CW-NET for multitype cell detection and classification in bone marrow examination and mitotic figure examination.

MOTIVATION: Bone marrow (BM) examination is one of the most important indicators in diagnosing hematologic disorders and is typically performed under the microscope via oil-immersion objective lens with a total 100× objective magnification. On the other hand, mitotic detection and identification is critical not only for accurate cancer diagnosis and grading but also for predicting therapy success and survival. Fully automated BM examination and mitotic figure examination from whole-slide images is highly demanded but challenging and poorly explored. First, the complexity and poor reproducibility of microscopic image examination are due to the cell type diversity, delicate intralineage discrepancy within the multitype cell maturation process, cells overlapping, lipid interference and stain variation. Second, manual annotation on whole-slide images is tedious, laborious and subject to intraobserver variability, which causes the supervised information restricted to limited, easily identifiable and scattered cells annotated by humans. Third, when the training data are sparsely labeled, many unlabeled objects of interest are wrongly defined as background, which severely confuses AI learners. RESULTS: This article presents an efficient and fully automatic CW-Net approach to address the three issues mentioned above and demonstrates its superior performance on both BM examination and mitotic figure examination. The experimental results demonstrate the robustness and generalizability of the proposed CW-Net on a large BM WSI dataset with 16 456 annotated cells of 19 BM cell types and a large-scale WSI dataset for mitotic figure assessment with 262 481 annotated cells of five cell types. AVAILABILITY AND IMPLEMENTATION: An online web-based system of the proposed method has been created for demonstration (see https://youtu.be/MRMR25Mls1A).

Psychiatric implications of anti-seizure medications in epileptic population.

BACKGROUND AND OBJECTIVE: Epilepsy is a prevalent neurological disorder that affects a significant number of individuals globally. This condition is associated with a high occurrence of psychiatric comorbidities, which can significantly affect the quality of life of individuals affected. The aim of this study was to investigate the association between antiseizure therapies and the likelihood of psychiatric comorbidities in individuals with epilepsy. METHODOLOGY: Data for this study was gathered from the Neurology referral center in Islamabad, Pakistan. A standardized questionnaire was utilized to gather data from 120 individuals diagnosed with epilepsy. The survey consisted of inquiries regarding the management of seizures, the utilization of anti-seizure medications, and the presence of psychiatric comorbidities. The data was analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The findings indicated that individuals who were using multiple antiseizure medications had a notably higher likelihood of having psychiatric comorbidities in comparison to those who were on mono therapy (p = 0.010). suggests that patients with unsuccessful seizure control are more probable to have psychiatric comorbidities as compared to those with good seizure control (p = 0.029). CONCLUSION: To conclude poor seizure control and poly therapy are associated with increased risk of psychiatric comorbidities.

Tranexamic Acid: Safeguarding Children with Craniosynostosis from Bleeding. A Review Article.

Craniosynostosis is a congenital condition characterized by the premature closure of one or more sutures in the skull after birth, often necessitating urgent surgical intervention. Nevertheless, cranial vault reconstruction surgery can cause rapid and massive blood loss. This procedure requires a blood transfusion, which entails potential hazards. In addition, the hemostatic system in children differs significantly from that in adults, resulting in increased bleeding during surgical procedures. We conducted a comprehensive literature review in the PubMed, Scopus, and Web of Science databases, referring to their inception for studies on the use of tranexamic acid in pediatric craniosynostosis surgery. Selection criteria were based on the relevance of tranexamic acid, its clinical efficacy, and its safety profile in pediatric populations. Authoritative reviews were considered to ensure a comprehensive synthesis of current knowledge and practice trends in the field. We determined that a low loading dose of 10 mg/kg followed by a maintenance dose of 5 mg/kg/h is as effective as a high dose of 50 mg/kg followed by a maintenance dose of 10 mg/kg/h of tranexamic acid when administered after induction of anesthesia through skin closure and can reduce blood loss by up to 72% and total packed red blood cell transfusion by up to 85%. No difference in safety profile is observed. We concluded that a low dose of tranexamic acid, administered as a loading dose followed by a maintenance dose, is beneficial and safe for reducing blood loss and transfusion following craniosynostosis surgery.

A Single Stage Composite Cleft Septorhinoplasty for Correction of the Mature Unilateral Cleft Nose Deformity - The Gujrat Technique.

OBJECTIVE: To evaluate the results of a single stage composite cleft septorhinoplasty procedure ("The Gujrat Technique") to correct the exaggerated cleft nose deformity after completion of nasal growth in an adult patient cohort. METHODS: Adult patients with a residual unilateral cleft nasal deformity were deemed eligible for the proposed "Gujrat Technique". Over a 10-year period (2007-2017), 96 adult patients underwent this composite cleft septorhinoplasty as a single stage operation. Post-operative nasal symmetry evaluation was undertaken using the validated computer program 'SymNose'. Functional outcome and patient satisfaction were assessed using Nasal Obstruction Symptom Evaluation scale and Rhinoplasty Outcome Evaluation (ROE) questionnaires respectively. Various statistical analysis methods were used to validate the obtained results. RESULTS: Due to poor compliance with follow-up, post-operative assessments were undertaken in only 32 patients. The single group study design using the non-parametric matching pairs Wilcoxon Sign test (p < 0.001) showed overall good to excellent functional and aesthetic outcomes and higher scores of the digital SymNose grading system. There was a significant improvement in ROE scores (from 26.4 ± 2.9 to 85.9 ± 4.7, p < 0.001). There were no major complications or revisions needed in our series. CONCLUSION: The individual components of "The Gujrat Technique" are not novel but their combination in this adult unilateral cleft rhinoplasty cohort has demonstrated a high patient satisfaction with its aesthetic appeal and functional versatility. In the background of limited resources and unpredictable patient follow up, the simplicity, reproducibility and cost effectiveness of this technique make it a practical reconstructive option.

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries.

BACKGROUND: In low- and middle-income countries (LMIC) Staphylococcus aureus is regarded as one of the leading bacterial causes of neonatal sepsis, however there is limited knowledge on the species diversity and antimicrobial resistance caused by Gram-positive bacteria (GPB). METHODS: We characterised GPB isolates from neonatal blood cultures from LMICs in Africa (Ethiopia, Nigeria, Rwanda, and South Africa) and South-Asia (Bangladesh and Pakistan) between 2015-2017. We determined minimum inhibitory concentrations and performed whole genome sequencing (WGS) on Staphylococci isolates recovered and clinical data collected related to the onset of sepsis and the outcome of the neonate up to 60 days of age. RESULTS: From the isolates recovered from blood cultures, Staphylococci species were most frequently identified. Out of 100 S. aureus isolates sequenced, 18 different sequence types (ST) were found which unveiled two small epidemiological clusters caused by methicillin resistant S. aureus (MRSA) in Pakistan (ST8) and South Africa (ST5), both with high mortality (n = 6/17). One-third of S. aureus was MRSA, with methicillin resistance also detected in Staphylococcus epidermidis, Staphylococcus haemolyticus and Mammaliicoccus sciuri. Through additional WGS analysis we report a cluster of M. sciuri in Pakistan identified between July-November 2017. CONCLUSIONS: In total we identified 14 different GPB bacterial species, however Staphylococci was dominant. These findings highlight the need of a prospective genomic epidemiology study to comprehensively assess the true burden of GPB neonatal sepsis focusing specifically on mechanisms of resistance and virulence across species and in relation to neonatal outcome.

IV3000 semi-occlusive dressing use in simple and complex fingertip injuries: efficacy and affordability.

OBJECTIVE: This study aimed to explore the efficacy of the IV3000 semi-occlusive, transparent adhesive film dressing in the non-surgical management of simple as well as more complex fingertip injuries. METHOD: In this qualitative study, patients with fingertip injuries were prospectively recruited and treated conservatively with the dressing between 2015 and 2017. Inclusion criteria included any fingertip injury with tissue loss and patient consent for non-surgical treatment consistent with the study protocol. Exclusion criteria included injuries needing surgical intervention for tendon injury or exposure, joint dislocations, distal phalangeal fractures requiring fixation, bone exposure, isolated nail bed lacerations and any patients eligible for surgical repair who did not wish to be managed conservatively. RESULTS: A total of 64 patients took part in the study. The patients treated with the dressing were asked to rate functional outcome, of whom 40 (62.5%) patients reported the outcome as 'excellent', 19 (29.7%) as 'satisfactory', five (7.8%) as 'indifferent' and none (0%) as 'unsatisfactory'. A reduced pulp volume at completion of healing was felt by 21 (32.8%) patients, but all patients were 'satisfied' with the aesthetic appearance of their fingertips at final clinical review. Average healing time was 4.5 weeks across the group, with the average time for return to work being just under one week. We estimate a 60% reduction in cost with the conservative versus the surgical management option. CONCLUSION: This study showed that, for participants, the IV3000 dressing was an affordable and effective option for the conservative treatment of simple fingertip injuries and in the management of more complex fingertip injuries.

Green Synthesis of Silver Nanoparticles Using the Plant Extract of Acer oblongifolium and Study of Its Antibacterial and Antiproliferative Activity via Mathematical Approaches.

In this study, the antibacterial and antifungal properties of silver nanoparticles synthesized with the aqueous plant extract of Acer oblongifolium leaves were defined using a simplistic, environmentally friendly, reliable, and cost-effective method. The aqueous plant extract of Acer oblongifolium, which served as a capping and reducing agent, was used to biosynthesize silver nanoparticles. UV visible spectroscopy, X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), and scanning electron microscopy were used to analyze the biosynthesized Acer oblongifolium silver nanoparticles (AgNPs). Gram-positive bacteria (Bacillus paramycoides and Bacillus cereus) and Gram-negative bacteria (E. coli) were used to test the AgNPs' antibacterial activity. The presence of different functional groups was determined by FTIR. The AgNPs were rod-like in shape. The nanoparticles were more toxic against Escherichiacoli than both Bacillus cereus and Bacillus paramycoides. The AgNPs had IC50 values of 6.22 and 9.43 and mg/mL on HeLa and MCF-7, respectively, proving their comparatively strong potency against MCF-7. This confirmed that silver nanoparticles had strong antibacterial activity and antiproliferative ability against MCF-7 and HeLa cell lines. The mathematical modeling revealed that the pure nanoparticle had a high heat-absorbing capacity compared to the mixed nanoparticle. This research demonstrated that the biosynthesized Acer oblongifolium AgNPs could be used as an antioxidant, antibacterial, and anticancer agent in the future.

Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement.

OBJECTIVE: To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND: SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS: Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS: Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98-1.007); p = .43], stroke [OR 1.009(0.99-1.02); p = .08], acute kidney injury [OR 0.99(0.96-1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. CONCLUSION: Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.

The increasing hunger concern and current need in the development of sustainable food security in the developing countries.

Background: COVID-19 has affected millions of people worldwide. Recently, international agencies have revealed that poverty and hunger could kill more people than COVID-19 victims. Many global workforces have lost their jobs during this pandemic situation. In developing countries, most of the workers and their families live hand to mouth, depending on daily wage, and loss of income would be a hunger pandemic. Globally, the proportion of undernourished and hungry people have been on an upswing due to climate changes and violent conflicts. The millions of people are facing chronic malnourishment and COVID-19 menaces undermining the endeavour of philanthropic and food security. COVID-19 has increased the risk of livelihood by the shortage of food and distraction of the supply chain especially in the developing countries where rural expanses depend on agriculture production and seasonal jobs. So, if they are forced to limit their activities, their livelihoods will be demolished. Scope and approach: COVID-19 is increasing the jeopardy of food prices over the world, which would prompt a crisis in several developing countries. The government organizations in developing countries are doing well to protect people from the current pandemic. But they are also in critical situation regarding food supply chains and are facing difficulties in providing nutrient-rich foods. The susceptible people are fraught to secure household income and manage their food. In this review, we have explored the food security approach, food supply chain and risk of food shortage. Every country in the world needs to implement effective interventions to maintain open trade and food supply chains, ensure access to nutrients for all at affordable prices and develop co-operation to preserve the flexibility of universal food markets.

Design and Analysis of In-Pipe Hydro-Turbine for an Optimized Nearly Zero Energy Building.

Pakistan receives Direct Normal Irradiation (DNI) exceeding 2000 kWh/m²/annum on approximately 83% of its land, which is very suitable for photovoltaic production. This energy can be easily utilized in conjunction with other renewable energy resources to meet the energy demands and reduce the carbon footprint of the country. In this research, a hybrid renewable energy solution based on a nearly Zero Energy Building (nZEB) model is proposed for a university facility. The building in consideration has a continuous flow of water through its water delivery vertical pipelines. A horizontal-axis spherical helical turbine is designed in SolidWorks and is analyzed through a computational fluid dynamics (CFD) analysis in ANSYS Fluent 18.1 based on the K-epsilon turbulent model. Results obtained from ANSYS Fluent have shown that a 24 feet vertical channel with a water flow of 0.2309 m3/s and velocity of 12.66 m/s can run the designed hydroelectric turbine, delivering 168 W of mechanical power at 250 r.p.m. Based on the turbine, a hybrid renewable energy system (HRES) comprising photovoltaic and hydroelectric power is modelled and analyzed in HOMER Pro software. Among different architectures, it was found that architecture with hydroelectric and photovoltaic energy provided the best COE of $0.09418.

Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

Entropy Generation Analysis of Hybrid Nanomaterial through Porous Space with Variable Characteristics.

Salient features of hybrid nanofluid (MoS2-SiO2/water) for Darcy-Forchheimer-Brinkman porous space with variable characteristics is examined. Heat transfer analysis subject to viscous dissipation, nonlinear thermal radiation, and heat generation/absorption is carried out. Disturbance inflow is created by an exponentially stretching curved sheet. Relevant equations are simplified by employing boundary layer theory. Adequate transformations lead to a set of dimensionless equations. Velocity, temperature, and entropy generation rate are analyzed graphically. Comparative results are obtained for hybrid (MoS2-SiO2/water) and nanofluid (MoS2-water and SiO2-water). Physical quantities are analyzed through numerical data.

Fully Automatic Registration Methods for Chest X-Ray Images.

PURPOSE: Image registration is important in medical applications accomplished by improving healthcare technology in recent years. Various studies have been proposed in medical applications, including clinical track of events and updating the treatment plan for radiotherapy and surgery. This study presents a fully automatic registration system for chest X-ray images to generate fusion results for difference analysis. Using the accurate alignment of the proposed system, the fusion result indicates the differences in the thoracic area during the treatment process. METHODS: The proposed method consists of a data normalization method, a hybrid L-SVM model to detect lungs, ribs and clavicles for object recognition, a landmark matching algorithm, two-stage transformation approaches and a fusion method for difference analysis to highlight the differences in the thoracic area. In evaluation, a preliminary test was performed to compare three transformation models, with a full evaluation process to compare the proposed method with two existing elastic registration methods. RESULTS: The results show that the proposed method produces significantly better results than two benchmark methods (P-value ≤ 0.001). The proposed system achieves the lowest mean registration error distance (MRED) (8.99 mm, 23.55 pixel) and the lowest mean registration error ratio (MRER) w.r.t. the length of image diagonal (1.61%) compared to the two benchmark approaches with MRED (15.64 mm, 40.97 pixel) and (180.5 mm, 472.69 pixel) and MRER (2.81%) and (32.51%), respectively. CONCLUSIONS: The experimental results show that the proposed method is capable of accurately aligning the chest X-ray images acquired at different times, assisting doctors to trace individual health status, evaluate treatment effectiveness and monitor patient recovery progress for thoracic diseases.

Echocardiographic parameters associated with recovery in heart failure with reduced ejection fraction.

OBJECTIVE: The study aims to determine the clinical and echocardiographic parameters of patients with recovered heart failure (HFrecEF). METHODOLOGY: Sixty-seven patients (cases) were identified as heart failure with recovered ejection fraction (HFrecEF), defined as improvement in EF ≥ 10%. Sixty-nine patients (controls) were randomly selected by convenience sampling with no or <10% improvement in EF (HFrEF non-recovered). RESULTS: The mean interval between baseline and follow-up echocardiography was 10.5 months in cases and 11.2 months in the control group. HFrecEF showed a 22.7% improvement in mean ejection fraction, and HFrEF non-recovered group also showed a minor increment of 5.5%. HFrecEF patients were significantly younger (49.51 vs 57.54 years, P .001) with non-ischemic cardiomyopathy (86.6% vs 52.2%). Patients with HFrecEF had significantly less left ventricular end-diastolic and end-systolic volumes (LVEDV: 162.51 mL vs 208.54 mL, P < .001; LVESV: 119.81 mL vs 157.13 mL, P < .001) and index left atrial volume (37.66 mL vs 47.09 mL, P < .001) than patients with non-recovered EF. The right ventricle (RV) and inferior vena cava were significantly dilated with higher mean tricuspid annular plane systolic excursion (TAPSE) among patients with HFrecEF than HFrEF non-recovered. CONCLUSION: Based on univariate analysis, younger age, non-ischemic etiology, LVEDV, LVESV, deceleration time, better TAPSE, dilated right ventricle, dilated IVC, and smaller left atrial volumes were found significant, but on multivariate logistic regression model only left ventricle end-diastolic volume, left atrial volume, and TAPSE were linked to the recovery of ejection fraction.

Bilateral basal ganglia bleed in traumatic brain injury: A case report.

Intracerebral haemorrhage can be classified into traumatic and non-traumatic. Traumatic Basal Ganglia Haemorrhage (TBGH) has been reported in 2.4-3% cases of all closed head injuries whereas the incidence is higher in postmortem studies (9.8%), nevertheless, a bilateral TBGH is an extremely rare entity. According to our search through literature, only 12 case reports of bilateral TBGH have been published previously. A simple bilateral TBGH is rarely seen without any other lesions as it is usually associated with skull fractures, haemorrhages or brainstem injuries, making its incidence more during autopsies. We present a 30-year old male patient who had a traumatic brain injury (TBI) secondary to Road Traffic Accident (RTA) with GCS of 12/15, having no other co-morbids. CT-scan revealed bilateral basal ganglia bleed and the patient improved on conservative management only.

Characterization of Marangoni Forced Convection in Casson Nanoliquid Flow with Joule Heating and Irreversibility.

The Marangoni forced convective inclined magnetohydrodynamic flow is examined. Marangoni forced convection depends on the differences in surface pressure computed by magnetic field, temperature, and concentration gradient. Casson nanoliquid flow by an infinite disk is considered. Viscous dissipation, heat flux, and Joule heating are addressed in energy expressions. Thermophoresis and Brownian motion are also examined. Entropy generation is computed. The physical characteristics of entropy optimization with Arrhenius activation energy are discussed. Nonlinear PDE's are reduced to highly nonlinear ordinary systems with appropriate transformations. A nonlinear system is numerically computed by the NDSolve technique. The salient characteristics of velocity, temperature, concentration, entropy generation, and Bejan number are explained. The computational results of the heat-transfer rate and concentration gradient are examined through tables. Velocity and temperature have reverse effects for the higher approximation of the Marangoni number. Velocity is a decreasing function of the Casson fluid parameter. Temperature is enhanced for higher radiation during reverse hold for concentration against the Marangoni number. The Bejan number and entropy generation have similar effects for Casson fluid and radiation parameters. For a higher estimation of the Brinkman number, the entropy optimization is augmented.

Beyond transmission: Dire need for integration of nutrition interventions in COVID-19 pandemic-response strategies in Developing Countries like Pakistan.

Synergistic associations between infection and nutrition are well known. Impact of nutrition interventions on the outcomes have been scientifically assessed and reported. The role of nutrition in limiting the infection related morbidity and mortality does not appear to be a debatable question but nutrition interventions do not appear to be an essential part of current COVID-19 management strategies. Given the nature of pandemic and lack of organism-specific evidence, variability in nutrition interventions and lack of nutrition interventions is not unexpected. However, delay in realization of the crucial need of nutrition interventions to limit the immediate and long term outcomes at personal and community level may aggravate health related issues that can have long term impact on quality of life and economy. Due to existing undernutrition and lack of nutrition related awareness and competence, need for timely and appropriate interventions is much more critical for developing countries. This manuscript highlights the need and feasibility of various nutrition interventions to assure optimum quality of life during and after COVID-19 pandemic. Available evidence provides enough guidance for nutrition interventions that are safe and promise to accrue various degrees of benefits with almost no likelihood of harm. Nutrition interventions suggested by author are: 1) population level efforts for promoting better use of existing resources; 2) quicker augmentation of nutrition status of high risk people and non-hospitalized cases by use of supplement and individualized guidance and 3) nutritional support of sever case by timely and adequate enteral and parenteral feeding.

Patients' perspectives on dialysis decision-making and end-of-life care
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BACKGROUND: Few studies have explored dialysis patients' perspectives on dialysis decision-making and end-of-life-care (EoLC) preferences. We surveyed a racially diverse cohort of maintenance dialysis patients in the Cleveland, OH, USA, metropolitan area. MATERIALS AND METHODS: In this cross-sectional study, we administered a 41-item questionnaire to 450 adult chronic dialysis patients. Items assessed patients' knowledge of their kidney disease as well as their attitudes toward chronic kidney disease (CKD) treatment issues and EoLC issues. RESULTS: The cohort included 67% Blacks, 27% Caucasians, 2.8% Hispanics, and 2.4% others. The response rate was 94% (423/450). Most patients considered it essential to obtain detailed information about their medical condition (80.6%) and prognosis (78.3%). Nearly 19% of respondents regretted their decision to start dialysis. 41% of patients would prefer treatment(s) aimed at relieving pain rather than prolonging life (30.5%), but a majority would want to be resuscitated (55.3%). Only 8.4% reported having a designated healthcare proxy, and 35.7% reported completing a living will. A significant percentage of patients wished to discuss their quality of life (71%), psychosocial and spiritual concerns (50.4%), and end-of-life issues (38%) with their nephrologist. CONCLUSION: Most dialysis patients wish to have more frequent discussions about their disease, prognosis, and EoLC planning. Findings from this study can inform the design of future interventions.
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Methanol outbreak in the district of Hulu Langat, 2018.

INTRODUCTION: A methanol outbreak occurred in the district of Hulu Langat on 16 September 2018. The Hulu Langat District Health Office received 25 notifications of a suspected methanol poisoning from Kajang and Ampang Hospital. An outbreak investigation was done to determine the source followed by a preventive and control measure. METHOD: Active case detection was done on cases living quarters and workplaces. Patients were interviewed, and their blood and urine samples were sent for methanol analysis. Samples of suspected alcoholic beverages were also sent for analysis. A suspected case was defined as any person presented with clinical symptoms with a history of consuming alcoholic beverages within five days before symptoms and high anion gap metabolic acidosis. A confirmed case was defined as a suspected case with positive blood and urine methanol. RESULTS: In total, there were 25 suspected cases, of which 12 cases were confirmed. The calculated attack rate was 48%. There were six mortalities (50%) secondary to severe metabolic acidosis. The most common presenting symptom was vomiting (75%) and abdominal pain (41.7%). These cases were linked to consumption of illicitly produced alcohol. Samples of the alcoholic drinks were positive containing high level of methanol. CONCLUSION: The methanol outbreak in the Hulu Langat was successfully managed. Appropriate control and prevention measures were taken, including health promotion and joint enforcement activities. Steps were taken successfully through collaborations with multiple agencies and cooperation with Selangor Health Departments and the Ministry of Health. Continuous surveillance on the product of liquor, and health promotion are essential to prevent a similar outbreak from happening again in future.

The Mechanisms of Dietary Phytoestrogen as a Potential Treatment and Prevention Agent against Alzheimer's Disease.

Alzheimer's disease (AD) is a major dementia disease worldwide with an increasing incidence rate among the elderly. It is a neurodegenerative disease with symptoms starting slowly and then progressing over time. There has been extensive research on AD prevention and treatment; however, there is no cure as of yet. Several drugs are being researched for the treatment and prevention of AD, with a rising interest in specific dietary compounds as potential interventions with lower side effects. One such dietary compound being tested is phytoestrogen. Phytoestrogens are chemically, structurally, and functionally similar to estrogen, which has numerous functions as a cognition-promoting agent; although, as a supplement it can be damaging. Phytoestrogens have the unique ability to substitute for estrogen in elderly individuals with Alzheimer's disease and depleted estrogen levels. This paper aims to contribute to the collective understanding of phytoestrogen's role in the treatment and prevention of Alzheimer's disease by describing its various mechanisms, including its ability to decrease amyloid beta peptide production, promote calcium outflow and acetylcholine release, and reduce Tau protein phosphorylation. The paper also addresses phytoestrogen's role as an anti-inflammatory and antioxidant agent for the cholinergic neurons associated with Alzheimer's disease.