Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low (I2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.
The affinity of zeolite nanoparticles (diameter of 8-12 nm) possessing high surface area and high pore volume towards human plasma proteins has been investigated. The protein composition (corona) of zeolite nanoparticles has been shown to be more dependent on the plasma protein concentrations and the type of zeolites than zeolite nanoparticles concentration. The number of proteins present in the corona of zeolite nanoparticles at 100% plasma (in vivo state) is less than with 10% plasma exposure. This could be due to a competition between the proteins to occupy the corona of the zeolite nanoparticles. Moreover, a high selective adsorption for apolipoprotein C-III (APOC-III) and fibrinogen on the zeolite nanoparticles at high plasma concentration (100%) was observed. While the zeolite nanoparticles exposed to low plasma concentration (10%) exhibited a high selective adsorption for immunoglobulin gamma (i.e. IGHG1, IGHG2 and IGHG4) proteins. The zeolite nanoparticles can potentially be used for selectively capture of APOC-III in order to reduce the activation of lipoprotein lipase inhibition during hypertriglyceridemia treatment. The zeolite nanoparticles can be adapted to hemophilic patients (hemophilia A (F-VIII deficient) and hemophilia B (F-IX deficient)) with a risk of bleeding, and thus might be potentially used in combination with the existing therapy.
The curvature correction factor is an important parameter in the stress calculation formulation of a helical extension spring, which describes the effect of spring wire curvature on the stress increase towards its inner radius. In this study, the parameters affecting the curvature correction factor were investigated through theoretical and numerical methods. Several finite element (FE) models of an extension spring were generated to obtain the distribution of the tensile stress in the spring. In this investigation, the hook orientation and the number of coils of the extension spring showed significant effects on the curvature correction factor. These parameters were not considered in the theoretical model for the calculation of the curvature correction factor, causing a deviation between the results of the FE model and the theoretical approach. A set of equations is proposed for the curvature correction factor, which relates both the spring index and the number of coils. These equations can be applied directly to the design of extension springs with a higher safety factor.
It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not always present. This case describes an atypical presentation of aortic dissection, in which the patient walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein. Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for aortic dissection in the absence of classic features. The case is discussed with reference to the literature on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this frequently lethal condition.
Porous silicon (Si) is a low thermal conductivity material, which has high potential for thermoelectric devices. However, low output performance of porous Si hinders the development of thermoelectric performance due to low electrical conductivity. The large contact resistance from nonlinear contact between porous Si and metal is one reason for the reduction of electrical conductivity. In this paper, p- and n-type porous Si were formed on Si substrate by metal-assisted chemical etching. To decrease contact resistance, p- and n-type spin on dopants are employed to dope an impurity element into p- and n-type porous Si surface, respectively. Compared to the Si substrate with undoped porous samples, ohmic contact can be obtained, and the electrical conductivity of doped p- and n-type porous Si can be improved to 1160 and 1390 S/m, respectively. Compared with the Si substrate, the special contact resistances for the doped p- and n-type porous Si layer decreases to 1.35 and 1.16 mΩ/cm2, respectively, by increasing the carrier concentration. However, the increase of the carrier concentration induces the decline of the Seebeck coefficient for p- and n-type Si substrates with doped porous Si samples to 491 and 480 μV/K, respectively. Power factor is related to the Seebeck coefficient and electrical conductivity of thermoelectric material, which is one vital factor that evaluates its output performance. Therefore, even though the Seebeck coefficient values of Si substrates with doped porous Si samples decrease, the doped porous Si layer can improve the power factor compared to undoped samples due to the enhancement of electrical conductivity, which facilitates its development for thermoelectric application.
BACKGROUND: Cryoprecipitate is generally used to treat bleeding patients with hypofibrinogenemia, and the transfusion decision is guided based on published guidelines.
AIM: This study aimed to evaluate the practice appropriateness in accordance to cryoprecipitate transfusion guidelines in Hospital Kuala Lumpur.
METHODOLOGY: This cross-sectional study of 117 cryoprecipitates transfused adult patients was conducted in Kuala Lumpur Hospital from January to June 2012. The compliance of the indication of cryoprecipitate was considered as appropriate if indicated for patients who have hypofibrinogenemia (<1.0 g/L) with bleeding, or otherwise inappropriate if pretransfusion fibrinogen level was more than 1.0 g/L, pretransfusion fibrinogen level was not examined and posttransfusion fibrinogen level more than 1.5 g/L.
RESULTS: Most of the cryoprecipitate prescriptions were found to be inappropriate, which read 81.2% (95% confidence interval = 0.740, 0.880). Patients who underwent neurovascular surgery were the major recipient of cryoprecipitate, but majority of the prescription was found not appropriate. The decision to transfuse cryoprecipitate was found mostly appropriate when was guided by fibrinogen (52.2%), but the percentage dropped to 10.6% when pretransfusion fibrinogen test was not performed. Regrettably, only 19.7% of total cryoprecipitate were given based on pretransfusion fibrinogen level.
KEYWORDS: Appropriateness; bleeding; cryoprecipitate transfusion; guideline
Journal of Sports Science and Physical Education 5(2): 44-52, 2016 - The aim of this study is
to identify the differences in academic achievement between athletes involved in Karnival
Kokurikulum Sukan antara Kolej Matrikulasi (KAKOM) and non-athletes in Labuan
Matriculation College. Overall 200 respondents selected athletes are students from KAKOM
athletes (n=100) and non-athlete students (n=100) in Semester 1, 2015/2016. The survey
design and purposely sampling technique was used for data collection. The respondents are
comprised of students majoring in Accounting, One Year Program (PST) Module 1, PST
Module 2 and PST Module 3. Descriptive statistic was used to obtain frequency and
percentage for each of the variables and to determine the level of academic achievement
(CGPA) of athletes and non-athletes. Inferential statistic was used to compare the mean
scores achieved by cumulative grade point average (CGPA) between KAKOM athletes and
non-athletes based on t-test. T test was also used to identify the differences in academic
performance of athletes and non-athletes based on gender. The findings of this study showed
no significant differences in terms of academic achievement among student who are athletes
and non-athletes. Similarly, the findings of the performance of athletes and non-athletes
based on gender showed no significant differences. From the results of this study, it shows
that there are no differences in academic achievement between students who involved in
KAKOM sports and those who dont involved. The researcher suggests that students should
be active in sports and recreational activities during college because it will be beneficial for
health and indirectly develop their soft skills. The study found that sports factor is not the
cause for deterioration in academic achievement but there are other factors that affect
academic performance which needs further study focusing more on students who are failing
academically.
Centrifugation of blood samples to produce platelet-poor plasma is one of the important steps for coagulation testing. Reduction of the time required for specimen processing without affecting quality of results should be ideal for tests which require immediate results. Centrifugation of platelet-poor plasma (3580 rpm) for 15 minutes performed for routine coagulation tests would prolong the turn-around time for an urgent test (30 minutes). This study was done to determine the effect of reducing centrifugation time for routine coagulation tests in order to meet the turn-around time (TAT) for urgent tests. Seventy-nine blood samples sent for routine coagulation tests, were assayed for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level and platelet counts, using two different centrifugation speed for plasma preparation: centrifugation at 3580 rpm for 15 minutes and rapid centrifugation at 4000 rpm for five minutes. Paired sample t-test showed that there was a significant
difference in the platelet count between the two groups (p=0.001). However, there was no significant difference in the normal APTT (p=0.16), abnormal APTT (p=0.80), abnormal PT (p=0.43) and the results of fibrinogen levels (p=0.36). In conclusion, rapid centrifugation at 4000 rpm for five minutes does not modify results of routine coagulation tests (PT, APTT and fibrinogen). It would be beneficial in providing rapid results for urgent coagulation tests.
Dengue and dengue hemorrhagic jiever are still a serious public health problem among people in developing countries. The study was conducted to assess the knowledge, attitude and practice among students in University Technology of MARA in Shah Alam Selangor, Malaysia, and to determine its association withprevious infection. A total of 218 students were selected randomly fom several residential colleges within the university main campus. They were interviewed for their perception of risk to dengue and their blood were taken for serological examination (Dengue IgG). It was found that 49.1% of students have had previous infection, however onlv 0.9% had history of symptomatic dengue infection. Males students originating fom urban areas were more at risk of being infected. The perception of risk to dengue was good among students but this factor is
unable to explain the magnitude of infection among them. Further study should look at the interaction between behaviour and environment among students who are sero negative.
Introduction: The aims of this study were to assess the differences in the percentages of abnormal morphology between the epididymal and testicular spermatozoa of mature male offspring mice whose mothers were injected with various doses of lead acetate during gestation. Materials and Methods: Seventy two healthy female mice were divided into three major groups according to the number of injections involving 1, 2 or 3 injections at 8th day; 8th and 13th days; and 8th, 13th and 18th days of gestation period, respectively. Each major group was subdivided into four minor groups according to the dosage of lead administered (0, 25, 50 and 100) mg/Kg. Results: The percentages of abnormal morphology of epididymal and testicular spermatozoa were studied and the data were statistically analyzed. The results of this study proved that an increased number of injections and/or dose of lead acetate injected to the mothers during gestation cause an elevation in the percentage of abnormal morphology of both epididymal and testicular spermatozoa of the male mice offspring. Conclusion: In conclusion this study demonstrated that lead acetate when exposed prenatally have toxic effects on the sperm in the offspring male mice resulting in abnormal morphology of spermatozoa. The most likely causative factor is disturbances in the phase(s) of spermatogenesis and/or spermiogenesis.
Introduction: Home visits are complex processes for clients and occupational therapists. Despite the benefits of home
visits, the numbers of home visits being conducted are decreasing in international settings due to service constraints
or client reluctance. Published international studies may not be applicable to Malaysia due to cultural and geodemographic
differences relating to the home context. This study aimed to explore the experience of occupational
therapists in Malaysia in conducting home visits. Materials and Methods: A focus group discussion was conducted
with seven occupational therapists in one teaching hospital in Kuala Lumpur. The group session was audio-recorded,
transcribed, summarised and analysed using thematic analysis. Results: Themes developed were: i) client factors
inhibiting effective service provision, ii) uninformed policies and guidelines, and iii) professional identity and
growth. Conclusions: Our study has revealed major challenges for Malaysian occupational therapists with regards
to conducting home visits. Future studies should now evaluate factors underlying reluctance to participate in home
visits and effective strategies to overcome these difficulties.
The purpose of this study is to verify the constructs found in the technological problem solving instrument. The instrument used to measure the technological problem solving is the Technology Problem Solving Inventory (PSI-TECH), derived from the original instrument PSI-PSYCH which consists of three constructs. Exploratory Factor Analysis (EFA); KaiserMeyer-Olkin (KMO) and Barlett's analysis were applied for factor analysis in the validity and reliability of the PSI-TECH instrument. The minimum weighting factor is 0.60, used as the cut off value for factor loading. Meanwhile, the Cronbach alpha value 0.70 and above is considered reliable in this study. A total of 102 primary school students, 12 years old were randomly selected among Miri district primary school students in Sarawak. After the survey was carried out, the results of the analysis confirmed that there were three constructs that had been successfully extracted as described in the original PSI-TECH. However, 4 items were dropped from the list. The results of the analysis can provide guidance to researchers in developing this technological problem solving questionnaire, since demographics and geographies tested were diverse. As a result, the findings provide guidance to local researchers in using these instruments.
This study was performed to observe the variation in the distribution of 210Po,210Pb and 210Po/210Pb activity ratio throughtheir vertical profile of the sediment cores takenat surrounding Sungai Linggi estuary. Five sediment cores were takenin February 2011 and were cutto an intervalof 2 cm layer. Activity concentrations of 210Po and 210Pb were determined using alpha radiochemical analysis and gamma direct measurement, respectively. Generally, the measured activity of 210Po, 210Pb and 210Po/210Pbwere in the ranges of 22.73 –139.06 Bqkg-1dw., 37.88 –176.24 Bqkg-1dw.and 0.23 –1.34, respectively. The variation in the distribution profile for the radionuclides are believed to be influencedby human activities such as agriculture, fertilizer, vehicles, burned fuel fossil and forest, industrialand others via river input from land-base.Other factor is due to organic mattercontent played importantrole as the geochemical carrier to transportthose radionuclides at study area. It was provedthat hasa strong correlation between the radionuclide distribution and the sedimentcomposition of organic matter.Furthermore, in those rangesreflectedthat 210Pb activities were higher than210Po with an activity ratio average of 0.79. This is probably due to dramatic increase of excess 210Pb supplied from atmospheric deposition, in situ decay of 226Ra and as a result of diagenetic remolibilazationof 210Pbin deeper layesof the sediment column. Thus, thosefactors are majorcontributions on thevariation of 210Po and 210Pb in the sediment core at surrounding Sungai Linggi estuary.
Catheterization of the umbilical artery has been a useful aid in the management of sick neonates for the past few decades. However, it is associated with various complications. Reported studies strongly suggest a significant role of intravascular catheterization in the development of aortic thrombi. Increase in thrombosis of large vessels is believed to be related to mechanical injury in the catheterized vessels, which provide direct exposure of blood to tissue factor (TF), the primary cellular initiator of the extrinsic coagulation pathway. This study was conducted to determine the levels of plasma TF, tissue factor pathway inhibitor (TFPI) and D-dimer (DD) in infants with umbilical arterial catheter (UAC)-associated thrombosis. Quantification of TF was carried out using an in-house sandwich ELISA, whereas TFPI and DD levels were measured with commercial immunoassay kits. Infants with UAC inserted were found to have significantly higher levels of plasma TF (p < 0.001) than baseline levels. However, there were no significantly elevated levels of TFPI or DD. Infants with UAC-associated thrombosis demonstrated a greater increase of TF level (median: 414.5 pg/mL; range: -76.0, 6667.0) than infants without UAC-associated thrombosis (105.0 pg/mL; -976.0, 9480.0; p = 0.009) following UAC insertion. Our findings indicate that quantification and monitoring of TF levels could predict thrombus formation in infants with indwelling UAC. Following umbilical arterial catheterisation, infants with an approximately 3-fold rise in plasma TF levels were most at risk of developing abdominal aorta thrombosis as confirmed by real-time abdominal ultrasonography.
Forty-five Asian patients (Indians 35, Chinese 8, Malay 2) with histologically proven lichen planus were studied by immunofluorescence. The most characteristic feature, seen in 93% of the cases, was shaggy deposition of fibrinogen along the basement membrane. Immunoglobulin deposition along the basement membrane was notably, absent. Colloid bodies were observed in 87% of the cases. Fibrinogen was the most common immunoreactant, and its presence in colloid bodies was always associated with fibrinogen deposition along the basement membrane zone. Colloid bodies also contained a variety of other immunoreactants. However, staining for IgM was noted to be the most intense. The combination of shaggy deposition of fibrinogen along the basement membrane, in the absence of immunoglobulins, and the presence of colloid bodies around the basement membrane zone, is highly characteristic of lichen planus. The pattern of immunofluorescence among Asians with lichen planus, conforms to that observed in other races. There did not appear to be any difference in the immunofluorescence staining with pattern in the three racial groups studied.
Since thrombi continue to incorporate fibrin during lysis we tested the effect of pretreatment with ancrod, a defibrinating agent from Malaysian pit viper venom, on thrombolysis with urokinase and streptokinase. Thrombi were induced by copper-coils in the carotid arteries of the dogs, weighed after 1 hour and inserted into the femoral arteries of the same animals. They were then exposed for 15 min to iv boluses of streptokinase 10,000 U/kg, urokinase 10,000 U/kg and urokinase 25,000 U/kg with or without pretreatment with ancrod. Ancrod depleted fibrinogen within 5 min and enhanced the lytic effect of streptokinase from 25 +/- 8% to 59 +/- 13% (p less than .05), urokinase 10,000 U/kg from 16 +/- 11% to 66 +/- 18% (p less than .01) and urokinase 25,000 U/kg from 27 +/- 17% to 85 +/- 8% (p less than .001) of the initial thrombus weight. Ancrod itself did not activate plasminogen to plasmin. We conclude that ancrod enhances thrombolysis probably by depleting fibrinogen and preventing new fibrin incorporation into the thrombus during lysis.
The investigation of many hemostatic defects in newborns is restricted by the lack of normal reference values. The coagulation system of the neonate differs in many ways from that of the adult. The present study was designed to compare the concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI) and D-dimer (DD) in the umbilical cord blood of healthy newborns and in adult plasma. TF antigen was quantified using an in-house enzyme-linked immunosorbent assay, whereas TFPI and DD levels were measured with commercial kits. The mean TF level in cord blood (mean standard deviation, 183.94 103.63 pg/ml) was significantly higher ( = 0.008) than that in adults (136.64 65.09 pg/ml). Cord blood exhibited enhanced fibrinolysis, as was reflected by a significantly higher level of DD (924.57 733.87 ng/ml, 0.001) than that in adults (45.57 17.21 ng/ml). Conversely, cord blood (30.88 10.16 ng/ml) demonstrated significantly lower ( 0.001) TFPI levels than that in adults (55.77 21.16 ng/ml). However, no significant differences of these three hemostatic markers were noted between both gender groups in newborns and adults. Our findings indicate that an active and dynamic state of hemostasis exists in cord blood, as the fluidity of cord blood remains preserved in the presence of birth injury.