition.
Green ecological development has become an inevitable choice to achieve sustainable urban development and carbon neutrality. This paper evaluates the level of green ecological city development in the Xin'an watershed as measured by green total factor productivity (GTFP), analyzes the direct and spatial effects of the Watershed Horizontal Ecological Compensation policy on GTFP, and further examines the moderating effect of the Research and Development (R&D) incentives, industrial structure, and income gap. This paper conducts difference-in-differences (DID) and spatial regression analysis on 27 cities from 2007 to 2019. The results show that GTFP progresses to varying degrees across cities over time, especially in the pilot cities. Crucially, the Watershed Horizontal Ecological Compensation policy significantly improved GTFP, although the effect was slight. Interestingly, the increase in GTFP in pilot cities that implemented the policy spatially suppressed the increase in GTFP in cities that did not implement the policy. Our evidence also shows that the positive effect of the policy is higher in regions with higher R&D incentives and industrial structure upgrading, which indicates that R&D incentives and industrial upgrading are crucial. In comparison, the income gap has not made the expected negative adjustment effect under the Chinese government's poverty alleviation policy. However, the positive policy effect is heterogeneous in the downstream and upstream pilot cities. The "forcing effect" of the policy on the downstream cities is more favorable than the "compensating effect" on the upstream cities. Therefore, policymakers should pay more attention to ensuring the effectiveness of the Watershed Horizontal Ecological Compensation policy in enhancing GTFP as a long-term strategy to guarantee the sustainability of green ecological development in Chinese cities.
Neurotization of the brachial plexus is an established procedure in the upper limb. However, neurotization of the lower limb remains experimental. Brunelli reported the use of the ulnar nerve to neurotize the lower limb. Zhao et al reported the use of intercostals nerve to neurotize the lower limb in rats. The aim of the study was to determine the feasibility of using intercostals nerve to neurotize the femoral nerve in human cadavers and to ascertain the ideal intercostals nerve that has the anatomical course that suit this role. Six fresh cadaveric dissection were performed through an extensile midline incision in the postmortem room and the lower six (T7-T12) were identified and traced from their origin. Their length and course identified and charted. T9 and T10 intercostal nerve was thought to be the most suitable nerve as the donor nerve, and the T11 and T12 intercostal nerve could not be free from its intra-muscular course sufficiently to be use as donor.
The Malacca river runs through the Malacca UNESCO heritage site where a number of historical buildings are located. The river itself runs through several industrial sites that increase the chances of the water being polluted. Water pollution including heavy metals, in the long run, can damage the reputation of the site. Hence monitoring of the water quality needs to be done periodically. As the cost of instrumental monitoring is costly, biomonitoring using enzyme is being intensely developed worldwide. In this study, a rapid inhibitive enzyme assay using the molybdenum-reducing enzyme from the bacterium Serratia sp. strain DRY6 sensitive to the heavy metals mercury, copper, silver, and chromium was developed as a method for a rapid monitoring of heavy metals. The IC¬50 values for mercury, copper, silver and chromium were 0.268, 0.352, 0.393 and 0.499 mg L-1, while the LOD values were 0.166, 0.071, 0.033 and 0.064 mg L-1, respectively. The IC50 values for these heavy metals are comparable and in several cases, more sensitive than established assays. Water samples from various locations in the Melaka river were tested for the presence of heavy metals using the developed assay. Enzyme activity was found to be inhibited in one sampling location, but the concentration of metal ions on the site was found to be below the Maximum Permissible Limit according to Malaysian Environmental Quality standard. The assay for heavy metals can be completed in less than 10 minutes and can be carried out at ambient temperature. The assay is rapid and simple and can be used as a first screening method or even near real-time method for routine monitoring of heavy metals.
This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.
The aetiology and pathogenesis of Reye's syndrome (RS) are incompletely understood. A number of environmental toxins and biological agents, including viruses, have been postulated to cause RS, either acting alone or synergistically. Most investigations have suggested that the primary insult is in the liver mitochondria, leading to a complex biochemical catastrophe, with death from encephalopathy. Margosa oil (MO), a long-chain fatty acid compound, has been shown to cause a Reye-like syndrome with death from hepatoencephalopathy, in children in Malaysia and India. The present time-course study performed in MO-administered mice showed the development of hepatic lesions with many features of RS. MO acts rapidly, within 30 min, on the nuclei of hepatocytes inducing mitoses and binucleated cells. This is followed by mitochondrial injury, with swelling, rarefaction of matrix, loss of dense bodies, pleomorphism, and loss of ribosomes starting at 60 min. There is loss of liver glycogen, and proliferation and hypertrophy of the endoplasmic reticulum (ER), followed by the presence of lipid droplets in the hyaloplasm, and globules within dilated cisterns of the ER. Additional fatty acids from lipolysis of body adipocytes, and fat globules from intestinal MO ingestion further aggravate the liver fatty change. There is evidence of fat globule ingestion by endocytosis into hepatocytes at the level of the sinusoids. The development of microvesicular liver steatosis and glycogen depletion due to involvement of liver cell organelles occur rapidly as in RS.
Heavy metals pollution has become a great threat to the world. Since instrumental methods are expensive and need skilled technician, a simple and fast method is needed to determine the presence of heavy metals in the environment. In this study, an inhibitive enzyme assay for heavy metals has been developed using crude proteases from Coriandrum sativum. In this assay, casein was used as a substrate and Coomassie dye was used to denote the completion of casein hydrolysis. In the absence of inhibitors, casein was hydrolysed and the solution became brown, while in the presence of metal ions such as Hg²⁺ and Zn²⁺, the hydrolysis of casein was inhibited and the solution remained blue. Both Hg²⁺ and Zn²⁺ exhibited one-phase binding curve with IC₅₀ values of 3.217 mg/L and 0.727 mg/L, respectively. The limits of detection (LOD) and limits of quantitation (LOQ) for Hg were 0.241 and 0.802 mg/L, respectively, while the LOD and LOQ for Zn were 0.228 and 0.761 mg/L, respectively. The enzyme exhibited broad pH ranges for activity. The crude proteases extracted from Coriandrum sativum showed good potential for the development of a rapid, sensitive, and economic inhibitive assay for the biomonitoring of Hg²⁺ and Zn²⁺ in the aquatic environments.
OBJECTIVES: This study was initiated to determine the local profile of blood culture isolates and antibiotic sensitivities in febrile neutropenic patients following chemotherapy, and to establish if any modifications to treatment guidelines are necessary.
DESIGN: A total of 116 episodes of febrile neutropenia admitted to the adult hematology ward at a university medical center in Malaysia were studied retrospectively from January 2004 to January 2005.
RESULTS: The study showed 43.1% of febrile neutropenic episodes had established bacteremia. Gram-negative bacteria accounted for 60.3% of isolates. Sensitivities of Gram-negative bacteria to the antibiotics recommended in the Infectious Diseases Society of America (IDSA) guidelines were 86.1-97.2%. Coagulase-negative staphylococci were the most common Gram-positive organisms isolated (23.3%). The majority of these were methicillin-resistant.
CONCLUSIONS: Carbapenem monotherapy, as recommended in the 2002 IDSA guidelines, is effective treatment for the infections most often encountered at our center. Combination therapy with an aminoglycoside should be considered when using ceftazidime, cefepime or piperacillin-tazobactam, particularly in high-risk patients. Vancomycin should be used if a Gram-positive organism is suspected or isolated.
The objective of the study is to determine the proportion and different types of birth defects among the children born in Hospital Kuala Lumpur. A cross-sectional study was conducted for a period of 18 months where all consecutively born infants, dead or alive were included. There were total of 34,109 births recorded during this period. The proportion of birth defects in Hospital Kuala Lumpur was 3.1% (n = 1056). The commonest involved were the hematology system, (157.7 per 10,000 births), the central nervous system, genitourinary system and chromosomal anomalies. The proportion was significantly higher in males and in the Chinese (p < 0.001). The commonest abnormalities are Glucose 6 Phosphate Deficiency (157.7/10000), Down's syndrome (12.6/10000), thalassaemia (8.8/10000), cleft lip and/or palate (7.6/10000) and anencephaly (7.3/10000). Neural tube defect is common and ranked second after G6PD deficiency. There is a need for a birth defect registry to assess the extent of the problem in Malaysia.