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Fulltext Public health preparedness and response to flood disaster in Johore, Malaysia : challenges and lessons learned

Arbaiah, O., Daud, A.R., Surinah, A., Noorhaida, U., Shaharom, N.A.M.C.D., Rahim, A.

Malaysian Journal of Community Health, 2009;15(3):126-131.
MyJurnal

Introduction : The 2006 -2007 flood in Johore which displaced more than 312,386 residents of the state was an extraordinary event and tested everyone preparedness. The disaster caused massive material, economic and environmental losses exceeded the state and local community capacity, forcing them seeks help from other states. Needs assessment, effectiveness of health services as well as leadership and nongovernment organization involvement were evaluated and constitute lessons learnt from the experiences.
Methodology : This is a descriptive review of the Johore flood. The review was based on literature search using established data and published reports of previous disasters. Discussion will focus on the 4 S’s of the surge capacity that is Structure, Staffing, Supplies and System (policies & procedures). Result : Structure- although 49 or 14% of health facilities in the state were affected by the flood, health services continued to be given. Majority of the relief centers were schools with better facilities. Funding for repairs obtained early approval as estimation of damages was timely applied. Temporary isolation centers for the conjunctivitis outbreak was appropriate implemented. Staffing- Leadership was assumed by the Johore State Health Department, the strongest and most prepared health sector. Needs assessment resulted in additional staff being deployed from other states allowing local staff to have their break from work as well as personal stress. Local staff became multi-skilled players. Training in disaster preparedness has to be of utmost priority to support such needs. Supplies- Personnel protective and pest control equipment, and medical supplies were adequately supplied. The laboratory services were well prepared. Pamphlets, posters, buntings and banners were distributed including five new health promotion materials. System- Flood disaster plan of action was well in place resulting in efficient management of the operating rooms, data management, coordination of services and disease surveillance through early warning system.
Conclusion : Public health preparedness is a matter of good governance and management based on evidence and experience. There is a need for a permanent and stable program for the Ministry of Health to prepare and coordinate the response to all disasters.
Fulltext Comparison of soil phosphorus tests for assessing plant availability of phosphorus in an ultisol amended with water-soluble and phosphate rock sources

Gikonyo EW, Zaharah AR, Hanafi MM, Anuar RA

ScientificWorldJournal, 2010 Sep 01;10:1679-93.
PMID: 20842313 DOI: 10.1100/tsw.2010.174

The effectiveness of different soil tests in assessing soil phosphorus (P) in soils amended with phosphate rocks (PRs) is uncertain. We evaluated the effects of triple superphosphate (TSP) and PRs on extractable P by conventional soil tests (Mehlich 3 [Meh3] and Bray-1 [B1]) and a nonconventional test (iron oxide-impregnated paper, strip). Extracted amounts of P were in the order: Meh3 >B1 > strip. All the tests were significantly correlated (p = 0.001). Acidic reagents extracted more P from TSP than PRs, while the strip removed equal amounts from the two sources. The P removed by the three tests was related significantly to dry matter yield (DMY), but only in the first harvest, except for B1. Established critical P levels (CPLs) differed for TSP and PRs. In PR-fertilized soils, CPLs were 27, 17, and 12 mg P kg(-1) soil for Meh3, B1, and strip, respectively, and 42, 31, and 12 mg P kg(-1) soil, respectively, in TSP-fertilized soils. Thus, the strip resulted in a common CPL for TSP and PRs (12 mg P kg(-1) soil). This method can be used effectively in soils where integrated nutrient sources have been used, but there is need to establish CPLs for different crops. For cost-effective fertilizer P recommendations based on conventional soil tests, there is a need to conduct separate calibrations for TSP- and PR-fertilized soils.
Rapid tea catechins and caffeine determination by HPLC using microwave-assisted extraction and silica monolithic column

Rahim AA, Nofrizal S, Saad B

Food Chem, 2014 Mar 15;147:262-8.
PMID: 24206716 DOI: 10.1016/j.foodchem.2013.09.131

A rapid reversed-phase high performance liquid chromatographic method using a monolithic column for the determination of eight catechin monomers and caffeine was developed. Using a mobile phase of water:acetonitrile:methanol (83:6:11) at a flow rate of 1.4 mL min(-1), the catechins and caffeine were isocratically separated in about 7 min. The limits of detection and quantification were in the range of 0.11-0.29 and 0.33-0.87 mg L(-1), respectively. Satisfactory recoveries were obtained (94.2-105.2 ± 1.8%) for all samples when spiked at three concentrations (5, 40 and 70 mg L(-1)). In combination with microwave-assisted extraction (MAE), the method was applied to the determination of the catechins and caffeine in eleven tea samples (6 green, 3 black and 2 oolong teas). Relatively high levels of caffeine were found in black tea, but higher levels of the catechins, especially epigallocatechin gallate (EGCG) were found in green teas.
A checklist of the marine Anthuroidea (Crustacea: Isopoda: Cymothoida) from the reefs of Peninsular Malaysia, with some new distributional data

Chew M, Abdul Rahim A

Biodivers Data J, 2020;8:e54748.
PMID: 32675937 DOI: 10.3897/BDJ.8.e54748

Background: An up-to-date checklist of the Peninsular Malaysian marine Anthuroidea is presented, based on previous taxonomic or ecological literature and recent collections. The present study, a part of the subproject on the Biodiversity of Sultan Iskandar Marine Park, recognised 24 species in 12 genera and 5 families from Peninsular Malaysia. An extensive list of bibliographical references, detailed information on habitat and distributional records, museum locations of type material are provided for each species. Amongst the listed species, 11 are recently discovered Malaysian species belonging to the genera Amakusanthura Nunomura, 1977, Apanthura Stebbing, 1900, Expanathura Wägele, 1981, Leptanthura G. O. Sars, 1897, Kupellonura Barnard, 1925, Pendanthura Menzies & Glynn, 1968 and Tinggianthura Chew, Rahim & bin Haji Ross, 2014. Our records were limited to shallow subtidal reefs of peninsular Malaysian coast, suggesting that the number of species in the list may rise with an extensive survey.
New information: The up-to-date checklist of marine Anthuroidea of the Peninsular Malaysia comprises 24 species in 12 genera and 5 families, including some new distributional data.
Fulltext Effectiveness of domestic water filters in removing suspended solids, residual chlorine and coliform bacteria

Chong, Chee Kheong, Vijayakumar, G., Teoh, Leong Hooi, Siti Zubaidah, A.R., Mohamed Sapian, M., Abdul Rahim, A.

Malaysian Journal of Public Health Medicine, 2003;3(2):38-40.
MyJurnal

Water filters are being increasingly promoted and used in the home. There are many types of commercial water jilters available for domestic use but almost all of them employ a physical filter media and an activated substance. The study showed that water filters effectively removed suspended solids and residual chlorine. However, as far as removing colhform bacteria is concerned, in ZZ .5% of the cases, bacteria were in fact introduced into the water. And in 20% ofthe cases, the amount of bacteria introduced was “too numerous to count (TNTC)". Furthermore, water hlters can lose their ability to filter bacteria without losing their ability to filter suspended solids and residual chlorine. This highlights the necessity of some authorized body looking into the claims made by these water filter manufacturers and impose certain standards to ensure that at the very least, the water quality ofthe hltered water is not worse than the unfiltered water.
The relationship between CO2 emission, energy consumption and economic growth in Malaysia: a three-way linkage approach

Sulaiman C, Abdul-Rahim AS

Environ Sci Pollut Res Int, 2017 Nov;24(32):25204-25220.
PMID: 28929456 DOI: 10.1007/s11356-017-0092-1

This study examines the three-way linkage relationships between CO2 emission, energy consumption and economic growth in Malaysia, covering the 1975-2015 period. An autoregressive distributed lag approach was employed to achieve the objective of the study and gauged by dynamic ordinary least squares. Additionally, vector error correction model, variance decompositions and impulse response functions were employed to further examine the relationship between the interest variables. The findings show that economic growth is neither influenced by energy consumption nor by CO2 emission. Energy consumption is revealed to be an increasing function of CO2 emission. Whereas, CO2 emission positively and significantly depends on energy consumption and economic growth. This implies that CO2 emission increases with an increase in both energy consumption and economic growth. Conclusively, the main drivers of CO2 emission in Malaysia are proven to be energy consumption and economic growth. Therefore, renewable energy sources ought to be considered by policy makers to curb emission from the current non-renewable sources. Wind and biomass can be explored as they are viable sources. Energy efficiency and savings should equally be emphasised and encouraged by policy makers. Lastly, growth-related policies that target emission reduction are also recommended.
The importance of worldwide governance indicators for transitions toward sustainable bioenergy industry

Alsaleh M, Abdul-Rahim AS, Abdulwakil MM

J Environ Manage, 2021 Sep 15;294:112960.
PMID: 34116310 DOI: 10.1016/j.jenvman.2021.112960

This study examined the impact of worldwide governance indicators on the sustainability of the bioenergy industry in selected European countries for the period 1996-2018. Applying the Fixed Effect (FE) Model, the results reveal that the bioenergy industry can significantly grow by improving the quality of worldwide governance indicators in European countries, especially in Western European Countries (WEC). Government effectiveness, rule of law, regulatory quality, and voice and accountability are found to be increasing the growth of the bioenergy industry. Precisely, the results further show that the magnitude of the effect of government effectiveness, voice and accountability, and Gross Domestic Product (GDP) on bioenergy output is higher in Western European Countries (WEC) as compared to the Central and Eastern European Countries (CEEC). Also, the findings further elaborate that the significant positive impact of regulatory quality and rule of law on bioenergy output is higher in CEEC countries compared to the WEC countries. The finding implies that the growth of the bioenergy industry in European countries can be effectively increased by improving the practice and quality of worldwide governance indicators. The study recommends for European countries to increase the efficiency of worldwide governance in their bioenergy industry to increase the sustainability of bioenergy production and reduce Dioxide Carbon (CO2) emissions. Policymakers in these countries should also invest more in worldwide governance to increase its effectiveness and transparency in the bioenergy industry. The authorities should equally emphasize the effectiveness and transparency of worldwide governance indicators to attain bioenergy security and lessen the dependence on fossil fuels.
Fulltext Physicochemical characteristics and nutritional compositions of MR219 mutant rice and their effects on glycaemic responses in BALB/c mice

Asma Ilyani, K., *Rafii, M. Y, Sobri, H., Anna, L. P. K., Rahim, A. H., Mahmud, T. M. M., et al.

International Food Research Journal, 2019;26(5):1477-1484.
MyJurnal

The awareness of the general public on healthy foods has been a major concern and people are looking for the right variety of rice for diabetic patients. High amylose content rice with low glycaemic index (GI), which is an indicator of sugar release in the blood, is beneficial for human health. The present work was aimed to determine the physicochemical characteristics and nutritional compositions of MR219 mutant rice, and the effects of amylose content to blood glucose response and glycaemic index in field condition. A total of 31 M4 mutant lines (ML1 to ML31) were evaluated for physicochemical characteristics and nutritional compositions in comparison with the parental variety, MR219. In glycaemic response study, 48 female BALB/c mice were fed with glucose (a baseline), saline water, two check varieties (MR219 and MRQ74) and four selected mutant lines with different amylose contents. The physicochemical and proximate analysis revealed highly significant differences among the mutant lines. Some mutant lines improved amylose content and nutritional composition. Mutant ML3 had slightly higher amylose content than the parental variety and was recommended for glycaemic responses. However, the field experiment results showed two mutant lines namely; ML3 and ML30, having significantly lower glucose reading (5.49 mmol/L and 5.47 mmol/L, respectively) as compared to the parental variety and other mutant lines. The glucose level was found highest at 60 min after feeding but significantly dropped at 120 min. The normal glucose reading in ML3 and ML30 also resulted in moderate GI values (65% and 66%, respectively). As low and moderate GI foods are recommended for diabetic patients, ML3 and ML30 had high potential for their consumption, and can be suggested for further breeding program to develop low GI rice.
Fulltext Awareness of Hyperlipidemia Among University Students and Staff Member

Rahim AA, Khan AH, Syed Sulaiman A, Aftab RA

Value Health, 2014 Nov;17(7):A759.
PMID: 27202775 DOI: 10.1016/j.jval.2014.08.249
Fulltext Tinggianthura alba: a new genus and species of Anthuridae (Isopoda, Cymothoida, Anthuroidea) from Pulau Tinggi, Johor, Malaysia with an updated key to the genera of Anthuridae

Chew M, Abdul Rahim A, bin Haji Ross O

PLoS One, 2014;9(6):e99072.
PMID: 24914642 DOI: 10.1371/journal.pone.0099072

A new anthurid isopod from dead coral rubble and stones in the intertidal area of Pulau Tinggi, Johor, Malaysia, is described. It is placed in a new genus and species, Tinggianthura alba. Tinggianthura is characterized by: (1) subtriangular carpus shape of pereopods 4-7, (2) pereopod 1 propodus palm without prominent tooth or steps and (3) maxillipedal palp 2-articled.
Fulltext Optic disc topography of normal tension glaucoma patients in Malaysia

Abdul Rahim A, Ismail S, Ahmad Tajudin LS, Ahmad MS

Med J Malaysia, 2013 Aug;68(4):338-42.
PMID: 24145263 MyJurnal

There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (p<0.05). In conclusion, most of the optic disc parameters were significantly different in NTG patients compared to healthy individuals in Malaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.
Fulltext Clinical and Radiological Study of Serum Fluoride in Relation to Knee Osteoarthritis

Singh VK, Rathore KS, Khan G, Rahim A, Rashid A, Chauhan S

Malays Orthop J, 2020 Nov;14(3):151-154.
PMID: 33403076 DOI: 10.5704/MOJ.2011.023

Introduction: Fluorosis has been associated with an increased risk of degenerative changes in the knee. Multiple studies have found an association between arthritis and elevated fluoride levels. We aim to delineate if elevated fluoride level has any direct correlation with the degree of radiological grading and clinical symptoms in knee arthritis.
Materials and Methods: A cross-sectional study of 80 knee arthritis patients was conducted from February 2017 to April 2018. Serum fluoride levels were measured and patient's pain scores, WOMAC scores and radiological grading were correlated with the elevated fluoride levels.
Results: In our study, 30 out of 80 patients had increased serum fluoride level. Statistically significant differences were noted in VAS score, WOMAC score and Kellgren and Lawrence radiological grades between patients with normal serum fluoride level and those with elevated fluoride level.
Conclusion: There is an increased risk of knee arthritis in patients with elevated blood fluoride levels and patients with increased fluoride levels are associated with more severe symptoms and radiographic disease.
Fulltext Effects of Palm Oil Tocotrienol-Rich Fraction (TRF) and Carotenes in Ovalbumin (OVA)-Challenged Asthmatic Brown Norway Rats

Zainal Z, Abdul Rahim A, Khaza'ai H, Chang SK

Int J Mol Sci, 2019 Apr 10;20(7).
PMID: 30974772 DOI: 10.3390/ijms20071764

Synthetic therapeutic drugs for asthma, a chronic airway inflammation characterised by strong eosinophil, mast cell, and lymphocyte infiltration, mucus hyper-production, and airway hyper-responsiveness, exhibit numerous side effects. Alternatively, the high antioxidant potential of palm oil phytonutrients, including vitamin E (tocotrienol-rich fractions; TRF) and carotene, may be beneficial for alleviating asthma. Here, we determined the therapeutic efficacy of TRF, carotene, and dexamethasone in ovalbumin-challenged allergic asthma in Brown Norway rats. Asthmatic symptoms fully developed within 8 days after the second sensitization, and were preserved throughout the time course via intranasal ovalbumin re-challenge. Asthmatic rats were then orally administered 30 mg/kg body weight TRF or carotene. TRF-treated animals exhibited reduced inflammatory cells in bronchial alveolar lavage fluid. TRF- and carotene-treated rats exhibited notable white blood cell reduction comparable to that from dexamethasone. TRF- and carotene-treatment also downregulated pro-inflammatory markers (IL-β, IL-6, TNF-α), coincident with anti-inflammatory marker IL-4 and IL-13 upregulation. Treatment significantly reduced asthmatic rat plasma CRP and IgE, signifying improved systemic inflammation. Asthmatic lung histology displayed severe edema and inflammatory cell infiltration in the bronchial wall, whereas treated animals retained healthy, normal-appearing lungs. The phytonutrients tocotrienol and carotene thus exhibit potential benefits for consumption as nutritional adjuncts in asthmatic disease.
Fulltext Health System Governance for the Integration of Mental Health Services into Primary Health Care in the Sub-Saharan Africa and South Asia Region: A Systematic Review

Abd Rahim A, Abdul Manaf R, Juni MH, Ibrahim N

Inquiry, 2021 7 20;58:469580211028579.
PMID: 34275346 DOI: 10.1177/00469580211028579

Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.
Wood fuel consumption and mortality rates in Sub-Saharan Africa: Evidence from a dynamic panel study

Sulaiman C, Abdul-Rahim AS, Chin L, Mohd-Shahwahid HO

Chemosphere, 2017 Mar 06;177:224-231.
PMID: 28292722 DOI: 10.1016/j.chemosphere.2017.03.019

This study examined the impact of wood fuel consumption on health outcomes, specifically under-five and adult mortality in Sub-Saharan Africa, where wood usage for cooking and heating is on the increase. Generalized method of moment (GMM) estimators were used to estimate the impact of wood fuel consumption on under-five and adult mortality (and also male and female mortality) in the region. The findings revealed that wood fuel consumption had significant positive impact on under-five and adult mortality. It suggests that over the studied period, an increase in wood fuel consumption has increased the mortality of under-five and adult. Importantly, it indicated that the magnitude of the effect of wood fuel consumption was more on the under-five than the adults. Similarly, assessing the effect on a gender basis, it was revealed that the effect was more on female than male adults. This finding suggests that the resultant mortality from wood smoke related infections is more on under-five children than adults, and also are more on female adults than male adults. We, therefore, recommended that an alternative affordable, clean energy source for cooking and heating should be provided to reduce the wood fuel consumption.
Planning Accessibility Strategies and Connectivity for Malaysian Urban Built Environment

Abd Samad NA, Said I, Abdul Rahim A

Stud Health Technol Inform, 2018;256:367-377.
PMID: 30371497

Access to our buildings relies to the accessibility of its external environment and the route taken. Developments and planning in urban areas has many several requirements and restrictions. Planning accessibility for Malaysian built environment is achievable by designing in compliance to the requirements enforced by authorities. Accessible design is commonly associated with providing facilities for Persons with Disabilities (PwDs), the issue that is often brought up is the inaccessibility of the external environment and lacking of seamless connectivity between buildings and the outdoor. The intention is to formulate accessibility strategies and work out planning process on how accessibility can be achieved. Universal Design will be the basis for the design and planning concept to accommodate all users to enjoy our urban built environment. It is notable that developed countries advances more in terms of implementing and enforcing accessibility measures via legislative and regulatory documents, government strategies and initiatives within its planning approach than the developing nations. The methodology will be looking into the establishment of strategies and measures of international and local planning policy, local and action plans of City of London as selected Local Authority to be analyzed its inclusive policy has been successfully implemented in their jurisdiction. The findings, discussions and result will be an outcome of generating a framework of accessibility strategies that is derived from interviews and government documents accordingly to targeted Malaysian urban areas focusing the City of Petaling Jaya and Putrajaya and how it can be improvised. Therefore, an interpretation of adopting accessibility planning strategies of developed country, to be adapted locally according to Malaysian legislation, culture and lifestyles.
Fulltext Orbital Tumours in Northern Malaysia: A Five-Year Review

Qi-Xian T, Chew-Ean T, Abdul Rahim A, Nasaruddin RA

Cureus, 2022 Jan;14(1):e20941.
PMID: 35004088 DOI: 10.7759/cureus.20941

BACKGROUND: This study was conducted with the objective to examine demographic statistics and histopathological diagnoses of orbital biopsies from cases referred to the Oculoplastic subspecialty of the Ophthalmology department in Hospital Sultanah Bahiyah, Kedah, from 2016 to 2020.
METHOD: This study is a case series of 28 patients who underwent orbital biopsy.
RESULT: A total of 34 orbital biopsies from 28 patients were recorded. The mean age was 48.3 ± 19.1 years old. 22 (78.4%) cases manifested unilaterally and six (21.4%) manifested bilaterally. The commonest presentations were orbital mass (36.6%) and proptosis (24.4%). The mean duration of the presentation was 16.2 ± 19.5 months. Fourteen (50.0%) patients underwent orbital biopsy within six months of symptoms. 52.8% of the tumours are situated at supero-temporal region of the orbit. 53.0% (18) situated in extraconal space of orbit. Out of all, 23 (67.6%) cases were benign and 11 (32.4%) cases were malignant. All were primary in origin (100%). The commonest orbital tumours reported were malignant lymphoma (29.4%), reactive lymphoid hyperplasia (14.7%), non-caseating granulomatous inflammation (11.8%), non-granulomatous inflammation (5.9%) and cavernous haemangioma (5.9%). Of all 10 malignant lymphomas from eight patients (two were bilateral eyes) were all mucosa-associated lymphoid tissue (MALT) of primary non-Hodgkin lymphomas. None of the cases were reported to be metastasis from the systemic spread. The majority of patients' eyes (20, 58.8%) remained the same visual acuity post-biopsy while six (17.6%) eyes had improvement in visual acuity and eight (23.5%) eyes had reduced postoperative visual acuity.
CONCLUSION: Malignant tumours are more common in the elder age group especially malignant lymphoma which is in contrast to Caucasian populations. Understanding the relative incidence of these various orbital tumours is essential to patient evaluation and management.
Catching an ectopic caesarean scar pregnancy - Radiological perspective

Seah SC, Laili SAL, Hairiah A, Ab Rahim AG

Med J Malaysia, 2018 02;73(1):51-53.
PMID: 29531205

Caesarean scar implantation is one of the rarest form of ectopic pregnancies and most unwanted complication of caesarean scar. However, with the increasing numbers of caesarean section performed, caesarean scar pregnancy (CSP) may be on the rise. The diagnosis is often difficult, but establishing an accurate diagnosis of CSP in the early first trimester is utmost important to prevent its detrimental consequences of uterine rupture and fatal haemorrhage. Hence, we present a case to highlight the role of imaging in diagnosing and managing this condition to prevent its associated high morbidity and mortality.
Urbanization and carbon dioxide emissions in Singapore: evidence from the ARDL approach

Ali HS, Abdul-Rahim AS, Ribadu MB

Environ Sci Pollut Res Int, 2017 Jan;24(2):1967-1974.
PMID: 27798805 DOI: 10.1007/s11356-016-7935-z

The main aim of this article is to examine empirically the impact of urbanization on carbon dioxide emissions in Singapore from 1970 to 2015. The autoregressive distributed lags (ARDL) approach is applied within the analysis. The main finding reveals a negative and significant impact of urbanization on carbon emissions in Singapore, which means that urban development in Singapore is not a barrier to the improvement of environmental quality. Thus, urbanization enhances environmental quality by reducing carbon emissions in the sample country. The result also highlighted that economic growth has a positive and significant impact on carbon emissions, which suggests that economic growth reduces environmental quality through its direct effect of increasing carbon emissions in the country. Despite the high level of urbanization in Singapore, which shows that 100 % of the populace is living in the urban center, it does not lead to more environmental degradation. Hence, urbanization will not be considered an obstacle when initiating policies that will be used to reduce environmental degradation in the country. Policy makers should consider the country's level of economic growth instead of urbanization when formulating policies to reduce environmental degradation, due to its direct impact on increasing carbon dioxide emissions.
Fulltext Reliability and limitations of permanent tooth staging techniques

Abdul Rahim AH, Davies JA, Liversidge HM

Forensic Sci Int, 2023 May;346:111654.
PMID: 37011430 DOI: 10.1016/j.forsciint.2023.111654

Reliability, or repeatability, of permanent tooth staging techniques is usually expressed as Cohen's Kappa. This single value obscures information about the quantity and allocation of disagreements. In this study we assess and compare intra-observer reliability of permanent tooth staging techniques described by Nolla, Moorrees et al. and Demirjian et al. The sample was panoramic radiographs of healthy dental patients made up of 100 males and 100 females aged 6-15 years. All permanent teeth on the left side (excluding third molars) were scored twice. Weighted Kappa and percentage agreement were calculated. Results show Kappa values for all teeth combined as 0.918, 0.922 and 0.938 for Demirjian (number of teeth N = 2682), Nolla (N = 2698) and Moorrees (N = 2674) respectively. A comparison of Kappa values between upper and lower teeth showed marginally higher values for upper incisors and lower molar for all three scoring methods. Small differences in Kappa values were noted between tooth types with the upper first molar having smaller values than other teeth. Percentage agreement ranged from 81 % (Moorrees), 86 % (Nolla) to 87 % (Demirjian). Tooth stage differences between first and second assessments were not more than one stage. Our findings show that Demirjian scoring is marginally more reliable than Nolla or Moorrees. We suggest that (1) data for reliability are tabulated in full to show the quantity and allocation of disagreement between first and second readings, and (2) that the reliability sample is sufficiently large with a wide age range to include multiple different tooth stages.

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