Awareness of pelvic organ prolapse and attitude towards its treatment among Malaysian women.

INTRODUCTION: The aim of this study is to determine the level of awareness of pelvic organ prolapse (POP) and factors that influence the attitude towards the treatment of POP among Malaysian women. MATERIALS AND METHODS: This was a cross-sectional study of 400 women from registered non-government organisations (NGOs) in Malaysia who voluntarily answered questionnaires distributed through Google form via emails. Data were analysed using descriptive statistics, independent t-test and one-way ANOVA test. RESULTS: Four hundred respondents participated in this study. The mean age was 40.42 years old (SD=12.566). The mean score for the studied population was 4.96 (SEM 0.124). Only 58 (14.5%) respondents obtained a score of eight or more, and 235 (58.8%) respondents scored between 4 and 7. The rest of 107 (26.7%) respondents scored 3 and less. There were statistically significant differences in the mean score for level of awareness between marital statuses, menopausal status, number of children and occupation. There were only 273 (68%) respondents who will seek treatment if they experience symptoms of POP. The most frequent reasons for not seeking treatment were unawareness of the availability of medical treatment for POP (69 %). CONCLUSION: Majority of the respondents have an inadequate level of awareness on POP. Although more than half of the respondents will seek treatment if they experience symptoms of POP, concerns raised by those who chose not to seek treatment should be addressed by a more effective public awareness programme. This includes the unawareness of the availability of medical treatment and the embarrassment to see medical practitioners.

Amelioration of inflammation in young men with cardiovascular risks participating pedometer-based walking programme.

INTRODUCTION: Inflammation plays a central role in the pathogenesis of cardiovascular events. The lack of exercise among Malaysians and the increasing cardiovascular diseases among young men are of concern. The aim of this study was to evaluate the reducing of inflammation by measuring C-Reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). MATERIALS AND METHODS: A total of 70 young men (20 - 40 years) who were sedentary, achieving less than 5,000 steps/day in casual walking with 2 or more cardiovascular risk factors were recruited in Institute of Vocational Skills for Youth (IKBN Hulu Langat). Subjects were randomly assigned to a control group (CG) (n=34; no change in walking) and pedometer group (PG) (n=36; minimum target: 8,000 steps/day). All parameter was measured at baseline, at 6 weeks and after 12 weeks. RESULTS: At post intervention, the CG step counts were similar (4983 ± 366vs 5697 ± 407steps/day). The PG significant increased step count from 4996 ± 805 to 10,128 ±511 steps/day (p<0.001). The PG showed significant improvement in anthropometric variables and lipid (time and group effect p<0.001). After intervention, CRP, IL-6 and TNF- α were significantly reduced for time and group effect (p<0.001). However, no changes were seen in CG. CONCLUSION: The pedometer-based walking programme improved health status in terms of improving inflammation and arterial stiffness.

Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein.

OBJECTIVE: To determine the association between carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) with future cardiovascular disease (CVD) risk, and to assess whether high sensitivity C-reactive protein (hs-CRP) is an important mediator towards these vascular changes, among young men. METHODS: This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWVCF and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score (FRS) and age adjusted FRS (A-FRS). Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 (SPSS Inc., Chicago, IL, USA). RESULTS: The mean age of the subjects was 27.09 (95% confidence intervals [CI] 26.39-27.79) years old. Those with ≥2 risk factors had significantly higher AI [10.09 (95% CI: 9.06-11.12) versus 6.56 (95% CI: 5.54-7.57) (p=0.001), but not PWVCF 7.45 (95% CI: 7.29-7.61) m/s versus 7.29 (95% CI: 7.06-7.51) m/s, (p=0.90) when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS (p=0.0001). CONCLUSION: To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP.

Presentation of frozen shoulder among diabetic and non-diabetic patients.

OBJECTIVE: The literature is inconsistent regarding the level of pain and disability in frozen shoulder patients with or without diabetes mellitus. The aim of this study is to evaluate some demographic features of frozen shoulder patients and to look into the disparity of information by comparing the level of pain and disability due to frozen shoulder between diabetic and non-diabetic people. DESIGN: This is a prospective comparative study. People with frozen shoulder attending an outpatient department were selected by consecutive sampling. Disability levels were assessed by the Shoulder Pain & Disability Index (SPADI). Means of pain and disability scores were compared using unpaired t-test. RESULTS: Among 140 persons with shoulder pain 99 (71.4%) had frozen shoulder. From the participating 40 frozen shoulder patients, 26 (65%) were males and 14 (35%) were females. Seventeen participants (42.5%) were diabetic, two (5%) had impaired glucose tolerance and 21 (52.5%) patients were non-diabetic. Mean disability scores (SPADI) were 51 ± 15.5 in diabetic and 57 ± 16 in non-diabetic persons. The differences in pain and disability level were not statistically significance (respectively, p = 0.24 and p = 0.13 at 95% confidence interval). CONCLUSIONS: No difference was found in level of pain and disability level between frozen shoulder patients with and without diabetes.

Total testosterone and sex hormone-binding globulin are significantly associated with metabolic syndrome in middle-aged and elderly men.

Testosterone and sex hormone-binding globulin (SHBG) have been shown to be associated with metabolic syndrome (MS) in men. This study aimed at validating these relationships in a group of middle-aged and elderly men and assessing their strength of association to MS. A cross-sectional study of 332 Malaysian men aged 40 years and above was conducted. The blood of subject was collected under fasting condition for determination of testosterone, SHBG, glucose and lipid levels. Their medical history, smoking and alcohol consumption status, waist circumference (WC), body mass index (BMI) and blood pressure (BP) were recorded. All testosterone and SHBG levels were significantly reduced in MS subjects compared to non-MS subjects (p<0.05). Testosterone and SHBG were correlated significantly with most of the MS indicators without adjustments. In multiple regression analysis, the triglyceride level was the only MS indicator that was significantly, inversely and independently associated with all testosterone measurements and SHBG (p<0.05). Waist circumference was significantly and negatively associated with SHBG level (p<0.05) though not independent of BMI. Total testosterone and SHBG were significantly and inversely associated with the presence of MS. Testosterone and SHBG are potential intervention targets for the prevention of MS in men.

Adipose tissue hypoxia induces inflammatory M1 polarity of macrophages in an HIF-1α-dependent and HIF-1α-independent manner in obese mice.

AIMS/HYPOTHESIS: As obesity progresses, adipose tissue exhibits a hypoxic and inflammatory phenotype characterised by the infiltration of adipose tissue macrophages (ATMs). In this study, we examined how adipose tissue hypoxia is involved in the induction of the inflammatory M1 and anti-inflammatory M2 polarities of ATMs. METHODS: The hypoxic characteristics of ATMs were evaluated using flow cytometry after the injection of pimonidazole, a hypoxia probe, in normal-chow-fed or high-fat-fed mice. The expression of hypoxia-related and inflammation-related genes was then examined in M1/M2 ATMs and cultured macrophages. RESULTS: Pimonidazole uptake was greater in M1 ATMs than in M2 ATMs. This uptake was paralleled by the levels of inflammatory cytokines, such as TNF-α, IL-6 and IL-1ß. The expression level of hypoxia-related genes, as well as inflammation-related genes, was also higher in M1 ATMs than in M2 ATMs. The expression of Il6, Il1ß and Nos2 in cultured macrophages was increased by exposure to hypoxia in vitro but was markedly decreased by the gene deletion of Hif1a. In contrast, the expression of Tnf, another inflammatory cytokine gene, was neither increased by exposure to hypoxia nor affected by Hif1a deficiency. These results suggest that hypoxia induces the inflammatory phenotypes of macrophages via Hif1a-dependent and -independent mechanisms. On the other hand, the expression of inflammatory genes in cultured M2 macrophages treated with IL-4 responded poorly to hypoxia. CONCLUSIONS/INTERPRETATION: Adipose tissue hypoxia induces an inflammatory phenotype via Hif1a-dependent and Hif1a-independent mechanisms in M1 ATMs but not in M2 ATMs.

Age-related rarefaction in retinal vasculature is not linear.

The fractal dimension is a global measure of complexity and is useful for quantifying anatomical structures, including the retinal vascular network. A previous study found a linear declining trend with aging on the retinal vascular fractal dimension (DF); however, it was limited to the older population (49 years and older). This study aimed to investigate the possible models of the fractal dimension changes from young to old subjects (10­73 years). A total of 215 right-eye retinal samples, including those of 119 (55%) women and 96 (45%) men, were selected. The retinal vessels were segmented using computer-assisted software, and non-vessel fragments were deleted. The fractal dimension was measured based on the log­log plot of the number of grids versus the size. The retinal vascular DF was analyzed to determine changes with increasing age. Finally, the data were fitted to three polynomial models. All three models are statistically significant (Linear: R(2) = 0.1270, 213 d.f., p < 0.001, Quadratic: R(2) = 0.1536, 212 d.f., p < 0.001, Cubic: R(2) = 0.1529, 211 d.f., p < 0.001). The quadratic regression is significantly better than the linear regression (p < 0.001); however, the increase in R(2) from the quadratic model to the cubic model is not significant (p = 0.97). These results suggest that the decreasing trend of the fractal dimension associated with aging is better explained by the quadratic model than by the linear and cubic models in a sample with a broader age spectrum.

Age-related rarefaction in retinal vasculature is not linear.

The fractal dimension is a global measure of complexity and is useful for quantifying anatomical structures, including the retinal vascular network. A previous study found a linear declining trend with aging on the retinal vascular fractal dimension (DF); however, it was limited to the older population (49 years and older). This study aimed to investigate the possible models of the fractal dimension changes from young to old subjects (10-73 years). A total of 215 right-eye retinal samples, including those of 119 (55%) women and 96 (45%) men, were selected. The retinal vessels were segmented using computer-assisted software, and non-vessel fragments were deleted. The fractal dimension was measured based on the log-log plot of the number of grids versus the size. The retinal vascular DF was analyzed to determine changes with increasing age. Finally, the data were fitted to three polynomial models. All three models are statistically significant (Linear: R2 = 0.1270, 213 d.f., p < 0.001, Quadratic: R2 = 0.1536, 212 d.f., p < 0.001, Cubic: R2 = 0.1529, 211 d.f., p < 0.001). The quadratic regression is significantly better than the linear regression (p < 0.001); however, the increase in R2 from the quadratic model to the cubic model is not significant (p = 0.97). These results suggest that the decreasing trend of the fractal dimension associated with aging is better explained by the quadratic model than by the linear and cubic models in a sample with a broader age spectrum.

Solid-pseudopapillary carcinoma: a case study and literature review.

Solid-pseudopapillary tumour (SPT) is a rare exocrine tumour of the pancreas and is considered to have low malignant potential. Few morphological criteria are used to predict malignant behaviour such as equivocal perineural invasion, angioinvasion and invasion to surrounding tissue, and should be designated as solid-pseudopapillary carcinoma (SPC). We report a case of SPC. Clinical and radiological findings are typical for SPT with no metastatic disease. There is no tumour recurrence after 4 months postresection. Clinical history and radiological findings were retrieved from the patient's record sheet and Viarad system. H&E staining and few immunoproxidase staining were reviewed by several pathologists. The histological findings are typical for SPT, with additional perineural invasion. There is no angioinvasion or capsular invasion identified. This is our first experience in diagnosing and managing SPC. We look forward to seeing the patient's disease status during her next routine follow-up. We expect good disease-free survival and very low risk of tumour recurrence, in view of only one risk factor (perineural invasion) and uninvolved surgical margins by the tumour.

Dynamic manipulation of modes in an optical waveguide using dielectrophoresis.

The emergence of optofluidics has brought a high degree of tuneability and reconfigurability to optical devices. These possibilities are provided by characteristics of fluids including mobility, wide range of index modulation, and abrupt interfaces that can be easily reshaped. In this work, we created a new class of optofluidic waveguides, in which suspended mesoparticles were employed to greatly enhance the flexibility of the system. We demonstrated tuneable quasi single mode waveguides using spatially controllable mesoparticles in optofluidics. The coupling of waveguiding modes into the assembly of mesoparticles produces strong interactions and resonant conditions, which promote the transitions of the waveguiding modes. The modal response of the system depends on the distribution of packed particles above the polymeric rib waveguide which can be readily controlled under the appropriate combination of dielectrophoresis and hydrodynamic forces.

Thermal analysis of nanofluids in microfluidics using an infrared camera.

We present the thermal analysis of liquid containing Al(2)O(3) nanoparticles in a microfluidic platform using an infrared camera. The small dimensions of the microchannel along with the low flow rates (less than 120 µl min(-1)) provide very low Reynolds numbers of less than 17.5, reflecting practical parameters for a microfluidic cooling platform. The heat analysis of nanofluids has never been investigated in such a regime, due to the deficiencies of conventional thermal measurement systems. The infrared camera allows non-contact, three dimensional and high resolution capability for temperature profiling. The system was studied at different w/w concentrations of thermally conductive Al(2)O(3) nanoparticles and the experiments were in excellent agreement with the computational fluid dynamics (CFD) simulations.

Active control of silver nanoparticles spacing using dielectrophoresis for surface-enhanced Raman scattering.

We demonstrate an active microfluidic platform that integrates dielectrophoresis for the control of silver nanoparticles spacing, as they flow in a liquid channel. By careful control of the nanoparticles spacing, we can effectively increase the surface-enhanced Raman scattering (SERS) signal intensity based on augmenting the number of SERS-active hot-spots, while avoiding irreversible aggregation of the particles. The system is benchmarked using dipicolinate (2,6-pyridinedicarboxylic acid) (DPA), which is a biomarker of Bacillus anthracis. The validity of the results is discussed using several complementing characterization scenarios.

Optofluidics incorporating actively controlled micro- and nano-particles.

The advent of optofluidic systems incorporating suspended particles has resulted in the emergence of novel applications. Such systems operate based on the fact that suspended particles can be manipulated using well-appointed active forces, and their motions, locations and local concentrations can be controlled. These forces can be exerted on both individual and clusters of particles. Having the capability to manipulate suspended particles gives users the ability for tuning the physical and, to some extent, the chemical properties of the suspension media, which addresses the needs of various advanced optofluidic systems. Additionally, the incorporation of particles results in the realization of novel optofluidic solutions used for creating optical components and sensing platforms. In this review, we present different types of active forces that are used for particle manipulations and the resulting optofluidic systems incorporating them. These systems include optical components, optofluidic detection and analysis platforms, plasmonics and Raman systems, thermal and energy related systems, and platforms specifically incorporating biological particles. We conclude the review with a discussion of future perspectives, which are expected to further advance this rapidly growing field.

Dielectrophoresis-Raman spectroscopy system for analysing suspended nanoparticles.

A microfluidic dielectrophoresis platform consisting of curved microelectrodes was developed and integrated with a Raman spectroscopy system. The electrodes were patterned on a quartz substrate, which has insignificant Raman response, and integrated with a microfluidic channel that was imprinted in poly-dimethylsiloxane (PDMS). We will show that this novel integrated system can be efficiently used for the determination of suspended particle types and the direct mapping of their spatial concentrations. We will also illustrate the system's unique advantages over conventional optical systems. Nanoparticles of tungsten trioxide (WO(3)) and polystyrene were used in the investigations, as they are Raman active and can be homogeneously suspended in water.

Novel tuneable optical elements based on nanoparticle suspensions in microfluidics.

This work demonstrates the application of dielectrophoretic (DEP) control of silica nanoparticles to form tuneable optical elements within a microfluidic system. The implementation consisted of a microfluidic channel with an array of curved microelectrodes along its base. Various DEP conditions were investigated at alternating current voltage amplitudes, flow rates and frequencies from 5 to 15 V, 2 to 10 microL/min and 0 to 20 MHz, respectively. The fluid channel was filled with deionized water suspending silica particles with diameters of 230 and 450 nm. Experiments were conducted to demonstrate DEP concentration and deflection of the particles and the impact of these particles distributions on the optical transmission through the fluid channel. Both confinement and scattering of the light were observed depending on the particle dimensions and the parameters of the DEP excitation. The results of this investigation illustrate the feasibility of DEP control in an optofluidic system and represent a significant step toward the dynamic formation of electrically controlled liquid optical waveguides.

Analysis of PCR-RAPD DNA and antibiotic susceptibility profiles of antrum and corpus isolates of Helicobacter pylori from Malaysian patients.

This study was conducted to determine whether there was any genetic heterogeneity among Helicobacter pylori strains isolated from the antrum and corpus of the same individual in a Malaysian population and to determine the presence of heterogeneous susceptibility of the isolates by comparing PCR-RAPD and antibiotic profiles. Forty-four H. pylori isolates cultured from the antrum and corpus of 22 patients were analyzed. Antibiotic susceptibility testing was carried out by minimum inhibitory concentration determination, using E-Test method strips. PCR-RAPD was carried out on all the strains and the profiles generated were analysed for cluster analysis. Twenty-nine different PCR-RAPD profiles were observed in the 44 isolates. Fifteen pairs of the isolates from the same patients had the same PCR-RAPD patterns while in 7 pairs, the profiles were different. The strains were clustered into 2 separate clusters at a low coefficient of similarity, where most of the strains were in cluster 1. The degree of similarity was very low among most of the isolates. Most of the patients (16 of 22) were infected with strains that have the same antibiotic susceptibility profiles. Out of these, only 10 pairs shared the same PCR-RAPD and antibiotic profiles. Five pairs of isolates with similar PCR-RAPD profiles differed in their antibiotic profiles due to metronidazole resistance in one of the sites. A large degree of genetic heterogeneity was observed among H. pylori strains circulating among Malaysian patients. An individual patient can be infected with multiple strains and the strains can be antibiotic resistant.

Evaluation of the effects of shortwave diathermy in patients with chronic low back pain.

A prospective experimental study on 97 patients of chronic low back pain was conducted to find out the effects of shortwave diathermy. They were divided randomly into two groups and treated with nonsteroidal anti-inflammatory drugs, exercises, activities of daily living instructions and with or without shortwave diathermy. After six weeks of treatment, improvements were observed in both the groups. But significant difference in improvement was found in shortwave diathermy group than in placebo group. The present study suggests that shortwave diathermy is effective for the treatment of patients with chronic low back pain.

A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke.

Dysphagia following stroke is common problem and is of particular concern because of its potental for malnutrition. Nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tube feeding are recognized methods for nutritional support for patients with persistent neurologic dysphagia. However, the former is associated with tube dislodgement and blockage that might compromise the patients' nutritional status. There have been few randomized prospective studies to date comparing the efficacy and safety of these 2 modes of dysphagia management in stroke patients. The objective of this study was to compare PEG with NG tube feeding after acute dysphagic stroke in terms of nutritional status and treatment failure. This was a randomized prospective clinical trial. A total of 23 consecutive patients who fulfilled the criteria were recruited from the medical wards in Hospital Universiti Kebangsaan Malaysia. The diagnosis of stroke (acute cerebral infarct) was based on clinical and brain computed tomographic (CT scan) findings; and the diagnosis of dysphagia was done clinically by using the 'swallowing test'. At recruitment, upper-arm skin fold thickness (triceps and biceps) and mid-arm circumference were measured; and blood was drawn for serum albumin level. They were then followed up at 4 weeks where the above tests were repeated. A total of 22 patients completed the study (12 patients in the NG group and 10 patients in the PEG group). Serum albumin levels (p = 0.045) were significantly higher in the PEG as compared to the NG group at 4 weeks post-intervention. There were statistically significant improvements in serum albumin level (p = 0.024) in the PEG group; and statistically significant reductions in serum albumin level (p = 0.047) in the NG group 4 weeks after the intervention. However, there were no significant differences in anthropometric parameters between the two groups and no significant changes in these parameters for each group 4 weeks after the intervention. Treatment failure occurred in 5 out of 10 patients (50.0%) in the NG group, but none in PEG group (p = 0.036). PEG tube feeding is more effective than NG tube feeding in improving the nutritional status (in terms of the serum albumin level) of patients with dysphagic stroke. NG tube feeding, in fact, reduced the nutritional status (in terms of the serum albumin level) of the patients.

Training-induced increases in sea level VO2max and endurance are not enhanced by acute hypobaric exposure.

The present study used untrained subjects to examine the effect of acute hypobaric exposure during endurance training on subsequent exercise performance at sea level. Two groups, each of nine subjects, completed 5 weeks of endurance training [cycle ergometer exercise for 45 min, three times per week at a heart rate corresponding to 70% of that achieved at the maximal O2 consumption (VO2max) either at sea level or at high altitude] in a hypobaric chamber, under either normobaric [sea level, SL; 750 mmHg (100 kPa) approximately 90 m] or hypobaric [altitude, ALT; 554 mmHg (73.4 kPa) approximately 2500 m] conditions and the changes in SL VO2max, SL endurance time and peak blood lactate during the endurance test compared. While each group showed increases in both SL VO2max (approximately 12%) and SL endurance time (approximately 71%), there were no significant differences between the groups [SL VO2max, mean (SE)-SL group: pre-training = 42.4 (3.5), post-training = 46.1 (3.5) ml.kg-1.min-1, P < 0.005; ALT group: pre-training = 40.8 (2.6), post-training = 47.2 (3.4) ml.kg-1.min-1, P < 0.01; SL endurance time-SL group: pre-training 7.1 (1.5), post-training 11.8 (2.9) min, P < 0.01; ALT group: pre-training = 7.5 (0.6), post-training = 13.3 (1.4) min, P < 0.001]. Peak blood lactate during the endurance test was not altered by either training regimen. It is concluded that acute exposure of untrained subjects to hypobaric hypoxia during endurance training has no synergistic effect on the degree of improvement in either SL VO2max or endurance time.