Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progressive septal as well as palatal perforation. Progression from septal perforation to palatal perforation occurred after cessation of intranasal cocaine abuse. This patient had a weakly positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) but no histologic evidence of Wegener's Granulomatosis. The differential diagnosis for septal and palatal perforation is reviewed. This case represents the fifth reported case of palatal perforation secondary to cocaine abuse in the literature, and the second associated with positive C-ANCA.
Central serous choroidopathy is a spontaneous serous detachment of the sensory retina, usually affecting adults between 20 to 50 years of age but is also found in patients older than 60 years of age. This disease usually affects males with a male to female ratio of 8-10 to 1. Many aetiological or associated factors have been described. Here we report a 39-year-old pregnant lady presented with left central serous chorioretinopathy preceded by an unusual emotional disturbance. She was not given any photocoagulative treatment to avoid possible photocoagulative complications. Post delivery, she presented with resolution of the CSC.
Two cases of invasive early-onset neonatal pneumococcal sepsis are reported. One neonate was born at term with no risk factors and the other preterm at 35 weeks. Sepsis was not detected at birth for either of these babies and diagnosis was made at the stage of severe sepsis. A fatal outcome resulted despite treatment. Pneumococcal sepsis was confirmed after death in both these cases. Although maternal carriage was not documented in either case, the ages at presentation and progression suggested perinatal acquisition of infection. Early onset neonatal pneumococcal sepsis presents similarly as early onset neonatal Group B streptococcal (GBS) sepsis. Vaginal carriage of pneumococcus is rare but the micro-organism may have a higher invasion to colonisation ratio (attack rate) than GBS. Risk factors for invasive disease are similar to GBS.
A survey was carried out using a medical examination format that was prepared by the Malaysian Medical Association. The findings of the survey show that of the 266 cases surveyed, 64 drivers (24% of cases surveyed) are either totally unfit to drive or temporarily unfit to drive heavy goods and passenger vehicles. This is clear indication that the current format that is being used by the Road Transport Department is inadequate and needs to be reviewed. It must also be stressed that all the above 64 drivers have been certified fit using the existing Road Transport Department format and are currently driving in our highways and roads. Heavy vehicle goods and passenger vehicle drivers if not properly examined and medically certified are not only be endangering their own lives but also that of others. It is therefore recommended that based on the data available from this survey, the Road Transport Department should seriously consider adopting the medical examination format that was formalised by the Malaysian Medical Association and used in this survey.
MeSH terms: Automobile Driver Examination; Automobile Driving*; Health Status*; Health Surveys*; Humans; Malaysia; Motor Vehicles*
Solitary thyroid nodules are commonly seen in surgical outpatient clinics. A detailed history and a careful physical examination are essential. In the management of the solitary thyroid nodule, fine needle aspiration cytology has become the cornerstone investigation. Ultrasound cannot differentiate between benign and malignant nodules, however is useful in the follow-up period to identify any further nodular growth. As thyroid malignancy occurs in both hot and cold nodules, radionuclide scans are not useful in the management of solitary thyroid nodules. We have attempted to outline the process of managing the solitary thyroid nodule and discuss the options available.
The Sharpened Romberg Test (SRT) is a test of balance commonly used in Diving Medicine. Interpretation of an abnormal test can be confounded by several factors. This study was conducted to further evaluate the usefulness of the SRT. In the first part of the study, naval and civilian volunteers in a Naval Base were recruited as subjects. The SRT scores were recorded in two separate trials; once in the morning (4 attempts) and once in the evening (4 attempts) to evaluate the effect of practice on the SRT. In the second part of the study immediate pre- and post-dive scores in a group of divers were measured to evaluate: (1) the effect of decompression; (2) the effect of the normal post-dive fatigue; and (3) the vestibular effect of swaying after a boat ride. Comparisons were also made between the distributions of the SRTs of the normal subjects and those of a retrospective group of DCI patients treated at the Slark Hyperbaric Unit, Royal New Zealand Navy Hospital (RNZNH), Auckland. The SRT was found to have an early learning effect. Second attempts were significantly better than the first (p<0.001) within the same trial. However this learning effect plateaued by the third and fourth attempts. No difference was found between trials (morning and evening). There was a post-dive decline in the scores of the first attempts only (p<0.05). Subsequent second to fourth attempts were not affected by diving. The practice effect is only evident between the first and second attempts within the same trial but not between trials. The pre- and post-dive data showed that the SRT was not affected by decompression, post-dive fatigue or the vestibular sensation of swaying that is commonly experienced after a boat ride. Comparison of the distributions between controls and DCI patients showed a bimodal pattern. Fifty-four percent (54%) of the DCI patients had 'normal' scores (60 seconds), while 14% had scores between 16-35 seconds and 32% scored less than 15 seconds. In contrast, 95% of the control groups had 'normal' scores while 5% scored between 16-35 seconds. Therefore, accepting a score of less than 40 seconds as being "abnormal" will give the SRT a sensitivity of 46%, specificity of 95% and predictive value of 82%.
Malaysia plays the leading role in homeopathy in Southeast Asia. The history of homeopathy in the Malay civilization began in the 1930s. Since then, it has been practiced mainly by Malays who are all Muslims. Homeopathy in multiethnic Malaysia is embedded in Islamic culture and has to do with ethnic identity of the Malays within the Malay/non-Malay dichotomy of the society. This survey explores the relationships between homeopathy and Malay traditional medicine, as well as between homeopathy and Islam.
MeSH terms: Ethnic Groups/history*; Homeopathy/history*; Islam/history*; Malaysia; History, 20th Century
In the presence of guest 2,4'-bpy molecules or under acidic conditions, three compounds, [Cd(4,4'-bpy)(2)(H(2)O)(2)](ClO(4))(2).(2,4'-bpy)(2).H(2)O (1), [Zn(4,4'-bpy)(2)(H(2)O)(2)](ClO(4))(2).(2,4'-bpy)(2).H(2)O (2), and [Cu(4,4'-bpy)(2)(H(2)O)(2)](ClO(4))(4).(4,4'-H(2)bpy) (3), were obtained from the reactions of the metal salts and 4,4'-bpy in an EtOH-H(2)O mixture. 1 has a 2-D square-grid network structure, crystallizing in the monoclinic space group P2/n, with a = 13.231(3) Å, b = 11.669(2) Å, c = 15.019(3) Å, beta = 112.82(3) degrees, Z = 2; 2 is isomorphous with 1, crystallizing in the monoclinic space group P2/n, with a = 13.150(3) Å, b = 11.368(2) Å, c = 14.745(3) Å, beta = 110.60(3) degrees, Z = 2. The square grids superpose on each other into a channel structure, in which each layer consists of two pairs of shared edges, perfectly square-planar with an M(II) ion and a 4,4'-bpy at each corner and side, respectively. The square cavity has dimensions of 11.669(2) x 11.788(2) and 11.368(2) x 11.488(2) Å for 1 and 2, respectively. Every two guest 2,4'-bpy molecules are clathrated in each hydrophobic host cavity and are further stabilized by pi-pi stacking and hydrogen bonding interactions. The NMR spectra clearly confirm that both 1 and 2 contain 4,4'-bpy and 2,4'-bpy molecules in a 1:1 ratio, which have stacking interaction with each other in the solution. 3 crystallizes in the orthorhombic space group Ibam, with a = 11.1283(5) Å, b = 15.5927(8) Å, c = 22.3178(11) Å, Z = 4. 3 is made up of two-dimensional square [Cu(4)(4,4'-bpy)(4)] grids, where the square cavity has dimensions of 11.13 x 11.16 Å. Each [4,4'-H(2)bpy](2+) cation is clathrated in a square cavity and stacks with one pair of opposite edges of the host square cavity in an offset fashion with the face-to-face distance of ca. 3.95 Å. Within each cavity, the [4,4'-H(2)bpy](2+) cation forms twin three-center hydrogen bonds with two pairs of ClO(4)(-) anions. The results suggest that the guest 2,4'-bpy molecules and protonated [4,4'-H(2)bpy](2+) cations present in the reaction systems serve as structure-directing templates in the formation of the crystal structures and exclude self-inclusion of the networks having larger square cavities.
"This paper analyzes the determinants of female migration to export processing zones (EPZs) in Malaysia. A comparison of the individual and household migration models reveals interesting and important contrasting results. First, the role played by the expected net income gains is opposite in the two models: negative in the individual model, positive in the household model. Second, family migration experience is significant in the individual model but not in the household model. Third, attitudes matter to the household decision on a daughter's migration but not in the individual model. These contrasting results suggest that explaining the daughter's migration decision may require more than separation of the individual motives and familial needs."
MeSH terms: Asia; Asia, Southeastern; Attitude*; Behavior; Decision Making*; Demography; Developing Countries; Economics; Emigration and Immigration; Family Characteristics*; Family Relations; Health Services Needs and Demand*; Income*; Malaysia; Motivation*; Nuclear Family*; Population; Population Dynamics*; Psychology; Socioeconomic Factors
MeSH terms: Age Factors; Asia; Asia, Southeastern; Demography; Developing Countries; Economics; Malaysia; Population; Population Characteristics; Population Growth*; Public Policy*; Research; Socioeconomic Factors; Statistics as Topic; Women's Rights*; Age Distribution*
"A graphical chain modelling approach is used to study the determinants of neonatal and post-neonatal mortality in Malaysia. This approach provides an easily interpretable empirical description and illustrates explicitly the conditional independence structure between each pair of variables. The interpretation can be read directly from a mathematical graph. Besides examining the direct association of each determinant on mortality, we also examine the effects of socio-economic determinants on intermediate determinants to understand the pathways through which the socioeconomic determinants affect the chance of mortality. The data anlaysed come from the second Malaysian Family Life Survey, fielded between August 1988 and January 1989. "
The bioavailability of a generic preparation of acyclovir (Avorax) was compared with the innovator product, Zovirax. Twelve healthy volunteers participated in the study, conducted according to a randomized, two-way crossover design. The preparations were compared using the parameters area under the plasma concentration time curve (AUC(0-infinity), peak plasma concentration (Cmax), and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed between the Tmax or the logarithmic transformed AUC(0-infinity) and C(max) values of the two preparations. In addition, the 90% confidence interval for the ratio of the logarithmic transformed AUC(0-infinity) values of Avorax over those of Zovirax was found to lie between 0.85 and 1.06, while that of the logarithmic transformed Cmax values was between 0.95 and 1.25, being within the bioequivalence limit of 0.80-1.25. Moreover, the elimination rate constant (k(e)), elimination half-life (t(1/2)), and apparent volume of distribution (Vd) values obtained with the two preparations were comparable and not significantly different statistically.
MeSH terms: Acyclovir/blood; Acyclovir/pharmacokinetics*; Adult; Biological Availability; Chromatography, High Pressure Liquid; Half-Life; Humans; Male; Middle Aged; Tablets; Cross-Over Studies; Area Under Curve
Ethyl acrylate-methyl methacrylate copolymer (Eudragit NE40D) was evaluated as matrix material for preparing controlled-release tablets of diclofenac sodium. Drug release could be modified in a predictable manner by varying the Eudragit NE40D content, but was pH dependent, being markedly reduced at lower pH. This could be attributed to the low solubility of the drug at these pH values. Thermal treatment of the tablets at 60 degrees C was also found to affect the rate of drug release, which was found to decrease with an increase in the treatment duration, but could be stabilized after 96 hr of treatment. This was also associated with a corresponding increase in the tablet tensile strength. However, treatment of the granules for 5 hr prior to compaction into tablets could shorten the stabilizing time of the drug release to 48 hr and that of the tensile strength to 24 hr. The effect of thermal treatment may be ascribed to better coalescence of the Eudragit particles to form a fine network, resulting in matrix of higher tortuosity and lower porosity.
MeSH terms: Diclofenac/chemistry*; Drug Compounding; Drug Stability; Excipients/chemistry*; Heating; Hydrogen-Ion Concentration; Methacrylates/chemistry*; Polymers/chemistry*; Solubility; Tablets; Tensile Strength; Time Factors; Porosity
An analytical method using HPLC with UV detection was developed to investigate the quassinoid content of Eurycoma longifolia Jack (Simaroubaceae) collected from various sources. Eurycomanone (1), longilactone (2), 14,15beta-dihydroxyklaineanone (3), 15beta-acetyl-14-hydroxyklaineanone (4), 6alpha-hydroxyeurycomalactone (5), and eurycomalactone (7) were isolated as reference standards and together with the synthesized 1beta,12alpha,15beta-triacetyleurycomanone (6, internal standard), were identified by NMR, MS, UV and IR spectroscopies. Their coefficient of variation values for 0.50-35 microg ml(-1) concentrations of quassinoids and their retention times measured within- and between-day were small. The recoveries of the spiked quassinoids in E. longifolia samples and their detection limits at 8.5 times signal to noise ratio were 99.75-109.13% and 0.01 microg ml(-1), respectively. From the root samples analysed, 1 had the highest concentration, being about 16.8-39.6 fold higher than the other quassinoids 2, 3, 5, 7 but 145.3 fold higher than 4 which showed the lowest concentration.
MeSH terms: Chromatography, High Pressure Liquid; Magnetic Resonance Spectroscopy; Plant Extracts; Reference Standards; Simaroubaceae; Eurycoma; Quassins; Limit of Detection; Signal-To-Noise Ratio