Response Surface Methodology (RSM) with Central Composite Rotatable Design (CCRD) was performed in this study to develop an acceptable reduced calorie chocolate cake. The range of the independent variables, namely Jackfruit Seed (JFS) flour (20-25% replacement of wheat flour) and polydextrose (10-15% replacement of sucrose) were identified which affect the volume, specific volume, symmetry and uniformity of the chocolate cake. The coefficient of determination, R2 values for volume, specific volume, symmetry and uniformity were greater than 0.900. The optimum level for replacement of sugar with polydextrose was at 11% and wheat flour with JFS flour was at 16% with calorie reduction approximately 34% from the control cake formulation.
Evaluation of pre-qualifying interprofessional education (IPE) programmes is important in exploring its effectiveness. The University of the West of England Interprofessional Questionnaire (UWE IPQ) has been rigorously validated, yet few studies using this tool have been published. We aimed to explore the attitudes of final year allied health profession (AHP), midwifery and nursing students towards IPE in this study. Differences between students’ attitudes towards IPE according to gender, undergraduate programmes, academic background and experience were also explored. A total of 103 participants, AHP (n = 10), midwifery (n = 19) and nursing (n = 74) students took part in the study. This study design used a cross-sectional questionnaire survey, and was conducted within the Faculty of Health Sciences, University of Southampton. The validated UWE IPQ was administered to a volunteer sample of final year AHP, nursing and midwifery students in June 2010. Findings revealed that majority of the students rated their communication and teamwork skills (76.7%), interprofessional learning (74.8%) and interprofessional relationships (92.2%) positively, but they held negative attitudes towards interprofessional interactions (69.9%). Significant differences were found between participants’ attitudes towards interprofessional learning in relation to undergraduate programmes (p = 0.01) and prior working experience in health and social care (p = 0.03). IPE has shaped the students’ views regarding their collaborative learning and teamwork. Therefore, introducing IPE initiative from the beginning of the pre-qualifying stage at universities would motivate them to become interprofessional collaborative-ready professionals.
Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.
The EQ-5D is a quality of life instrument that measures five dimensions of health. This study investigated the reliability and validity of its use in the Malaysian dialysis population. Test-retest reliability, convergent and discriminant validity were assessed. Responses of 86 subjects who completed both surveys were used in analysis. Test-retest reliability using Cohen's kappa was acceptable in four out of five dimensions, with the exception of self-care. Convergent validity was present. Discriminant validity was found in only two out of six hypotheses tested. In conclusion, the EQ-5D has potential in this population but further study is required.
We hereby present a case of planned complex suicide. In this case study, we report a teen-aged girl who committed suicide by strangulating herself, and subsequently fell from the 13th floor of a housing apartment. The planned complex suicide was substantiated by the presence of a suicide note and a photograph captured in a mobile handset. To the best of our knowledge, it is the first case involving self-strangulation and fall from height, in which the photograph was stored in the handset. This is to further emphasize that objects like mobile handsets can be important in determining the cause and manner of death. The available evidence at the site of incident should be explored meticulously in order to arrive at a proper conclusion.
The single emulsion or single screen system is usually reserved for mammography since its use in general radiography is limited. The purpose of this study is to compare the mammographic film-screen combination (MFC) and the standard film-screen combination (SFC) in terms of fracture and soft tissue injuries detection. PATIENTS, METHODS AND MATERIALS: In this prospective study, 41 patients from Accident and Emergency suspected of having injury in the hands, wrists, ankles and feet regions were radiographed using both MFC and SFC. These were compared in terms of image quality, presence of fractures and soft tissue injuries. The two different film-screen combinations were also compared in terms of detection of bony fragments, film characteristics such as film speed, contrast and spatial resolution, dose and cost.
Magnetic resonance imaging is gaining importance in the diagnosis of nerve and muscular disorders. The ability of magnetic resonance imaging to delineate the different muscles and the nerve in any plane has made the differentiation between the changes of neuropathy, denervation, and nerve entrapment possible. Although findings on magnetic resonance imaging are non-specific, their use, coupled with clinical symptoms and electromyographic findings, allow an accurate diagnosis to be made without resorting to invasive biopsies.
83 Malays with HbE beta-thalassaemia who were not transfusion dependent were investigated. 79 persons showed no beta0 formation indicating the predominant gene in Malays with HbE beta-thalassaemia was beta0. HbF assays showed levels that were similar to transfusion dependent patients. Further studies are necessary to determine the presence of the alpha, (alpha+) gene Interacting with HbE and beta0 to produce the milder phenotype of HbE beta-thalassaemla.
Immunoglobulin G, A and M levels were determined in paired maternal and cord sera of premature, full term and postmature newborns of urban dwelling Chinese, Indian, Malay and full term newborn of the forest dwelling Orang Asli (Malaysian aborigines). The mean serum IgC level in the full term Orang Asli newborns (1254±441 mg per 100 mil is comparable to that of the Indians (1211±282 mg per 100 ml) and Malays (1169±286 mg per 100 ml) but these levels are higher than those of the Chinese
newborns (1092±270 mg per 100 ml). Statistical analysis indicates a significant dependence of cord serum IgG level on maternal serum IgG level in the . Chinese, Indians and Malays. In addition, in Indians the cord serum IgG was significantly dependent at 5% level on the gestation age. The fetomaternal serum IgG level ratios at term were equal to or just less than one. The cord serum IgM levels of the Chinese, Indian, Malay and Orang Asli newborns at term were 11.6.±. 6.5, 12.5.±. 7.3, 10.9.±. 5.8 and
16.7±6.9 mg per 100 ml respectively. Statistical analysis showed absence of correlation between cord serum IgM level and birthweight, gestation age or maternal serum IgM level in Chinese and Malays. In Indians the cord sera IgM level showed a dependence on the birthweight. Immunoglobulin A was present in 34.6%, 40.5%, 31.6% and 62.5% of full term Chinese, Indian, Malay and Orang Asli newborns respectively. These observations are discussed in relation to the immunoglobulin levels observed in populations residing in temperate and other tropical regions.
Introduction: Preparation of herbal mixtures from the traditional knowledge has been used for over centuries to im- prove and maintain health condition. Nonetheless, lack of scientific evaluations on regard to their bioactive metab- olites as a mixture and their pharmacological effects have yet to be reported. Therefore, the objectives of this study are 1) to determine the effect of processing techniques (blending and juicing) on extracting polyphenols and 2) to determine the effect ratio of honey in herbal mixture (containing ginger, garlic, honey, apple cider vinegar, and lem- on juice). Methods: Raw ingredients such as garlic, ginger, lemon and apple cider (1:1:1:1) were used as the base for this herbal mixture. The base was either blended using a blender or juiced using a juicer. The mixture was simmered (85oC - 100oC) until reduced to half of the initial volume and cooled down before being added with honey in 1:1 (rA) or 1:3 (rB) ratio. The mixtures were tested for pH, total phenolic, total flavonoid content and alpha glucosidase inhibitory activities. Results: Both of juiced samples in both honey ratio (rA and rB) have lower acidity compared to blended samples. Total phenolic content (TPC) and total flavonoid content (TFC) also showed significantly high- er levels (p
Introduction: The aim of thalassaemia screening is to reduce thalassaemia syndromes with significant clinical implication. Therefore, detection of α0 thalassaemia with two genes deletion is clinically more important than α+ thalassaemia with one gene deletion. The aim of this study is to determine the mean corpuscular haemoglobin (MCH) cut-off point for α0 thalassaemia screening. Method: A total of 688 α0 and α+ thalassaemia cases confirmed by DNA analysis were analysed. Red cell indices (MCV, MCH, RBC, Hb) were retrieved from the laboratory information system. Receiver operating characteristic (ROC) curve is generated to determine the MCH cut-off point for α0 thalassaemia. The diagnostic performance of MCH cut-off value was evaluated with a validation group comprising 100 samples of alpha thalassaemia carriers. Results: ROC curve analysis with area under the curve (AUC) of 0.969 showed that MCH at cut-off of 23.5pg has high sensitivity and specificity in detecting α0 thalassaemia with 98% sensitivity and 85% specificity. Conclusion: MCH cut-off value of 23.5pg can be adopted as the cut-off point for α0 thalassaemia screening to detect clinically significant thalassaemia syndrome and reduce cost and burden of screening.
Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk
singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s
classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate
patterns were found to be associated with neonatal acidosis.
Central corneal thickness plays a major role in the management of many types of glaucoma. Therefore, our aim is to determine the relationship between the severity of glaucoma measured by optical coherence tomography (OCT) and central corneal thickness (CCT) among normal tension and high tension glaucoma patients. This is an observational cross sectional study on 190 patients carried out in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Three groups of patients were identified; 60 normal tension glaucoma (NTG), 61 primary open angle glaucoma (POAG) and 69 control. Patients were identified based on the glaucomatous visual field changes and previous record of intraocular pressure before treatment. Visual acuity and intraocular pressure measurements were recorded. Specular microscope was used to measure the CCT and the severity of glaucoma was evaluated objectively based on the retinal nerve fibre layer (RNFL) thickness using optical coherence tomography. Results showed NTG patients had significantly thinner cornea, 503.07±32.27µm compared to the control group, 517.45±31.74 µm (p=0.012).
However, there was no significant difference between the CCT of POAG and NTG groups (p=0.386).Retinal nerve fibre layer (RNFL) thickness was significantly different between the glaucoma and the control groups (p
A 42-year-old Malay gentleman presented with progressive painless blurring of vision on his left eye associated with ocular ache, redness and increasing proptosis. Examination revealed presence of relative afferent papillary defect with visual acuity of counting finger, and 6/6 on the right eye. Extraocular muscle movement of the left eye was restricted to ten percent in all directions. Computed tomography (CT) and magnetic resonance imaging (MRI) showed enhancing mass occupying the left orbital apex. Diagnosis of optic nerve sheath meningioma was made, and patient subsequently went for radiotherapy. His symptoms subsided completely, until he presented with similar visual complains, and fullness of the upper lid two years later. A repeated MRI showed enlargement of superior and lateral recti muscles with extension to lacrimal gland region. Biopsy of the lacrimal gland revealed inflammatory cells consistent of inflammatory pseudotumor. High dose systemic steroid was instituted, followed by slow tapering of oral steroid. His symptoms completely resolved, and latest visual acuity was 6/9, with no recurrence, to date.
The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.
Study site: Physiotherapy department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and University Malaya Medical Centre (UMMC)
Milk lipids play an important role in the early nutrition of an infant's life. A study was undertaken to investigate the total lipid content of milk obtained from urban, exclusively breastfeeding Malaysian mothers offill term infants. Results from approximately 600 samples analysed using a commercial kit [MerckotestO] , showed that the total lipid concentration was lowest in colostrum [1.9 + 0.1 g/dl J, however this value increased gradually with days of lactation and attained a maximum concentration of 3.1 ± 0.1 g/dl during the mature milk stage. This agrees with results from other studies that the total lipid content is indeed influenced by the stage of lactation. The effect of socioeconomic factors such as income and parity on the milk lipids was also investi-gated and the results revealed that the above factors had no significant influence on the total lipid content of Malaysian mother 's milk obtained during all three stages of lactation studied [colostrum, transitional and mature milk] . However; ethnicity showed significant influence during the mature but not in the early [colostrum and transitional] stage of lactation. This however, is not filly explained by this study. As a whole, this study suggests that the human breast, through a mechanism that is ill understood, maintains cm optimal level of total lipid in milk despite their differing cultural and genetic background. It is hoped that such scientific evidence will instil more confidence among breastfeeding mothers in this fast developing cosmopolitan nation.
A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.
This study was undertaken to evaluate the antioxidant and acetylcholinesterase inhibition properties of stems and leaves of hexane and methanolic extracts of Pluchea indica. Methanolic extract of leaves showed the highest antioxidant activity (IC50 = 24.45 ± 0.34 µg/ml) and total phenolic contents (573.52 ± 6.2 mg GAE/100 g crude extract), in DPPH radical scavenging and Folin-Ciocalteu assays respectively, however, it failed to inhibit acetylcholinesterase in TLC bioautographic detection. The rest of plant extracts, including methanolic extract of stems, hexane extract of both leaves and stems, were detected to have acetylcholinesterase inhibitory properties. Hexane extract of both leaves and stems exhibited lower or negligible level of antioxidant activity and phenolic contents. Pluchea indica may provide a potential natural source of bioactive compounds, and maybe beneficial to the human health.