Spontaneous intracranial haemorrhage is one of the cerebrovascular complications in beta-thalassaemia major patients. This is a report of 2 cases of fatal intracranial haemorrhage. Their ages were 12 and 7 years respectively, and they had been receiving regular blood transfusion for the past 3 and 2 years respectively. They developed acute onset of headache, loss of consciousness and convulsions at 5 and 2 days respectively after their last blood transfusion. C-T scan of the brain showed massive intracranial haemorrhage with extension into the ventricles. The spontaneous intracranial haemorrhages in these two cases was probably multi-factorial in origin. The predisposing factors included recent blood transfusion, prolonged prothrombin time and partial thromboplastin time as well as reduced platelet count.
Congenital leukaemia which is characterised by proliferation and extrahaemopoietic infiltration of immature leucocyte precursor cells is a rare disorder encountered in the neonatal period. Although more than 100 cases of congenital leukaemia have been reported in the literature, the experience of most general paediatricians with this condition is very likely to be limited. Thus a patient presenting with congenital leukaemia admitted to Alor Star General Hospital is reported.
The purpose of the present study is to provide a critical review on the revolution of the "compliance" concepts from compliance to adherence, and adherence to concordance for both pharmacological and non-pharmacological therapies. A comprehensive literature search was performed using online databases from Library of University Putra Malaysia, and Pub Med based on the keywords. The present study showed that both quantitative and qualitative studies cannot be neglected in assessing adherence and its related problems. One of major findings from the present review is that "compliance" was no longer suitable for current treatments and it is important to define concepts of the terms used (adherence or concordance) correctly and clearly. The findings reflected that researchers placed greater value on medication adherence than non-pharmacological adherence. There were three general factors related to treatments adherence, namely socio-economic factor, treatments-related factor and disease-related factor. The findings showed that both qualitative and quantitative studies found consistent results for most of the factors, except for the experience of diseases symptoms. Both study design contribute important values to the adherence studies and future studies should incorporate both quantitative and qualitative studies to understand adherence in both pharmacological and non-pharmacological treatments.
Frank's sign, also known as diagonal earlobe crease (DELC), was observed to be an aural sign of coronary artery disease (CAD). Since then, there has been much interest in examining this unique and controversial association. This report describes a patient who has bilateral complete and deep diagonal ear lobe creases, presented with angina and diagnosed to have coronary artery disease on angiography. The characteristics of the sign and its association with atherosclerotic disease were discussed.
INTRODUCTION: Several studies have found higher in-hospital mortality for admissions during weekend or off hours, known as "weekend or off-hour effect". However, data for this on Malaysian populations is limited. This study was conducted to analyze the 3-year mortality trend in a secondary hospital and its relation to time and date of admission.
METHODS: The clinical data of 126,627 patients admitted to Taiping Hospital from 1st January 2008 to 31st December 2010 obtained via patient registry database of hospital was analyzed. This study compared mortality during weekdays with weekends, office hours (0800-1700) with off hours (1701-0759), and subanalysis of office hours with evening (1701-2259) or night hours (2300-0759), adjusted for age and gender.
RESULTS: Although the overall staff-to-patient ratio is improving, analyses showed a statistically significant increased risk of mortality for those patients admitted during weekends (OR = 1.22; 95% confidence interval [CI] = 1.14-1.31) or off hours in a weekday (OR = 1.67; 95% CI = 1.57-1.78). In the comparison between time of admission, there was statistically significant increased risk of mortality for admissions during evening hours (OR = 1.44; 95% CI = 1.28-1.62) and night hours (OR = 1.92; 95% CI = 1.71-2.16). Diseases of cardiovascular and respiratory system remained the top two causes of death over the three years.
CONCLUSION: The risk of mortality is significantly higher as a result of "weekend or off-hour effect". Recognition and intervention addressing these issues will have important implications for the healthcare system setting, hospital staffing and training, quality and timeliness of medical care delivery.
A 64-year-old man presented with prolonged history of intermittent dysphagia with sensation of food sticking at his upper chest. Physical examination was unremarkable, and an upper endoscopy did not reveal the underlying cause. On computed tomography scan of thorax, an aberrant right subclavian artery was seen coursing posterior to the esophagus resulting in external compression, which is a typical radiological feature of Dysphagia Lusoria. The pathophysiology, clinical features, imaging features and updated treatment modalities of this rare disease are discussed.
Fish can live healthier in aquarium with good water quality than they do in the wild. Maintaining
the quality of the water in fish facility is needed to avoid fluctuation of physicochemical
parameter values and contamination with pathogenic microorganisms that may cause serious
illness or even death among the fish. Contamination of the water, especially with animal
pathogens which are also pathogenic to human may pose health risk to those who are handling
or in direct contact with the water and fish in the facility. Therefore, there is a need to assess the
water quality and the risk associated with microorganisms in the water and the cultured animals.
The aim of this study was to determine the water quality with regard to the physicochemical
and microbiological parameters as well as the risk associated with bacteria in the water of the
fish facility. Samples of water from the water source and also from aquariums in the fish facility
were collected and analyzed. The water samples were plated on nutrient agar for bacterial
enumeration then bacterial colonies growing on the agar plates were randomly picked and
purified. (GTG)5
-PCR analysis was carried out to analyse the heterogeneity of the genome of the
bacterial isolated and a dendrogram was constructed from the (GTG)5
-PCR profile to determine
the genotypic group of the bacterial isolates. The risk associated with the bacteria from the
water was analyzed with respect to their antibiotic resitance. The result of this study revealed
that the (GTG)5
-PCR analysis was able to group the bacteria into 2 main genotypic clusters
which were further grouped into several sub-clusters. From the dengrogram, 12 representative
isolates were selected and identified using 16S rRNA sequencing. The identification confirmed
the presence of Aeromonas veronii (8 isolates), Aeromonas jandaei (2 isolates), Plesiomonas
shigelloides (1 isolate) and Pseudomonas alcaligene (1 isolate) from the water samples. All
of the isolates exhibited resistant towards ampicillin, penicillin and gentamicin. This study
revealed that the water from the fish facility harboured genetically diverse antibiotic resistance
bacteria which may pose health risk to the fish and also to those who are in direct contact
with the contaminated water and fish in the facility. Therefore, water in fish facility should be
monitored regularly and handled with caution.
Hypertension is one of the major risk factors for coronary heart disease and the most important factor for cerebrovascular diseases. Adherence to treatment is a fundamental pre-requisite for therapeutic benefit in hypertensive patients. Adherence is a complex behavioural process that is strongly influenced by the way in which patients live, as well as the psychological and social support system.
Aim: To understand and conceptualize the experience of people on long-term antihypertensive treatment Method: Qualitative analysis using semi-structured interviews with ten hypertensive patients from the medical clinic of Kuala Lumpur General Hospital.
Results: Although the participants were aware of having high blood pressure they declined receiving any treatment at the early stage of the disease. Fear of death and disease complications are reinforcements for participants to adhere to medication. They perceived the label of “hypertension” will affect their self-identity and social role. Positive thinking regarding medication assists participants to adhere to treatment. Conversely, participants who perceived medication negatively also adhere to a medication regime, as adherence behaviour satisfies the family. Participants justified modifying their regimen or taking Complementary and Alternative Medicine (CAM) as they believe know the their body best. However, participants wished to obtain more information regarding hypertension and its treatment from the doctors.
Conclusion: In finding the fine balance between stepping in and holding back treatment and care, health professionals need to know their clients in context. This balance can only be achieved by establishing processes of negotiation within an ongoing therapeutic relationship.
Study site: medical clinic of Kuala Lumpur General Hospital.
Oil palm (Elaeis guineensis Jacq.) fronds (OPF) are the most abundant oil palm solid wastes that are generated during oil palm agriculture and harvest. Palm oil and some other palm wastes have been reported to contain high concentrations of carotenoids with vital bioactive properties. However, the extraction and quantification of carotenoids from OPF have not been reported. In this study, ultrasonic-assisted extraction, HPLC-FLD for quantification, and response surface methodology (RSM) for optimization of β-carotene, lutein, and zeaxanthin from OPF extracts were investigated. The effects of extraction temperature (X1: 30-70°C), extraction time (X2: 10-50 min), and solvent-sample ratio (X3: 10-50 mL/g) on the recovery of β-carotene (Y1), lutein (Y2), and zeaxanthin (Y3) were investigated using three-level Box-Behnken design (BBD) experiment. At a desirability of 1, the optimum extraction conditions for β-carotene (30.14°C, 37.11 min, and 23.18 mL/g), lutein (30.00°C, 39.09 min, and 19.24 mL/g), and zeaxanthin (30.09°C, 36.76 min, and 22.38 mL/g) yielded carotenoid concentrations of 17.95 μg/g dry weight (DW), 261.99 μg/g DW, and 29.99 μg/g DW, respectively.
Varicella-zoster (chickenpox) infection is a common infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.
The role of bioregeneration process in renewing the adsorbent surface for further adsorption of organics during simultaneous adsorption and biodegradation processes has been well recognized. The extent of bioregeneration of powdered activated carbon (PAC) as an adsorbent loaded with phenol, p-methylphenol, p-ethylphenol and p-isopropylphenol, respectively, in the simultaneous adsorption and biodegradation processes were quantitatively determined using oxygen uptake as a measure of substrate consumption. Bioregeneration phenomenon was also evaluated in the simultaneous adsorption and biodegradation processes under sequencing batch reactor (SBR) operation to treat synthetic wastewater containing 1200 mg l(-1) phenol and p-methylphenol, respectively. The SBR systems were operated with FILL, REACT, SETTLE, DRAW and IDLE periods in the ratio of 4:6:1:0.75:0.25 for a cycle time of 12 h. The results show that the percentage of desorption from loaded PAC decreased in the order phenol>p-methylphenol>p-ethylphenol>p-isopropylphenol. For the treatment of phenol and p-methylphenol in the SBR reactors, respectively, the simultaneous adsorption and biodegradation processes were able to produce a consistent effluent quality of COD < or = 100 mg l(-1) when the applied PAC dosage was 0.115 and 0.143 g PAC per cycle, respectively. When no further PAC was added, the treatment performance deteriorated to that of the case without PAC addition after 68 and 48 cycles of SBR operation, respectively, for phenol and p-methylphenol. This observation is consistent with the greater extent of bioregeneration for phenol-loaded PAC as compared to p-methylphenol-loaded PAC.
The objective of this study is to investigate the potential of the activated rice husk to be used as an alternative adsorbent to powdered activated carbon (PAC) in the simultaneous adsorption and biodegradation processes under sequencing batch reactor (SBR) operation to treat synthetic wastewater containing phenol, p-methylphenol, p-ethylphenol and p-isopropylphenol. The rice husk (PRH) was activated by pyrolysis at 600 degrees C for 5 hours in a nitrogen atmosphere. Using the Langmuir model, the limiting adsorption capacities of PRH for the phenols were found to vary from 0.015-0.05 of those of PAC. The SBR reactors with and without adsorbent addition were operated with fill, react, settle, draw and idle periods in the ratio of 4:6:1:0.76:0.25 for a cycle time of 12 hours. For phenolic wastewater containing, 1,200 mg/L phenol, 1,200 mg/L p-methylphenol, 800 mg/L p-ethylphenol and 660 mg/L p-isopropylphenol, it was found that the biodegradation process alone was unable to produce effluent of quality which would satisfy the discharge standards of COD < or = 100 mg/L and phenol concentration < or = 1 mg/L. The addition of PAC in the ratio of PAC/phenolic compound at 0.095 g/g for phenol, 0.119 g/g for p-methylpheol, 0.179 g/g for p-ethylphenol and 0.220 g/g for p-isopropylphenol, can improve the effluent quality to satisfy the discharge standards. Equivalent treatment performance was achieved with the use of PRH at dosages of 2-3 times higher than those of PAC for all the phenolic wastewater studied. The increased adsorption capacity of PRH shown in the treatment indicates bioregeneration of the adsorbed surface during the treatment process.
Gangliosides and glycophorin are receptors for wheat germ agglutinin. The competitive binding of these molecules to wheat germ agglutinin is studied by electron spin resonance spectroscopy with spin labels attached to the oligosaccharide chains of gangliosides. Evidence shows that glycophorin is more accessible to wheat germ agglutinin binding than gangliosides. The interactions of gangliosides and glycophorin in liposomes is disrupted on low level binding of WGA.
Sixty-two "leukoplakias" from the cheeks of betel-nut chewers in West Malaysia were studied histologically. Ten biopsies were from non-tobacco betel-nut chewers. An amorphous von Kossa positive layer was seen on the keratin surface in 42 specimens. Tobacco did not appear essential for its formation, and it appeared to be significantly associated with parakeratosis. Its possible significance as a cuticle-like layer prolonging contact between carcinogens and the mucosa is discussed.Parakeratosis appeared to be the most common form of cornification seen, and the mitotic activity in parakeratinized leukoplakias appeared to be significantly greater than orthokeratinized leukoplakias.Comparison with studies on other population samples using different quids suggested that severe histological changes were more likely to be seen when tobacoo-containing quids were chewed as compared to non-tobacco-containing quids.An attempt to correlate the histological changes seen with the clinical habit in leukoplakias from chewers using tobacco-containing quids suggested that epithelial atrophy appeared to be significantly related to the duration of the habit but not to the "intensity" of the habit.
The DCA (Drug Control Authority), Malaysia has implemented the phase three registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation found in Malaysia, containing tongkat Ali hitam, either single or combined preparations, were analyzed for the presence of a heavy toxic metal, mercury, using atomic absorption spectrophotometer, after performing a simple random sampling to enable each sample an equal chance of being selected in an unbiased manner. Results showed that 26% of these products possessed 0.53-2.35 ppm of mercury, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is not exceeding 0.5 ppm for mercury. Out of these 26 products, four products have already registered with the DCA, Malaysia whilst the rest, however, have not registered with the DCA, Malaysia.
Changes in the buccal mucosa of 296 Indian and Malay betel-nut chewers in Perak, West Malaysia, were studied clinically. 167 out of 212 Indian subjects incorporated tobacco in their quids, while 45 out of 84 Malay subjects incorporated. "Gambir". The Indians appeared to show a higher proportion of mucosal changes, particularly when tobacco was used. "Gambir" did not appear to be potent in the production of mucosal changes. Comparison with studies in other parts of the world suggested comparable findings with respect to both tobacco and non-tobacco chewing samples, and there would appear to be some evidence that tobacco-containing quids are likely to produce a higher proportion of mucosal changes as compared to non-tobacco-containing quids. An attempt to demonstrate a dose-effect relationship by dividing the subjects into "slight" and "heavy" chewers did not yield significant differences between these two categories in each of the groups.