A 13-year-old boy who had epigastric pain and pallor for 2 months and found to have an ulcerative mass in the stomach and underwent partial gastrectomy. A diagnosis of inflammatory myofibroblastic tumour (IMT) of the stomach was made on histological examination. Three years later, recurrence in the stomach, with invasion into the pancreas and hilum of the spleen was noted and was managed by wide wedge resection of the stomach, distal pancreatectomy and splenectomy. The patient has been recurrence-free for the past 2 years. Gastric IMT is an uncommon tumour in children with unpredictable prognosis.
PURPOSE:
This study examined the mutational profile of the adenomatous polyposis coli gene in relation to the development of desmoid tumors in familial adenomatous polyposis patients from a predominantly Chinese population.
METHODS:
This is a retrospective review of all patients with familial adenomatous polyposis coli from the Singapore Polyposis Registry. Identification of specific adenomatous polyposis coli gene mutation was performed and clinical course of associated desmoid disease obtained from case records and a computerized database.
RESULTS:
Two hundred five patients from 75 families afflicted with familial adenomatous polyposis coli were reviewed, with gene mutations identified in 107 patients. Of these, 23 (11.2 percent) developed desmoids. The male-to-female ratio was 1:1.3 and the ethnic distribution was Chinese (n=17) and Malay (n=6). Of the 92 patients with mutations 5' to codon 1444, 11 patients (12 percent) developed desmoids compared with 6 of 15 (40 percent) patients with adenomatous polyposis coli gene mutations 3' to codon 1444 (P<0.01). The clinical course of desmoid tumors can be divided into stable (n=11), variable (n=3), progressive (n=6), and aggressive growth (n=3). Only 3 (13 percent) patients with aggressive tumor growth required chemotherapy. There was no correlation between the site of mutation and the clinical progression of the desmoids. Seventy-four percent of these desmoids (17/23) developed at a mean interval of 2.98 years after restorative proctocolectomy, while only 30 percent (7/23) were diagnosed preoperatively or discovered during the initial surgery. The most common complications related to the mesenteric desmoids were intestinal obstruction (21.7 percent), ureteric obstruction (17.4 percent), and encasement of superior mesenteric vessels (13 percent).
CONCLUSION:
The clinical course of desmoids in an individual familial adenomatous polyposis patient remains unpredictable and no reliable genetic marker is available for prognostication in desmoid disease.
Catalytic cracking of high-density polyethylene (HDPE) over fluid catalytic cracking (FCC) catalysts (1:6 ratio) was carried out using a laboratory fluidized bed reactor operating at 450 degrees C. Two fresh and two steam deactivated commercial FCC catalysts with different levels of rare earth oxide (REO) were compared as well as two used FCC catalysts (E-Cats) with different levels of metal poisoning. Also, inert microspheres (MS3) were used as a fluidizing agent to compare with thermal cracking process at BP pilot plant at Grangemouth, Scotland, which used sand as its fluidizing agent. The results of HDPE degradation in terms of yield of volatile hydrocarbon product are fresh FCC catalysts>steamed FCC catalysts approximately used FCC catalysts. The thermal cracking process using MS3 showed that at 450 degrees C, the product distribution gave 46 wt% wax, 14% hydrocarbon gases, 8% gasoline, 0.1% coke and 32% nonvolatile product. In general, the product yields from HDPE cracking showed that the level of metal contamination (nickel and vanadium) did not affect the product stream generated from polymer cracking. This study gives promising results as an alternative technique for the cracking and recycling of polymer waste.
STUDY OBJECTIVE: The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital.
METHODS: All cases were recruited prospectively for 1 year. The hospitals were purposefully selected as typical for Malaysia. There are 3 primary outcome measures: death, musculoskeletal impairment, and disability at discharge. Adjustment was made for potential covariates and within-hospital clustering by using multivariable random-effects logistic regression analysis.
RESULTS: For direct admissions, logistic-regression-identified odds of dying were associated with older age (>55 years), odds ratio (OR) 1.9 (95% confidence interval [CI] 1.3 to 2.8); head injury, OR 2.7 (95% CI 1.9 to 3.9); arrival by means other than ambulance, OR 0.6 (95% CI 0.4 to 0.8); severe injuries (Injury Severity Score >15) at a district general hospital, OR 45.2 (95% CI 27.0 to 75.7); severe injuries at a tertiary care hospital, OR 11.2 (95% CI 7.3 to 17.3); and admission to a tertiary care hospital compared to a district general hospital if severely injured (Injury Severity Score >15), OR 0.2 (95% CI 0.1 to 0.4). Admission to a tertiary care hospital was associated with increased odds of disability (OR 1.9; 95% CI 1.5 to 2.3) and musculoskeletal impairment (OR 3.5; 95% CI 2.7 to 4.4) at discharge.
CONCLUSION: Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.
It is known that restoration of erased engraved identification marks on the engine and the chassis of a car or on a firearm has low success rate. Unlike stamping, engraving on a metal surface leaves no pronounced, permanent subsurface deformation in the crystalline structure, also called dislocation that can be revealed by suitable methods. Hence, the current research work investigated whether metallographic reagents used in the restoration of stamp (compression) marks could be applied to recover engraved marks on steel surfaces and also to establish the sensitivity and effectiveness of some of these reagents for the restoration of the marks. Experiments were conducted by mechanically engraving alphanumeric characters on several steel plates using a computer controlled engraving machine called Gravograph. The markings were later erased from the above steel plates by removing the metal in stages of 0.01 mm through 0.04 mm below the bottom of the engraving. Several plates were thus prepared wherein each one had been abraded to a specific depth. Then eight metallographic reagents were tested on each one of the above erased plates using a swabbing technique. The results had shown that while most of the reagents were able to restore marks up to certain levels of erasure, the reagent 5 g copper sulphate, 60 ml water, 30 ml concentrated ammonium hydroxide and 60 ml concentrated hydrochloric acid restored marks erased to a depth of 0.04 mm below the engraving depth, thus presenting itself the most sensitive reagent. Quite significantly, the above reagent was also able to decipher successfully the original engraved marks that had been erased and engraved with a new number, or obliterated by centre punching. The results of this research work should benefit the forensic practitioners engaged in the serial number recovery on vehicles, firearms and other objects.
MeSH terms: Computers; Engraving and Engravings; Firearms; Hydrochloric Acid; Indicators and Reagents; Steel; Water; Plant Leaves; Copper Sulfate; Data Compression; Physical Phenomena; Ammonium Hydroxide
The present study documents the school performance of 20 pediatric cochlear implant recipients who attended mainstream classes and compares their educational performance with their normally hearing peers.
Malaysia is facing an increase in the generation of waste and of accompanying problems with the disposal of this waste. In the last two decades, extensive building and infrastructure development projects have led to an increase in the generation of construction waste material. The construction industry has a substantial impact on the environment, and its environmental effects are in direct relation to the quality and quantity of the waste it generates. This paper discusses general characteristics of the construction contractors, the contractors' willingness to pay (WTP) for improved construction waste management, determining factors which affect the amount of their willingness to pay, and suggestions and policy implications in the perspective of construction waste management in Malaysia. The data in this study is based on contractors registered with the construction industry development board (CIDB) of Malaysia. Employing the open ended contingent valuation method, the study assessed the contractors' average maximum WTP for improved construction waste management to be RM69.88 (1US$=3.6 RM) per tonne of waste. The result shows that the average maximum WTP is higher for large contractors than for medium and small contractors. The highest average maximum WTP value is RM88.00 for Group A (large contractors) RM78.25 for Group B (medium-size contractors) and RM55.80 for Group C (small contractors). One of the contributions of this study is to highlight the difference of CIDB registration grade in the WTP for improved construction waste management. It is found that contractors' WTP for improved waste collection and disposal services increases with the increase in contractors' current paid up capital. The identified factors and determinants of the WTP will assist the formulation of appropriate policies in addressing the construction waste problem in Malaysia and indirectly improve the quality of construction in the country.
MeSH terms: Attitude*; Construction Materials*; Facility Design and Construction/economics*; Humans; Industrial Waste*; Malaysia; Surveys and Questionnaires; Waste Management/economics*
Parotid abscess is an uncommon complication of suppurative infection of the parotid gland parenchyma, commonly bacterial or viral. Ductal ectasis, primary parenchymal involvement, or infection of the intraparotid or periparotid lymph nodes can result in abscess formation. Parotid abscess may arise from ductal ectasis, primary parenchymal involvement, or infection of the subcapsular lymph nodes. The operative records for all the patients who underwent surgeries in the Department of Otorhinolaryngology, Head and Neck Surgery of the National University Hospital, Kuala Lumpur, Malaysia between January 2001 and December 2005 were retrospectively reviewed. Our case series comprises 15 patients, with 10 males and five females with a median age at presentation of 51 years old. Diabetes mellitus is a significant comorbid factor, with six patients being diabetics. Among the diabetics, two patients presented with facial nerve palsy and one of them also died due to overwhelming septicaemia. Here, we discuss the presenting symptoms, predisposing factors, investigations, microbiology and complications of this condition.
Stones in the biliary tract are routinely identified using MRCP (magnetic resonance cholangiopancreatography). The noisy nature of the images, as well as varying intensity, size and location of the stones, defeat most automatic detection algorithms, making computer-aided diagnosis difficult. This paper proposes a multi-stage segment-based scheme for semi-automated detection of choledocholithiasis and cholelithiasis in the MRCP images, producing good performance in tests, differentiating them from "normal" MRCP images. With the high success rate of over 90%, refinement of the scheme could be applicable in the clinical environment as a tool in aiding diagnosis, with possible applications in telemedicine.
Since 2003, highly pathogenic A(H5N1) influenza viruses have been the cause of large-scale death in poultry and the subsequent infection and death of over 140 humans. A group of 55 influenza A(H5N1) viruses isolated from various regions of South East Asia between 2004 and 2006 were tested for their susceptibility to the anti-influenza drugs the neuraminidase inhibitors and adamantanes. The majority of strains were found to be fully sensitive to the neuraminidase inhibitors oseltamivir carboxylate, zanamivir and peramivir; however two strains demonstrated increased IC50 values. Sequence analysis of these strains revealed mutations in the normally highly conserved residues 116 and 117 of the N1 neuraminidase. Sequence analysis of the M2 gene showed that all of the A(H5N1) viruses from Vietnam, Malaysia and Cambodia contained mutations (L26I and S31N) associated with resistance to the adamantane drugs (rimantadine and amantadine), while strains from Indonesia were found to be a mix of both adamantane resistant (S31N) and sensitive viruses. None of the A(H5N1) viruses from Myanmar contained mutations known to confer adamantane resistance. These results support the use of neuraminidase inhibitors as the most appropriate class of antiviral drug to prevent or treat human A(H5N1) virus infections.
MeSH terms: Amantadine/analogs & derivatives*; Amantadine/pharmacology; Animals; Antiviral Agents/pharmacology*; Base Sequence; Birds; Cyclopentanes/pharmacology; Enzyme Inhibitors/pharmacology*; Influenza in Birds/virology*; Guanidines/pharmacology; Humans; Influenza, Human/virology*; Neuraminidase/antagonists & inhibitors*; Neuraminidase/genetics; Drug Resistance, Viral; Influenza A Virus, H5N1 Subtype/drug effects*; Influenza A Virus, H5N1 Subtype/genetics; Influenza A Virus, H5N1 Subtype/isolation & purification; Oseltamivir/pharmacology; Zanamivir/pharmacology
Tannery waste is categorized as toxic and hazardous in Malaysia due to its high content of Cr (in excess of 500 mg/kg) and other heavy metals. Heavy metals, when in high enough concentrations, have the potential to be both phytotoxic and zootoxic. Heavy metals are found as contaminants in tannery sludge. This investigation aimed to identify the fate of chromium, cadmium, copper, lead, and zinc concentrations in tannery sludge throughout a 50-day composting cycle. The results of this study showed a general increase in the removal of Cr, Cd, Pb, and to a much smaller extent Zn and Cu, manifested by a decrease in their overall concentrations within the solid fraction of the final product (the decreases were likely the result of leaching). Furthermore, in using a sequential extraction method for sludge composting at different phases of treatment, a large proportion of the heavy metals were found to be associated to the residual fraction (70-80%) and fractions more resistant to extraction, X-NaOH, X-EDTA, X-HNO3 (12-29%). Less than 2% of the metals were bound to bioavailable fractions X-(KNO3+H2O).
Chloroquine (CQ) and mefloquine (MQ) are no longer potent antimalarial drugs due to the emergence of resistant Plasmodium falciparum. Combination therapy has become the standard for many regimes in overcoming drug resistance. Roxithromycin (ROM), a known p-glycoprotein inhibitor, is reported to have antimalarial activity and it is hoped it will potentiate the effects of both CQ/MQ and reverse CQ/MQ-resistance. We assayed the effects of CQ and MQ individually and in combination with ROM on synchronized P. falciparum (Dd2 strain) cultures. The IC(50) values of CQ and MQ were 60.0+/-5.0 and 16.0+/-3.0 ng/ml; these were decreased substantially when combined with ROM. Isobolograms indicate that CQ-ROM combinations were relatively more synergistic (mean FICI 0.70) than MQ-ROM (mean FICI 0.85) with their synergistic effect at par with CQ-verapamil (VRP) (mean FICI 0.64) and MQ-VRP (mean FICI 0.60) combinations. We conclude that ROM potentiates the CQ/MQ response on multidrug-resistant P. falciparum.
Among the various biomaterials available for tissue engineering and therapeutic applications, microbial polyhydroxyalkanoates offer the most diverse range of thermal and mechanical properties. In this study, the biocompatibility of poly(3-hydroxybutyrate-co-4-hydroxybutyrate) [P(3HB-co-4HB); containing 50 mol % of 4-hydroxybutyrate] copolymer produced by Delftia acidovorans was evaluated. The cytotoxicity, mode of cell death, and genotoxicity of P(3HB-co-4HB) extract against V79 and L929 fibroblast cells were assessed using MTT assay, acridine orange/propidium iodide staining, and alkaline comet assay, respectively. Our results demonstrate that P(3HB-co-4HB) treated on both cell lines were comparable with clinically-used Polyglactin 910, where more than 60% of viable cells were observed following 72-h treatment at 200 mg/mL. Further morphological investigation on the mode of cell death showed an increase in apoptotic cells in a time-dependent manner in both cell lines. On the other hand, P(3HB-co-4HB) at 200 mg/mL showed no genotoxic effects as determined by alkaline comet assay following 72-h treatment. In conclusion, our study indicated that P(3HB-co-4HB) compounds showed good biocompatibility in fibroblast cells suggesting that it has potential to be used for future medical applications.
The 3D ultrasound systems produce much better reproductions than 2D ultrasound, but their prohibitively high cost deprives many less affluent organization this benefit. This paper proposes using the conventional 2D ultrasound equipment readily available in most hospitals, along with a single conventional digital camera, to construct 3D ultrasound images. The proposed system applies computer vision to extract position information of the ultrasound probe while the scanning takes place. The probe, calibrated in order to calculate the offset of the ultrasound scan from the position of the marker attached to it, is used to scan a number of geometrical objects. Using the proposed system, the 3D volumes of the objects were successfully reconstructed. The system was tested in clinical situations where human body parts were scanned. The results presented, and confirmed by medical staff, are very encouraging for cost-effective implementation of computer-aided 3D ultrasound using a simple setup with 2D ultrasound equipment and a conventional digital camera.
Hydrogen peroxide (H(2)O(2)) contributes in the regulation of vascular tone, especially in pathological states. The role of H(2)O(2) and superoxide anion free radicals in angiotensin II (Ang II)-induced contraction of diabetic tissues was examined with the aim of elucidating the underlying mechanisms. Isometric tension in response to various drug treatments was measured in isolated superior mesenteric arteries of streptozotocin (STZ)-induced diabetic WKY rats using the Mulvany wire myograph. Compared to the normal (euglycaemic) arteries, the Ang II-induced contraction was significantly reduced in diabetic arteries. Superoxide dismutase (SOD; converts superoxide to H(2)O(2)) significantly reduced the contraction in both types of arteries -- an effect abolished by catalase (H(2)O(2) scavenger), suggesting that the SOD effect was mediated by H(2)O(2). Treatment with catalase had no effect on the Ang II contraction in euglycaemic arteries, but it raised the contraction in diabetic arteries to euglycaemic levels. This increase was similar to that observed with diabetic arteries incubated with L-NAME. Combined catalase and L-NAME treatment further enhanced the contraction in diabetic arteries, suggesting that the catalase effect was not mediated by nitric oxide (NO). The catalase effect was abolished by indomethacin treatment. These results suggest that attenuation of Ang II-induced contraction in diabetic tissues is modulated by endogenous H(2)O(2), the scavenging of which unmasks an indomethacin-sensitive (and therefore cyclooxygenase product-mediated) Ang II-induced contraction.
A group of 31 rabies viruses (RABVs), recovered primarily from dogs, one deer and one human case, were collected from various areas in China between 1989 and 2006. Complete G gene sequences determined for these isolates indicated identities of nucleotide and amino acid sequences of >or=87% and 93.8%, respectively. Phylogenetic analysis of these and some additional Chinese isolates clearly supported the placement of all Chinese viruses in Lyssavirus genotype 1 and divided all Chinese isolates between four distinct groups (I-IV). Several variants identified within the most commonly encountered group I were distributed according to their geographical origins. A comparison of representative Chinese viruses with other isolates retrieved world-wide indicated a close evolutionary relationship between China group I and II viruses and those of Indonesia while China group III viruses formed an outlying branch to variants from Malaysia and Thailand. China group IV viruses were closely related to several vaccine strains. The predicted glycoprotein sequences of these RABVs variants are presented and discussed with respect to the utility of the anti-rabies biologicals currently employed in China.
Premature ejaculation (PE) is a common sexual dysfunction among the general population. PE has often been associated with a psychological state of mind. Hospital Anxiety and Depression Scale (HADS) can be used as an instrument to assess the emotional and psychological state. The present study was designed to assess the reliability and validity of the HADS in a Malaysian population. The validity and reliability were studied in subjects with and without PE. Test-retest methodology was used to assess the reliability whereas Cronbach's alpha was used to assess the internal consistency. In the control and the PE groups, the internal consistency was good and a high degree of internal consistency was observed for all 14 items. In the control group, the Cronbach's alpha values at baseline were from 0.811 to 0.834, whereas for retest, the Cronbach's alpha values were from 0.821-0.838 items. Intraclass correlation coefficient (ICC) was high for the control (0.797-0.868: baseline and 0.805-0.872: retest) and PE group (0.822-0.906: baseline and 0.785-0.887: retest). The high value of ICC and the internal consistency was due to high reliability and consistency of the items at 2-week interval. A degree of significance between the baseline and week-2 scores was observed across all items in the PE group but not in the control group. The HADS is a suitable, reliable, valid and sensitive instrument to measure the clinical change for anxiety and depression in the Malaysian population.
MeSH terms: Adult; Anxiety/diagnosis*; Depression/diagnosis*; Ejaculation; Humans; Male; Middle Aged; Personality Inventory/standards*; Psychometrics/standards*; Sexual Dysfunction, Physiological/psychology*; Reproducibility of Results