Oral health assessment of epilepsy patients from a tertiary hospital in Asia.

INTRODUCTION: Oral health problems are frequently overlooked in patients with epilepsy. We evaluate the oral health status of epilepsy patients from a tertiary teaching hospital. MATERIALS AND METHODS: We conducted a cross-sectional study of epilepsy patients from the neurology clinic, Hospital Canselor Tuanku Muhriz, Kuala Lumpur. The dental assessment included the decayed, missing and filled teeth (DMFT) criteria, as well as the plaque and periodontal status by dentists. RESULTS: A total of 151 patients were recruited. The median age of onset of epilepsy was 16 (IQR 7-30) years, with generalised seizures at 59.6% and focal seizures in 40.4% of patients. Fair or poor oral health was present in 59 (39.1%) and gingivitis was seen in 65 (43%). The median DMFT decayed (D), missing (M) and filled teeth (FT) was 3 (IQR 1- 7). The median age of patients with fair or poor oral health was older (40 years, IQR 31-51) than the patients with excellent or good oral health (33 years, IQR 26-45), (p=0.014). Multivariate logistic regression analysis showed that carbamazepine (Odds Ratios, OR: 3.694; 95% Confidence Intervals, 95%CI: 1.314, 10.384) and hypertension (OR 6.484; 95%CI: 1.011, 41.594) are the risk factors for fair or poor oral health. Phenytoin use is 4.271 times more likely to develop gingivitis (OR 4.271; 95% CI: 1.252, 14.573). CONCLUSION: Factors that contribute to fair or poor oral health include age, antiseizure medications like phenytoin and carbamazepine, and hypertension. Effective preventive strategies should be implemented to maintain oral health in epilepsy patients.

Efficacy and safety of adjunctive treatment with perampanel in epilepsy patients.

INTRODUCTION: Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy for both generalized and focal seizures. Owing to its high cost, the use of perampanel is limited in our country. MATERIALS AND METHODS: We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital. RESULTS AND CONCLUSIONS: From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects. CONCLUSION: Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.

Characteristics of electroencephalogram changes and correlation with seizures in hospitalised patients.

INTRODUCTION: Electroencephalogram (EEG) is an important investigational tool that is widely used in the hospital settings for numerous indications. The aim was to determine factors associated with abnormal EEG and its clinical correlations in hospitalised patients. MATERIALS AND METHODS: Patients with at least one EEG recording were recruited. The EEG and clinical data were collated. RESULTS: Two hundred and fifty patients underwent EEG and 154 (61.6%) were found to have abnormal EEG. The abnormal changes consist of theta activity (79,31.6%), delta activity (20, 8%), focal discharges (41,16.4%) and generalised discharges (14, 5.6%). Older patients had 3.481 higher risk for EEG abnormalities, p=0.001. Patients who had focal seizures had 2.240 higher risk of having EEG abnormalities, p<0.001. Low protein level was a risk for EEG abnormalities, p=0.003. CONCLUSION: This study emphasised that an abnormal EEG remains a useful tool in determining the likelihood for seizures in a hospital setting. The risk factors for EEG abnormality in hospitalised patients were age, focal seizures and low protein level. The EEG may have an important role as part of the workup in hospitalised patients to aid the clinician to tailor their management in a holistic manner.

Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur.

BACKGROUND AND OBJECTIVE: Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19. METHODS: This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists. RESULTS: In total there were 25 patients (all males; mean age [±SD], 21.64±2.40 years; range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were; upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19. CONCLUSION: We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.

Oesophageal intubation and ventilation as initial airway support of newborn infant with tracheal agenesis.

Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report.

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

The determination of glycyrrhizic acid in Glycyrrhiza uralensis Fisch. ex DC. (Zhi Gan Cao) root and the dried aqueous extract by LC-DAD.

A rapid, sensitive and specific reversed phase high-performance liquid chromatographic (LC) method with photodiode array detection (DAD) has been developed for the determination of glycyrrhizic acid in both the raw herb and a commercially prepared dried aqueous extract of Glycyrrhiza uralensis Fisch. ex DC. root (Zhi Gan Cao, liquorice). It was determined that extracting the raw herb in aqueous methanol (50:50 v/v) by sonication for 2 x 30 min was the most efficient sample preparation. Baseline resolution of the glycyrrhizic acid peak was achieved on a Varian Polaris RP C18-A (250 mm x 4.6 mm, 5 microm packing) column using an isocratic mobile phase consisting of 0. v aqueous phosphoric acid and acetonitrile in the ratio 60:40 v/v. Chromatograms were monitored between 200 and 400 nm for peak purity assessments, with quantitation performed at 254 nm. Glycyrrhizic acid calibration curves in the concentration range of 14-558 microg/ml were prepared on the day of analysis. Curve fitting was by the least-squares method, with correlation coefficients of >0.9998 obtained each time. The average recovery at three spike levels (50, 100, 200%) was of 95.91+/-1.05% and 98.36+/-3.45% (+/-S.D., n=7) for the spiked raw herb and dried aqueous extract respectively. The limit of detection and limit of quantitation was 0.52 and 1.72 mg/g respectively for the raw herb, and 0.75 and 2.51 mg/g respectively for the dried aqueous extract. Identity confirmation of the chromatographic peak was achieved by (-) electrospray ionisation tandem mass spectrometry. The concentration of glycyrrhizic acid in the root and dried aqueous extract was found to be 31.1+/-0.2 and 40.4+/-0.3mg/g (+/-S.D., n=7) respectively.

Successful intravenous thrombolysis of a wake-up stroke with underlying valvular atrial fibrillation.

A 42-year-old female admitted with new-onset atrial fibrillation had a wake-up stroke on the high-dependency unit and the time last seen well (TLSW) was 6.5 h. She suffered left-sided body weakness and her National Institutes of Health Stroke Scale (NIHSS) score was 17. An emergency CT perfusion showed right M1 segment occlusion with more than 50% penumbra. She was given recombinant tissue plasminogen activator (r-tPA) at 9 h from TLSW. An immediate diagnostic angiogram with intention to treat, owing to the presence of large vessel occlusion, showed complete reperfusion after intravenous r-tPA. She was discharged with NIHSS of 2, and at 3-month follow up her Modified Rankin Scale was 0. We demonstrated a successful reperfusion and excellent clinical recovery with intravenous thrombolysis in a patient who presented with a wake-up stroke with underlying valvular atrial fibrillation despite evidence of large vessel occlusion.

Validation of a method for the simultaneous determination of four schisandra lignans in the raw herb and commercial dried aqueous extracts of Schisandra chinensis (Wu Wei Zi) by RP-LC with DAD.

A rapid and specific reversed-phase high performance liquid chromatography (RP-LC) method with photodiode array detection (DAD) was developed and validated for the determination of four common schisandra lignans, schisandrin (1), schisandrol B (2), deoxyshisandrin (3) and gamma-schisandrin (4), in raw herb materials and commercial dried aqueous extracts of Schisandra chinensis (Wu Wei Zi). The extraction solvent and extraction method were optimised where it was found that a 4 h Soxhlet extraction using methanol was successful at extracting >99.5% of each of the schisandra lignans analysed from the raw herb material. The sample preparation process for the dried aqueous extract samples involved sonication using methanol for 2 x 30 min. The herb and extract solutions were separated on a Varian Microsorb-MV 100-5 C18 column using a gradient mixture of 0.1% aqueous phosphoric acid and acetonitrile. Subsequent detection and quantitation of the schisandra lignans was performed at 210 nm. The correlation coefficients of the linear regression analysis performed on these calibration curves were >0.9996 for all four schisandra lignans assayed. The detection limits and quantification limits ranged from 0.12 to 0.57 and 0.41 to 1.89 mg g(-1), respectively. The mean recoveries of the various analytes ranged from 92.20 to 107.01%. The method was used to investigate the levels of the four mentioned components in herb samples and dried aqueous extracts. The identities of the chromatographic peaks were confirmed by (+) electrospray ionisation LC-MS/MS.

Inhibition of elastolysis by proteinase inhibitors from chick plasma and aorta.

Chick plasma contains inhibitor(s) against trypsin and elastase which also appear to retard the degradation of tropoelastin by arterial tissue extracts. Chick aorta extracts also contain similar inhibitors against elastase and trypsin. Both levels of the plasma inhibitor(s) and inhibitor(s) extracted from thoracic aorta increase during early stages of growth and maturation. There is a three- to four-fold increase in the levels of the inhibitor(s) in chick plasma and aorta between one to four weeks after hatching. Of particular interest are the observations that the presence of the inhibitor(s) retards the conversion of soluble elastin (tropoelastin) to smaller elastin peptides. Subsequently, it is speculated that in addition to other vital roles, such proteinase inhibitors may also act in regulating elastogenesis and elastin fiber formation.

Choosing chemical markers for quality assurance of complex herbal medicines: Development and application of the herb MaRS criteria.

With increasing use of herbal medicines for chronic or serious illness, relevant quality assurance methods are essential for making claims of therapeutic benefit. Adequate demonstration of safety and efficacy based on chemical composition and ensuring consistency between manufactured batches is critical. To date, there has been no uniform standard approach or detailed framework provided to industry for selecting relevant chemical markers used to standardize herbal products. We developed the Herbal Marker Ranking System (Herb MaRS) providing guidance on prioritizing the selection of chemical markers for quality control of complex multi-herb mixtures, while also taking into account the bioactivity in relation to the symptoms of the disease and its concentration in the formula. We apply the Herb MaRS evaluation criteria to a seven-herb formulation for the treatment of irritable bowel syndrome with constipation. Our ranking scale accommodates the clinical and pharmacological use of the formulation and its claimed indications.

Demographic, dietary, life style, and anthropometric correlates of blood pressure.

The relationships between systolic and diastolic blood pressure, and select demographic, dietary, life-style, and anthropometric variables were examined for a specialized sample of 10,419 adults, 18 years and over, from the National Health and Nutrition Examination Survey (NHANES) I conducted in 1971-1974. The bivariate relationships of blood pressure to each of the measurements above were examined using zero-order correlation coefficients, and Step-wise linear regression. Age and body mass index (BMI) played a major role in accounting for most of the variance in blood pressure. These two indices alone accounted for 94.5% and 89.0% of the variance in systolic and diastolic blood pressure. In contrast, only 5.5% and 11.0% of the changes in systolic and diastolic blood pressure were explained by all other variables combined. Diet explained less than 1% of the total variance observed for blood pressure for whites, and less than 5% for nonwhites. Select dietary variables such as sodium/potassium ratio, calories from fat, and % saturated fat were not significantly (p less than 0.001) correlated to blood pressure. On the other hand, food calcium, sodium/calcium ratio, food vitamin C, and calcium/phosphorus ratio were significantly correlated to both systolic and diastolic blood pressure.

Dietary and serum folate: their influence on the outcome of pregnancy.

We examined the influence of folate intake from diet and supplements b y 28 wk of gestation and third trimester circulating concentrations of serum folate on the outcome of pregnancy in women from Camden, NJ. Mean daily folate intake by week 28 included both dietary and supplemental folate obtained prospectively in 832 women. Circulating concentrations of serum folate as well as serum vitamin B-12 were assayed at 28 wk of gestation (+/- 2 wk) by radioimmunoassay. The outcomes of interest included preterm delivery (<37 wk) and infants with low birth weight (<2500 g). Mean folate intake was significantly correlated with circulating concentrations of serum folate (r=0.17, P<0.001). Women with a low mean daily folate intake (

Maternal growth during pregnancy and the competition for nutrients.

The influence of maternal growth in knee height during pregnancy on birth weight, gestation, and maternal body composition was examined in 318 teenagers (144 growing, 174 nongrowing) and 276 mature women from the Camden Study. Body-composition differences associated with maternal growth did not arise until after 28 wk gestation, when growing gravidas continued to accrue fat, had larger gestational gains, and retained more of their gestational weight gain postpartum. Nevertheless, still-growing young mothers had infants with lower birth weight, particularly when the mother continued to accrue higher amounts of fat on the arm or back (subscapular site) late in gestation. Thus, despite an apparently sufficient weight gain and the accumulation of abundant stores during pregnancy, young still-growing women appeared not to mobilize fat reserves late in pregnancy to enhance fetal growth, apparently reserving them instead for their own continued development.

PIP: The influence of maternal growth in knee height during pregnancy on birth weight, gestation, and maternal body composition was examined in 318 teenagers (144 growing, 174 nongrowing) and 276 mature women from the prospective study of nutrition and pregnancy in Camden, NJ, one of the poorest cities in the continental United States. Enrollments included parous and nulliparous teenagers younger than 19 years of age along with more mature parous and nulliparous control subjects (aged 19-29 years) delivering between July 1987 and January 1992. Measures of maternal body composition taken at entry to prenatal care and at 28 weeks of gestation indicated little difference according to maternal growth in knee height. By the beginning of the third trimester, all groups had similar amounts of subcutaneous body fat and muscle. After 28 weeks, growing gravidas failed to lose fat at the sub-scapular site and tended to accrue fat at the triceps site, whereas mature women and nongrowing teenagers lost fat from their upper arms and backs. The more extreme example of this change in body composition for arm-fat area ( 2.6 square cm in 42% of growers vs. 18% of nongrowing teenagers and 21% of mature women, p 0.001) or subscapular skinfold thickness ( 1.5 mm in 32% of growers vs. 25% of nongrowing teenagers and 22% of mature women, p= 0.07) also was more prevalent among growers. When energy intake was adequate but growth continued, infant birth weight was reduced (-86 g), but when intake was inadequate and the mother continued to grow, the birth weight deficit was quite large (-320 g). Ratios of maternal net weight gain and infant birth weight to total gestational gain suggested that, when the mother was still growing, she retained a larger proportion of the total gestational gain. In the growing gravidas, infant weight was a significantly smaller proportion of total gestational gain; conversely, net maternal gain (at delivery) was a significantly larger proportion.

Maternal weight gain, diet and infant birth weight: correlations during adolescent pregnancy.

Inadequate weight gain during pregnancy is an important risk factor for low birth weight (LBW), but the contribution of diet to weight gain is uncertain. Pregnancy weight gains were examined at 4-week intervals from 12 to 36 weeks' gestation, as well as total gain for gestation, in a cohort of over 2000 young pregnant women, aged less than or equal to 18 at entry to prenatal care. The effect of diet was studied in a 15% random sample of the cohort, using a 24-hour dietary recall obtained at entry to prenatal care (averaging 17 weeks' gestation). As early as 16 weeks' gestation, gains below the lower limit of a clinical standard were associated with a decrement in birth weight at delivery of more than -85 g (p less than 0.01), and after 24 weeks of approximately -180 g (p less than 0.001). After adjusting for potential confounding variables, teenagers who went on to develop inadequate total weight gain for gestation had consumed 1878 kcal vs 2232 for teenagers with adequate total gain (p less than 0.05). There were significant deficits in protein (p less than 0.05) and carbohydrate intake (p less than 0.05) associated with inadequate gain. However, there was no direct effect of nutrient intake on birth weight, LBW, or preterm delivery. This suggests that the relationship between nutrient intake during pregnancy and birth weight may be indirect and moderated by weight gain during pregnancy.

Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight.

PURPOSE: The objective of this study was to determine the effect of total sugar intake by pregnant adolescents from low-income families on infant birth weight and small-for-gestational-age (SGA) infants. METHODS: The study sample consisted of 337 adolescents, enrolled in a county-wide demonstration project in Camden, New Jersey, who delivered live, singleton newborns. The adolescents were divided into two groups at the 90th percentile for the study sample total sugar intake (206 g): high-sugar intake (> or = 206 g, n = 34) and low-sugar intake group (< 206 g, n = 303). RESULTS: The sample was 46% black, 30% white, and 24% Hispanic. The sample gestational age and birth weight (mean +/- SD) were 39 +/- 3 weeks and 3189 +/- 666 g, respectively. After adjusting for energy intake, the high- compared with the low-sugar intake group was more likely to consume higher total sugar and carbohydrate but lower protein and fat. Likewise, the high-compared to the low-sugar intake group consumed significantly more calcium and magnesium. After adjusting for possible confounding variables such as maternal age, ethnicity, marital status, parity, smoking, net weight gain, body mass index, energy intake, and gestational age at birth, adolescents on high- compared to low-sugar diets gave birth to infants weighing 215 +/- 104 g less (p = 0.04). The adjusted odds ratios were 3.41 (95% confidence interval, 1.14 to 10.23) for delivering a SGA infant among adolescents with high- compared with low-sugar intakes. CONCLUSIONS: Low-income adolescents consuming high-sugar diets are at increased risk for delivering lower birth weight and SGA infants.

Role of plants, mycorrhizae and phytochelators in heavy metal contaminated land remediation.

Phytoremediation is a site remediation strategy, which employs plants to remove non-volatile and immisible soil contents. This sustainable and inexpensive process is emerging as a viable alternative to traditional contaminated land remediation methods. To enhance phytoremediation as a viable strategy, fast growing plants with high metal uptake ability and rapid biomass gain are needed. This paper provides a brief review of studies in the area of phytoaccumulation, most of which have been carried out in Europe and the USA. Particular attention is given to the role of phytochelators in making the heavy metals bio-available to the plant and their symbionts in enhancing the uptake of bio-available heavy metals.