Internuclear Ophthalmoplegia (INO) is an inability of the ipsilateral adduction with a contralateral horizontal abducting saccade on attempted gaze to the contra-lesion side. Injury to the medial longitudinal fasciculus (MLF) will obstruct the signalling pathway between the ipsilateral abducens nucleus and the contralateral medial rectus muscle. Infarction accounts for 38% of INO cases with mostly being unilateral (87%), followed by demyelination (34%), which mostly being bilateral (73%). Lacunar infarct is the most common ischemic stroke. INO can be easily missed due to its subtle presentation with no complaints from the patients. A full cranial nerves assessment, includes the extraocular muscles movement, is important. Ischemic and demyelinating INO typically recover. We present here of a case of INO following right lacunar infarct in a 72-year-old Malay woman. She had hypertensive crisis due to missed medications. Her blood pressure was well controlled throughout the hospital admission and finally she was discharged home with continuation of care at her primary facility.
Asthma is one of the chronic and long-term diseases of the airways. It is characterized by reversible airflow obstruction, chest tightness, and dyspnea with decreased work of breathing. The inside airway’s walls are swollen or inflamed. The aim of this study was to determine the effectiveness of active cycle of breathing technique as an airway clearance technique in patients with asthma. The health-related quality of life and functional capacity of patients was measured using a standardized airway questionnaire (AQ20) and six-minute walk test. The study was cohort design included 38 patients (mean age 41.131±14.711) of both genders with mild to moderate asthma. Each patient received multiple sessions (3 times/week for one month) of active cycle of breathing technique. Pre and post-treatment measures were recorded for functional capacity and health-related quality of life in the form of six-minute walk test and standardized airway questionnaire. All 38 patients were stable during the study period. The health-related quality of life and functional capacity of patient significantly improved post-treatment sessions with means [205.375±93.594 for week 1, 1248.719±112.187 for week 2, 306.429±140.5554 for week 3, 337.245±134.389 for week 4], for six-minute wall test and mean difference 4.13± 2.3 SD for standardized airway questionnaire with p-value (0.00) significant upon paired t-test. It is concluded that the active cycle of breathing technique is very beneficial intervention for improving quality of life and functional capacity of patients with mild to moderate asthma. Further, investigations are required to explore efficiency of ABCT as a tool for cardio-pulmonary rehabilitation.
The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery.
This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl.
The presentation and management of psoas abscess was studied prospectively in 5 patients and retrospectively in 4. 3 patients had bilateral abscesses. All patients had back pain and a mass in loin or iliac fossa. 7 patients had no hip findings. One patient had a perinephric abscess and another had radiological features of tuberculosis of the spine. In the other seven no cause for the abscess could be identified. Ultrasonography demonstrated the abscess in all patients; CT scanning done in 5 patients was confirmatory. Drainage was done by an extraperitoneal route. Biopsy of the abscess wall in 2 patients demonstrated tuberculosis. They, the patient with TB spine and 3 others put empirically on anti-tuberculosis chemotherapy responded well. The perinephric abscess grew Pseudomonas sensitive to gentamycin, but she and two other patients died due to multiorgan failure.
This study investigated the prevalence of the Melanocortin receptor 4 (MC4R) V1031 gene variant and its association with obesity among a cohort of 254 patients (101 males; 118 obese) attending the Kampar Health Clinic. Genotyping revealed the mutated I allele frequency of 0.02, no homozygous mutated (II), and similar distribution of V and I alleles across BMI groups, genders and ethnic groups. No significant difference was found for the means of anthropometric measurements between alleles. Prevalence of this gene variant among the Malaysian cohort was similar with previous populations (2-4% of mutated allele carrier), but was not associated with obesity.
Cocoa-specific aroma precursors and methylpyrazines in underfermented cocoa beans obtained from fermentation induced by indigenous carboxypeptidase have been investigated. Fermentation conditions and cocoa bean components were analyzed during 0 to 3 d of fermentation. Underfermented cocoa beans were characterized as having hydrophilic peptides and free hydrophobic amino acids much higher than unfermented ones. These 2 key components of cocoa aroma precursors may be produced from the breakdown of proteins and polypeptides by endogenous carboxypeptidase during the fermentation process. The enzyme was activated during fermentation. Polypeptides of 47, 31, and 19 kDa were observed in the samples throughout the 3-d fermentation period; however, only the first 2 polypeptides were remarkably reduced during fermentation. Since the 1st day of fermentation, underfermented cocoa beans contained methylpyrazines, a dominant group of cocoa-specific aroma. This might be due to microbial activities during fermentation, observed through a decrease of pH value and an increase of temperature of cocoa beans. The concentration of tetramethylpyrazines was significantly increased during the 3 d of fermentation. This may increase the cocoa-specific flavor to the beans.
A photoelectrochemical (PEC) sensor with excellent sensitivity and detection toward copper (II) ions (Cu2+) was developed using a cadmium sulphide-reduced graphene oxide (CdS-rGO) nanocomposite on an indium tin oxide (ITO) surface, with triethanolamine (TEA) used as the sacrificial electron donor. The CdS nanoparticles were initially synthesized via the aerosol-assisted chemical vapor deposition (AACVD) method using cadmium acetate and thiourea as the precursors to Cd2+ and S2-, respectively. Graphene oxide (GO) was then dip-coated onto the CdS electrode and sintered under an argon gas flow (50 mL/min) for the reduction process. The nanostructured CdS was adhered securely to the ITO by a continuous network of rGO that also acted as an avenue to intensify the transfer of electrons from the conduction band of CdS. The photoelectrochemical results indicated that the ITO/CdS-rGO photoelectrode could facilitate broad UV-visible light absorption, which would lead to a higher and steady-state photocurrent response in the presence of TEA in 0.1 M KCl. The photocurrent decreased with an increase in the concentration of Cu2+ ions. The photoelectrode response for Cu2+ ion detection had a linear range of 0.5-120 μM, with a limit of detection (LoD) of 16 nM. The proposed PEC sensor displayed ultra-sensitivity and good selectivity toward Cu2+ ion detection.
Naturally occurring seedlings of Neuwiedia veratrifolia were found in three localities in Sabah, Borneo, Malaysia. Seedlings consisted of an irregular oblong protocorm and a terminal leafy rooted shoot. Protocorms contained mycotrophic tissue of the kind typical of orchid mycorrhiza (tolypophagy). This finding demonstrates an important synapomorphy between Neuwiedia and other orchids and strongly supports the monophyly of Orchidaceae in the broad sense, including apostasiod orchids.
There has been increasing awareness that sexual abuse of children is a problem in Malaysia. Existing data is based on notification of cases. Population based studies are required to plan services for sexually abused children. This study utilized trainee paramedical staff as a community population to determine the prevalence of childhood sexual abuse. An anonymous, self-administered questionnaire was given to student nurses and trainee medical assistants at the Ipoh School of Nursing and Hospital Bahagia Medical Assistant Training School. Questionnaires were distributed directly to all students in a classroom setting and retrieved after a 30-minute interval. Information collected included questions on personal experiences of sexual abuse. Sexual abuse was defined as rape, sodomy, molestation, or exhibitionism occurring to a child less than 18 years of age. Six hundred and sixteen students participated in the study; 6.8% of the students admitted to having been sexually abused in their childhood, 2.1% of males and 8.3% of females. Of those abused, 69% reported sexual abuse involving physical contact, 9.5% of whom experienced sexual intercourse. The age at first abuse was < 10 years in 38.1% of the cases; 59.5% were repeatedly abused and 33.3% had more than one abuser. Of the abusers, 71.4% were known to the respondent, 14.2% of whom were brothers, 24.5% relatives, and 24.5% a family friend. Further, 28.9% of all students knew of an individual who had been sexually abused as a child. While this population may not be entirely reflective of the community, this study does provide an indication of the prevalence of sexual abuse in Malaysian children. The prevalence figures in this study are lower than those reported in industrialized countries and this may reflect local sociocultural limitations in reporting abuse.
All-trans retinoic acid therapy induces maturation in acute promyelocytic leukaemia. We document in vivo evidence of differentiation by all-trans retinoic acid in a case of acute promyelocytic leukaemia which was characterized by cytoplasmic vacuolations.
A comparative effect of propranolol and nifedipine administered individually and in combination at graded dose levels; and that of phenytoin at 30 mg kg-1 on maximal electroshock (MES)-induced seizure in mice was investigated. Propranolol in doses of 10 mg kg-1 and 20 mg kg-1, and nifedipine in doses of 8 mg kg-1 and 16 mg kg-1 significantly modified MES activity. Propranolol (40 mg kg-1), and a combination of propranolol (20 mg kg-1) and nifedipine (8 mg kg-1), produced antiMES activity, which was comparable to that of phenytoin (30 mg kg-1). In mice treated with propranolol and nifedipine combination, the tonic flexor and tonic extensor phase ratios (F/E ratio) were significantly higher than individual drug responses. Our findings suggest that a combination of propranolol and nifedipine has either synergistic or an additive effect in controlling MES-induced seizures in mice.