Anaemia in patients on renal replacement therapy is a cornmon problem and response to treatment with erythropoietin may be limited by functiollal iron deficiency. We recently studied prospectively for 22 weeks the effect of iron supplemetltation via intramuscular and oral vs intramuscular vs oral routes in 16 patients on chronic haemodialysis with renal anaenlia treated with erythropoietin injections. The rise in haemoglobin was significant in all patients except those on intramuscular iron only. This study supports unconfirmed observations that oral iron supplementation may be effective in patients with renal anaemia associated with functional iron deficiency. KEYWORDS: Renal, Anaemia, Erythropoietin, Iron deficiency, Oral, Parenteral.
Safety is vital in any industry, including the offshore sector, which is classified as a major hazard industry. Health, Safety and the Environment (HSE) identified that the probability of accidents is high while working on the offshore sectors where it will exposed workers to many hazardous work activities. The appropriate measures to prevent accident in this sectors must be laid out clearly. This paper is to identify the effectiveness of safety awareness campaign and the continuity of the awareness among the workers to prevent injuries at offshore. To achieve this, we have identified the level of awareness and propose a guideline on areas of improvement. Prior of embarking to offshore, staff were exposed to safety awareness program for four weeks. After the program, we started with the pretest to all staff. They were posted offshore for 6 weeks. Within the period, the performance awareness of each staff is monitored through observation and interview. During the final week, the posttest questionnaire were administered to all staff. Two instruments were used for the quantitative data collection, which are Unsafe Act Unsafe Condition (UAUC) card; and Behavior Observation Tool (BOT) card. Questionnaire data were analyzed quantitatively. Paired-sample t-test was used for analyzing pre and post result. The results show that the mean was increased. Recent studies on the safety briefing highlighted several significant changes in terms of employee understanding toward safety. Safety awareness training has been introduced in the new safety briefing prior to offshore mobilization.
We describe a rare encounte.r with a 6-year old Indian boy admitted with acute epiglottitis due to Haemophilus influenzae. Acute epiglottitis is an uncommon cause of lifethreatening upper airway obstruction and a rare presentation of invasive Haemophilus influenzae type b (Hib) disease in this region, compared to Ihe more developed West. The cause for this observation is often attributed to differences in the genetic predisposition and socio-economk parameters. The organism subtype and the host response have been shown to determine the type of invasive Hib disease. However, the evidence to explain this difference is poorly understood and remains an intriguing enigma. KEYWORDS: Epiglottitis, Haemophilus influenzae
Successful or unsuccessful female transfers were observed seven times during a 32-month field study of proboscis monkeys (Nasalis larvatus) inhabiting a riverine forest along a tributary of the Kinabatangan River, Sabah, Malaysia. In all cases, the females voluntarily left their own groups and immediately joined with another one. When adult females tried to shift to other groups, adult males called them back to their own groups, but appeared to be indifferent to subadult females. When the adult females returned, the males never attacked the females physically, but instead often emitted herding sounds to them. One subadult female was repelled by a resident adult female. When one adult female transferred into a new one-male group, she left her behind son in an all-male group. The number of females often fluctuated in most study groups, with this fluctuation being more prominent among subadult females than adult females. It is likely that female transfer in proboscis monkeys is not a rare occurrence and that it is especially common among sub-adult females.
1. 1. The results of various studies by other workers on the spleen and parasite rates in Indians, Malays and Bantu are summarized. 2. 2. The results of our own observations on Khonds in India, and on Masai and Bantu in East Africa are also summarized and compared with the foregoing and with one another. 3. 3. It is pointed out that wide differences may be found in the malarial status of communities in the same country and, in the case of the Bantu, of the same race; while close similarities occur in different countries. 4. 4. The results of experimental infections in birds and monkeys are cited and interpreted in terms of the two states of allergy and immunity. The probable significance of these is illustrated by reference to the role of the two states in tuberculosis. 5. 5. It is suggested that the observed contrasts in the spleen and parasite rates in diverse communities may also be explained in terms of immunity and hypersensitivity. 6. 6. It is concluded that the immune status is dependent not on race but on the frequency of infection; and that the most accurate index of endemicity is the frequency of infections in the non-immune, that is the rate in early infancy. 7. 7. While a consideration of the Spleen Rate and Endemic Index may be of value in forming an estimate of endemicity and immunity when similar communities are being compared, these indices may be misleading when the epidemiological surroundings are dissimilar. 8. 8. A consideration of the variation with age in the spleen and parasite rates throws more light on endemicity and immunity and on such variation a rough classification may be made into immune and sub-immune communities. 9. 9. But it is suggested that by far the most sensitive index at present available for field studies is the average parasite count, and its variation with age. c 1937.
Hypertensive disorders of pregnancy is a major cause of fetal and maternal morbidity. Epidemiologic observations have shown an inverse association between calcium intake and incidence of eclampsia. Calcium supplementation has been reported to decrease blood pressure in pregnant women, although this remains controversial. The mechanism responsible for the effect of calcium on hypertinsion in pregnant women is unknown. This paper is a review of some of the recent calcium supplementation trials that have been carried out and their effectiveness in reducing systolic and diastolic blood pressure and decreasing the incidence of hypertensive disorders of pregnancy.
Objectives: As advancing evidence on modifiable resources to support mental health in persons experiencing physical disabilities is of particular importance, we investigate whether structural and functional social relationships relate to mental health in people with spinal cord injury (SCI). Methods: Data from 12,330 participants of the International SCI community survey (InSCI) from 22 countries were analyzed. Structural (partnership status, living situation) and functional aspects of social relationships (belongingness, relationship satisfaction, problems with social interactions) were regressed on the SF-36 mental health index (MHI-5), stratified by countries and for the total sample using multilevel models. Results: Functional aspects of social relationships were consistently related to clinically relevant higher MHI-5 scores and lower risk of mental health disorders (MHI-5 >56). Structural social relationships were inconsistently associated with mental health in our sample. Conclusion: This study provides evidence that functional aspects of social relationships are important resources for mental health. Interventions to establish and maintain high quality relationships should be considered in public health interventions and rehabilitation programs to reduce long-term mental health problems in persons experiencing physical disabilities.
Although the role of primates in seed dispersal is generally well recognized, this is not the case for colobines, which are widely distributed in Asian and African tropical forests. Colobines consume leaves, seeds and fruits, usually unripe. A group of proboscis monkeys (Colobinae, Nasalis larvatus) consisting of 1 alpha-male, 6 adult females and several immatures, was observed from May 2005 to May 2006. A total of 400 fecal samples from focal group members covering 13 months were examined, with over 3500 h of focal observation data on the group members in a forest along the Menanggul River, Sabah, Malaysia. Intact small seeds were only found in 23 of 71 samples in Nov 2005, 15 of 38 in Dec 2005 and 5 of 21 in Mar 2006. Seeds of Ficus (all <1.5 mm in length) were found in all 3 months and seeds from Antidesma thwaitesianum (all <3 mm) and Nauclea subdita (all <2 mm) only in Nov and Dec, which was consistent with members of the study group consuming fruits of these species mostly at these times. To our knowledge, these are the first records of seeds in the fecal samples of colobines. Even if colobines pass relatively few seeds intact, their high abundance and biomass could make them quantitatively significant in seed dispersal. The potential role of colobines as seed dispersers should be considered by colobine researchers.
We observed the diet and activity of Bornean orangutans (Pongo pygmaeus morio) in the primary lowland dipterocarp forests of Danum Valley, Sabah, Malaysia, during 2005-2007, including two mast fruitings. We collected 1,785 hr of focal data on 26 orangutans. We identified 1,466 samples of their food plants and conducted a fallen fruit census to monitor fruit availability in the study area. Their activity budget was 47.2% feeding, 34.4% resting, and 16.9% traveling. Fruits accounted for the largest part (60.9%) of feeding time, especially during mast fruiting periods (64.0-100%), although the percentages of leaves (22.2%) and bark (12.3%) were higher than those reported for P. abelii and P. pygmaeus wurmbii. Although 119 genera and 160 plant species were consumed by focal animals, only 9 genera accounted for more than 3% of feeding time (total: 67.8% for 9 genera). In particular, the focal orangutans fed intensively on Ficus and Spatholobus during most of the study period, especially in periods of fruit shortage. The percentage of fruit feeding changed markedly from 11.7 to 100% across different months of the year, and was positively correlated with the amount of fallen fruit. When fruit feeding and availability decreased, orangutans fed primarily on leaves of Spatholobus and Ficus, and the bark of Spatholobus and dipterocarp. The percentage of time devoted to feeding during mast fruitings, when the orangutans foraged almost exclusively on fruits, was lower than during seasons when the orangutan diet included leaves and bark as well as fruits. Resting increased as feeding decreased in the late stage of each fruiting season, suggesting that the orangutans adopted an energy-minimizing strategy to survive the periods of fruit shortage by using energy stored during the fruit season.
Combining feeding appendage morphology and behavioural observation of the motion pattern of the feeding appendages clarified many aspects underlying the feeding processes of the giant freshwater prawn (Macrobrachium rosenbergii) and the marine whiteleg shrimp (Litopenaeus vannamei) in aquaria. The food intake behaviour was video recorded during eating pellet food, and pieces of fresh squid and fish. While M. rosenbergiitook pellet one by one, L. vannamei picked up many pellets at one time and held them at the mouth with the 3rd maxilliped endopods and the 1st walking legs. Both species used the right chelate walking legs rather than the left walking legs to pick up the food. The 3rd walking legs of L. vannameiwere longest and heaviest among the chelate walking legs but their major role was not for feeding but for feeding contests often in the form of aggression. While M. rosenbergii easily crunched pellets by the mandibles, L. vannamei did not crunch pellets due to the softer and not so strong mandibles and frequently spat out them, indicating that the present hard pellets are not suitable for L. vannamei. Both the species kept a piece of elastic fresh squid or fish flesh at the mouth and tore the food into small pieces with the help of repeated pulling down motion of the 3rd maxilliped endopods. However, the mandible teeth of the two spices were not sharp enough to gnaw off the fibrous muscle in one bite. The 2nd and 3rd maxilliped endopods were used for holding food at the mouth and did not contribute to mastication of food. The 2nd and 3rd maxilliped exopods exhibited the horizontal fanning motion, which caused a unidirectional water flow moving backwards in the gill chamber (visualized with milk). The maxilliped exopods were found to contribute not to feeding but ventilation. Based on the results obtained, development of softer pellets was recommended for L. vannamei.
OBJECTIVE: Safety of fasting in Ramadan for diabetic patients is not clearly known. The aim of this study was to determine the effects of fasting on glycemic excursions by continuous glucose monitoring system (CGMS).
MATERIALS AND METHODS: This pilot, observational study conducted in the Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, IRAN, in Ramadan 2008. Seventeen well controlled patients with diabetes type 2 who were taking oral agents underwent 72 hour monitoring of glycemic excursions by CGMS one month before Ramadan and during Ramadan. The extent and duration of hyperglycemic and hypoglycemic events were evaluated and compared.
RESULTS: A significant reduction in hyperglycemic events was observed during Ramadan. The extent and duration of hypoglycemic events was not significantly different between two states (Ramadan and before). A significant increase in number of hypoglycemic events in Ramadan was found in patients who take sulfonylurea compared with those who take only metformin.
CONCLUSION: Fasting in Ramadan can be safe for well controlled patients with type 2 diabetes.
Piriformis syndrome is a collection of symptoms and signs of pain from piriformis muscle and is characterized by pain in buttock with variable involvement of sciatic nerve. This syndrome is often overlooked in clinical practice because its presentation has similarities with other spine pathologies. A major problem with the clinical diagnosis of piriformis syndrome is the lack of consistent objective findings and an absence of single test that is specific for piriformis syndrome. Therefore, a precise and reliable clinical method of diagnosing piriformis syndrome should be developed by clinicians.
To perform a cost-effective analysis on the care of infants between 1000 and 1500 g birthweight (the study group), where outcomes are measured as survival to 1 year of age.
Purpose of the research: Epilepsy is a continuous process of neurodegeneration categorized by an enduring tendency to generate uncontrolled electrical firing known as seizures causing involuntary movement all over the body. Cognitive impairment and behavioral disturbances are among the more alarming co-morbidities of epilepsy. Anti-epileptic drugs (AEDs) were found to be successful in controlling epilepsy but are reported to worsen cognitive status in patients. Embelin (EMB) is a benzoquinone derived from the plant Embelia ribes and is reported to have central nervous system (CNS) activity. This study aims to evaluate the effectiveness of EMB against pentylenetetrazole (PTZ) induced acute seizures and its associated cognitive dysfunction. This was done via docking studies as well as evaluating neurotransmitter and gene expression in the zebrafish brain. The principal results: Behavioral observations showed that EMB reduced epileptic seizures and the T-maze study revealed that EMB improved the cognitive function of the fish. The docking study of EMB showed a higher affinity toward gamma-aminobutyric acid (GABAA) receptor as compared to the standard diazepam, raising the possibility of EMB working via the alpha subunit of the GABA receptor. EMB was found to modulate several genes, neurotransmitters, and also neuronal growth, all of which play an important role in improving cognitive status after epileptic seizures. Healthy zebrafish treated with EMB alone were found to have no behavioral and biochemical interference or side effects. The immunohistochemistry data suggested that EMB also promotes neuronal protection and neuronal migration in zebrafish brains. Major Conclusions: It was perceived that EMB suppresses seizure-like behavior via GABAA receptor pathway and has a positive impact on cognitive functions. The observed effect was supported by docking study, T-maze behavior, neurotransmitter and gene expression levels, and immunohistology study. The apparatus such as the T-maze and seizure scoring behavior tank were found to be a straightforward technique to score seizure and test learning ability after acute epileptic seizures. These research findings suggest that EMB could be a promising molecule for epilepsy induced learning and memory dysfunction.
Diopatra claparedii which is colloquially known as Ruat Sarung can be found along the west coast of Peninsular Malaysia. The species has a unique ability to regenerate anterior and posterior segments upon self-amputation or injury, thus having potential as a wound healing promoter. In this study, the wound healing potential of D. claparedii aqueous extract on acute wound model in rats was revealed for the first time. Various concentrations (0.1%, 0.5%, and 1.0% w/w) of D. claparedii ointment were formulated and tested on Sprague Dawley rats through topical application on full-thickness skin wounds for 14 days. The wound healing effects were investigated via behaviour observation, wound contraction, and histopathological analysis. Quality assessment was performed via skin irritation test, microbial contamination test (MCT), and heavy metal detection. The study also included test for antibacterial activities and detection of bioactive compounds in D. claparedii. One percent of D. claparedii ointment showed rapid wound healing potential with good soothing effects and more collagen deposition in comparison to the commercial wound healing ointments such as acriflavine (0.1% w/v) and traditional ointment gamat (sea cucumber extract) (15.0% w/v). No local skin irritation, microbial contamination, and insignificant concentration of heavy metals were observed, which indicate its safe application. Moreover, the aqueous extract of D. claparedii exhibited antibacterial activities against Escherichia coli and Pseudomonas aeruginosa with minimum inhibitory concentration (MIC) value at 0.4 g/ml. 1H NMR analysis of the aqueous extract of D. claparedii revealed some metabolites that might be responsible for its wound healing properties such as amino acids, halogenated aromatics, organic acids, vitamins, and others. Altogether, these results suggested that the aqueous extract of D. claparedii could be utilised as an alternative natural wound healing promoter.
The aim of this study was to: (1) determine the prevalence and patterns of lung dysfunction among transfusion dependent thalassemics; (2) determine the associated factors that might contribute to this problem. This was a cross-sectional study involving 66 patients with transfusion dependent thalassemia aged 10 years and above. All patients underwent physical examination, standardized pulmonary function tests including spirometry, lung volume, and the carbon monoxide diffusion capacity. A restrictive pattern of lung dysfunction was observed in 22 patients (33.3%) and none showed the presence of obstructive ventilatory impairment. A reduction in the carbon monoxide diffusion capacity (DLCO) was seen 87.9% of the patients, including 7.6% who had evidence of hypoxemia. Ten patients showed a reduction in the FEF25-75% although they did not fulfil the criteria for small airway disease. No correlation was found between lung dysfunction and serum ferritin levels in the patients. Restrictive lung dysfunction and diffusion impairment were the predominant abnormalities found in our cohort of patients.
Study site: Thalassemia clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants.
Methods: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy.
Results: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors.
Conclusion: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.
Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.