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.

Acceptance towards social network information system for earlier detection of Influenza outbreak.

INTRODUCTION: Influenza outbreak causes high economic burden to Malaysia and other countries in South East Asia. Scientists have found a relatively new way to detect influenza outbreaks early thus reducing the burden of disease by early intervention. This new technology is a social network information system which uses Facebook or Twitter data to detect potential influenza cases. Such system is good to be developed by the Malaysian government as it can detect influenza outbreaks three weeks earlier than the normal pathway. However, to implement this we require good evidence that the development will be accepted by potential users. OBJECTIVE: This study was looking at the acceptance towards using social network information system among public health workers. MATERIALS AND METHOD: This study was done on 205 Malaysian One Health University Network (MyOHUN) members through email and physical survey. RESULTS: Results show that 62.4% public health workers accepted the use technology. The acceptance was shown to be associated with performance expectancy (p<0.05). However, unlike the very famous Unified Theory of Acceptance and Use of Technology (UTAUT) model, the acceptance of social network information system was not associated with effort expectancy, social factors, facilitating conditions and socio-demographic factors. Therefore, it is suggested that social network information system be developed by the authorities in Malaysia, and be developed in a way that the system could strongly increase performance in detection of outbreak earlier than the current normal pathways. As such the system to be accepted and used, it must be sensitive, specific and be able to detect influenza outbreak early CONCLUSION: The development of social network information system is feasible as it is highly accepted and it's potential to improve early detection of influenza outbreak.

Time-kill and post-antibiotic effect of colistin at different static concentrations in in vitro Acinetobacter baumannii.

Nosocomial infection caused by Acinetobacter baumannii is common among immunocompromised patients. Treatment strategy is limited due to rapid resistance development and lack of novel antibiotic. Colistin has been the last line therapy with good in vitro activity against infections caused by multi-drug resistance A. baumannii. However, pharmacological updates are required to support dosing optimisation. This study aimed to determine the time-kill kinetic and resistance development after antibiotic exposure as well as post-antibiotic effect of colistin at different static concentrations in in vitro A. baumannii system. The static in vitro time-kill and post-antibiotic effect experiments were conducted against two clinical isolates as well as one reference isolate ATCC 19606. Time-kill and postantibiotic effect were studied at colistin concentrations ranging from 0.25MIC to 16.0MIC and 0.5MIC to 4.0MIC, respectively. Post-exposure resistance development was examined in time-kill study. Killing activity and post-antibiotic effect were in a concentration-dependent manner. However, delayed killing activity indicates colistin tolerance. Development of resistance after exposure was not detected except for the ATCC 19606 strain. Dosing suggestion based on the observations include administration of supplemental dose 3 MIU at 12 hours after loading dose, administration of maintenance dose 9 MIU in two divided doses and application of extended interval in renal adjustment dose. However, the information is applicable for non-colistin-heteroresistance A. baumannii with colistin MIC < 1.0 mg/L. As for heteroresistance and strain with colistin MIC > 1.0 mg/L, combination therapy would be the more appropriate treatment strategy.

Time-kill and post-antibiotic effect of colistin at different static concentrations in in vitro Acinetobacter baumannii

@# Nosocomial infection caused by Acinetobacter baumannii is common among immunocompromised patients. Treatment strategy is limited due to rapid resistance development and lack of novel antibiotic. Colistin has been the last line therapy with good in vitro activity against infections caused by multi-drug resistance A. baumannii. However, pharmacological updates are required to support dosing optimisation. This study aimed to determine the time-kill kinetic and resistance development after antibiotic exposure as well as post-antibiotic effect of colistin at different static concentrations in in vitro A. baumannii system. The static in vitro time-kill and post-antibiotic effect experiments were conducted against two clinical isolates as well as one reference isolate ATCC 19606. Time-kill and postantibiotic effect were studied at colistin concentrations ranging from 0.25MIC to 16.0MIC and 0.5MIC to 4.0MIC, respectively. Post-exposure resistance development was examined in time-kill study. Killing activity and post-antibiotic effect were in a concentration-dependent manner. However, delayed killing activity indicates colistin tolerance. Development of resistance after exposure was not detected except for the ATCC 19606 strain. Dosing suggestion based on the observations include administration of supplemental dose 3 MIU at 12 hours after loading dose, administration of maintenance dose 9 MIU in two divided doses and application of extended interval in renal adjustment dose. However, the information is applicable for non-colistin-heteroresistance A. baumannii with colistin MIC < 1.0 mg/L. As for heteroresistance and strain with colistin MIC > 1.0 mg/L, combination therapy would be the more appropriate treatment strategy.

Bullying and truancy: Predictors to sexual practices among school-going adolescents in Malaysia - a cross-sectional study.

INTRODUCTION: Adolescents' involvement in sexual practices are becoming a major public health concern in Malaysia. This study aims to determine the prevalence of sexual practices among Malaysian school-going adolescents and its predictive factors. METHODS: A cross-sectional study was carried out from April 2012 till September 2012 among 16-year-old school adolescents from two different schools. They were selected through simple random sampling and these adolescents answered a self-administered questionnaire consisting of three sections i.e. socio-demography, risk-taking behaviours and family-adolescents relationship. Data were analysed using Pearson Chi-Square test while Simple Logistic Regression and Multiple Logistic Regression were applied to determine the predictive factors. RESULTS: The prevalence of sexual practices among the adolescents was 30.1% in which they were either involved in pornography (26.8%), pre-sexual activities (8.5%) or premarital sex (2.9%). Six predictive factors associated with sexual practices among this age group were identified which were male (adjusted Odds Ratio (aOR) 2.7, 95% Confidence Interval (95%CI) 1.4 to 2.5), truancy (aOR 2.3, 95%CI 1.3 to 4.2), bully (aOR 3.5, 95%CI 1.7 to 7.3), hanging out (aOR 2.8, 95% 1.4 to 5.6), staying out late (aOR 3.2, 95%CI 1.5 to 6.8) and conflict with family (aOR 4.1, 95%CI 1.9 to 8.9). DISCUSSION: Asian background differs from the western countries and findings of this study may suggest suitable intervention programmes that can prevent high-risk sexual practices among Asian school-going adolescents.

Post-Traumatic Stress Disorder And Its Associated Factors Among School-Going Children Exposed To A Tsunami Disaster In Malaysia

Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis made when someone including children who experiences traumatic stressor. Those who are exposed to a more severe trauma have highest level of PTSD. The aim of this study was to measure the prevalence of PTSD and its associated factors among 219 children who were affected by a form of natural disaster which is the tsunami waves in a rural area in Malaysia. A cross sectional study was carried out among children aged 10-12 years 6 months after the traumatic event. Child Posttraumatic Stress Disorder –Reaction Index (CPTSD-RI) was used as a screening instrument which was answered by the affected children through a self-administered questionnaire. Forty six percent of these children had PTSD symptoms; 31.1% of these children had mild, 11.4% had moderate, 3.7% had severe PTSD and none had very severe PTSD. Result also showed that 91.8% had re-experiencing symptoms, 28.3% had numbing/avoidance symptoms and 49.3% had hyperarousal symptoms. Children with low social support (Adj OR = 2.3 (95% CI: = 1.3- 4.2)), and children who experienced deaths among someone close to them (Adj OR = 3.7 (95% CI =1.2 - 11.5)) were more likely to have symptoms of PTSD. This showed that children are at higher risk of developing PTSD as early as 6 months after the event and thus early intervention should be offered to them. Future longitudinal study can be carried out among affected children to assess whether these PTSD symptoms persist over time.

Outcome of oral tongue squamous cell carcinoma in patients with and without known risk factors.

BACKGROUND: Tobacco smoking and high alcohol consumption are considered major risk factors of oral tongue squamous cell carcinoma. This study compared disease outcome between patients with and without known risk factors. METHODS: Patients with oral tongue squamous cell carcinoma treated at two major medical centers from 1994 to 2008 were identified by cancer registry search. The medical files were reviewed for background-and-disease-related data, risk factors, and outcome. RESULTS: The study sample consisted of 291 patients: 175 had a history of heavy tobacco smoking and alcohol abuse and 116 did not. Comparison of the patients without risk factors between the two centers yielded no differences in background features. Men accounted for 74% of the total patients with risk factors and comprised 77% of the risk-factor group. The risk-factor group was characterized by a significantly higher mean tumor grade (p=0.0001) and greater tumor depth of invasion (p=0.022) than the non-risk-factor group. The 5-year local and regional control rates were 85.3% and 74%, respectively, with no significant difference between the groups. The 5-year overall survival rate was 68% in the risk-factor group and 64% in the non-risk-factor group (p=NS). Separate analysis of patients aged <40 years at diagnosis revealed a worse overall (p=0.015) and disease-free survival (p=0.038) in those without risk factors. CONCLUSIONS: The outcome of oral tongue carcinoma is similar in patients with and without risk factors. The worse prognosis in younger patients (<40 years) without risk factors suggests that the pathogenesis in these cases involves factors other than smoking and alcohol.

Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome.

OBJECTIVE: To assess the possible effect of young age on clinical behaviour and survival outcome of squamous cell carcinoma of the oral tongue. DESIGN: Retrospective, case control study. SETTING: A major tertiary referral centre. PARTICIPANTS: Eighty-five patients with oral tongue squamous cell carcinoma with at least 2 years of follow-up. MAIN OUTCOME MEASUREMENTS: Clinical and histopathological staging, disease-free survival, disease-specific survival and overall survival. RESULTS: Eleven patients (13%) were younger than 30 years. Compared to the older patients, they had a significantly worse N stage (P = 0.041), more perineural invasion (P = 0.012), and higher rates, though not significant, of treatment failure (46%, including 60% with distant metastases, versus 35%, nearly all locoregional) and mortality (100% of treatment failures versus 73%). There were no significant between-group differences in 5-year disease-free, disease-specific, and overall survival. CONCLUSION: In this study, patients younger than 30 years of age presented with advanced tumour stages and with a different failure pattern compared to the older age group. This may be attributable to age-related biologic behaviour or delayed cancer diagnosis. Differences in disease free survival and overall survival could not be established.

Carbon dioxide laser cordectomy for verrucous carcinoma of vocal folds.

BACKGROUND: Verrucous carcinoma occurs infrequently in the vocal folds. This tumour has an excellent prognosis with proper treatment. Management strategies include surgery, radiotherapy or both. AIM: To evaluate the long-term results of type I and II laser cordectomy for the treatment of verrucous carcinoma of the vocal folds. MATERIALS AND METHODS: We reviewed the files of 18 patients with verrucous carcinoma of the vocal folds treated by type I or II laser cordectomy in our department from 1989 to 2006, and recorded clinical and outcome data. RESULTS: None of the patients had any major post-operative complications. All had a subjectively satisfactory quality of voice, with no morbidity. Patient follow up ranged from three to 228 months (mean, 48 months). Five patients were treated with post-operative radiotherapy for persistent disease, of whom four underwent repeated surgery due to recurrence. CONCLUSION: Type I or II laser cordectomy is a safe, feasible, secure method of treating verrucous carcinoma of the vocal folds. There were no major complications in our patient series. Most recurrent disease was manageable locally with repeated surgery.

[Behavior of neonates with hyperbilirubinemia treated with blue light]. / Chováni novorozencu s hyperbilirubinémii lécených modrým svetlem.

Two groups of fullterm newborns were polygraphically examined. The first group consisted of 10 newborns with hyperbilirubinemia treated by phototherapy, the second group was a control one and consisted also of 10 newborns. The polygrams were made at the age of four days. The length of the sleep cycle, the length of quiet and paradoxical sleep, respiratory rate during both sleep states, the frequency of rapid eye movements during paradoxical sleep, the frequency of EMG discharges during paradoxical sleep, the number of sleep apneas during paradoxical sleep and the incidence of body movements during the whole recording time (100 minutes) were assessed. There were no significant differences in majority of parameters, only the length of paradoxical sleep and the number of sleep apneas were significantly higher in infants with hyperbilirubinemia. Infants with higher levels of bilirubin had longer sleep cycle, longer paradoxical sleep and lower incidence of body movements. Large individual differences in all parameters studied were observed, especially in infants with hyperbilirubinemia. This indicates that special observational care should be given to these infants.

[Photoisomers of bilirubin in the blood of neonates during phototherapy]. / Fotoizoméry bilirubinu v krvi novorozencu pri fototerapii.

In a group of mature neonates with hyperbilirubinaemia the authors investigated by chromatography, using the HPLC method, levels of bilirubin photoisomers before phototherapy, in the course of phototherapy and after its termination. The configuration isomer 4 Z, 15 E is detected in blood of all icteric neonates already before the onset of treatment in a mean concentration of 5.2 (s = 3.8) mumol/l, during phototherapy its mean concentration is 23.0 (s = 8.0) mumol/l. Photoisomers participate in non-conjugated bilirubinaemia on average by 10%: 92% are formed by isomer 4 Z, 15 E, 5% by isomer 4 E, 15 Z and 3% by the structural isomer lumirubin. On the day following discontinuation of treatment the mean photoisomer concentrations are significantly lower than during phototherapy and significantly higher than before its initiation.

Study of the mechanism of the photoisomerization and photooxidation of bilirubin using a model for the phototherapy of hyperbilirubinemia.

Liquid chromatography was employed for a study of photochemical degradation of bilirubin in the complex with human albumin, using a model system in the presence of riboflavin. The concentrations of bilirubin, the photoisomers and biliverdin were monitored. The reaction mechanism was verified using a quantified mathematical model and was represented by a reaction scheme. Photoisomerization is the initial process, followed by photooxidation to degradation products of the tetrapyrrole skeleton, with formation of biliverdin as an intermediate. The blood of newborns that were irradiated for treatment of hyperbilirubinemia was studied for the sake of comparison. The effect of some biochemically important substances was followed, in view of possible inhibition of the processes. The experimental results demonstrate that riboflavin acts as a catalyst, even at the concentrations typical for its occurrence in blood. The results are discussed from the point of view of the mechanism of bilirubin degradation during phototherapy.

[Transcutaneous measurement of the severity of icterus and bilirubinemia in normal neonates]. / Transkutánní merení intenzity ikteru a bilirubinémie fyziologických novorozencu.

Using a Minolta/Air Shields apparatus, the authors made 1040 transcutaneous estimations of the intensity of jaundice and examined at the same time the serum bilirubin in 603 normal mature neonates. They revealed a significant (P less than 0.001) correlation between the results of this estimation on the sternum and bilirubinaemia (r = 0.75). Based on the assessment of the 95% confidence limit of prediction of linear regression the authors defined and confirmed by statistical calculations for bilirubinaemia values of 200, 250 and 300 mumol/l four grades of intensity of jaundice. By the suggested procedure omission of early indication of laboratory examination and phototherapy is reduced to a minimum and conversely it is possible to avoid in some neonates collection of blood samples for laboratory examination.

[Alpha-fetoprotein in umbilical cord blood and hyperbilirubinemia in normal neonates]. / Alfa-fetoprotein v pupecníkové krvi a hyperbilirubinémie fyziologických novorozencu.

In a group of 154 mature normal neonates the authors recorded significantly higher mean alpha-fetoprotein values in children with hyperbilirubinaemia (higher than 205 mumol/l) than in other neonates. The differences were observed also in children of equal gestation age. Development of hyperbilirubinaemia is more probable and indication for phototherapy is significantly higher in neonates with alpha-fetoprotein levels in umbilical blood above 100 mg/l and these infants must be carefully observed. When the concentration is above 130 mg/l, the development of hyperbilirubinaemia may be assumed with certainty. Examination of alpha-fetoprotein in umbilical blood is an useful indicator of the functional maturity of the liver, but does not ensure reliable prediction of hyperbilirubinaemia in individual neonates. A concentration of alpha-fetoprotein above 100 mg/l is exceptional among neonates without hyperbilirubinaemia, while lower values do not rule out the development of hyperbilirubinaemia.

[Results of phototherapy in neonatal hyperbilirubinemia using green and blue light]. / Výsledky fototerapie novorozeneckých hyperbilirubinémií zeleným a modrým svetlem.

In a group of normal newborns with birth weights of 2500 g and more treated on account of hyperbilirubinaemia the authors recorded a significantly shorter period of decline of serum bilirubin in 40 children with blue light phototherapy than in 40 children with green light phototherapy. The period of decline of bilirubinaemia with green light phototherapy did not differ on average from the period of spontaneous decline recorded in a group of 40 normal neonates with untreated hyperbilirubinaemia.

[The effect of blue light on the behavior of neonates]. / Vliv modrého svetla na chování novorozencu.

In ten healthy neonates the influence of blue light was analyzed, using polygraphy. In each child the polygrams were assessed under two conditions--without irradiation and without irradiation. The length of the sleep, cycle, the length of quit and paradoxical sleep, the respiration rate during both behavioural states, the frequency of rapid eye movements during paradoxical sleep, the incidence of EEG activity corresponding to age and the EMG activity during both behavioural states did not change significantly under the influence of light. Only the number of apnoeic intervals during paradoxical sleep under blue light increased significantly. The authors assessed, using polygraphy, also a control group of ten healthy mature neonates. The two groups of children did not differ significantly in the investigated parameters. The results revealed a great inter- and intraindividual variability which suggests the low stability of the child's behaviour during the first days of life. Among the numerous stimuli of the external and internal environment which modify the behaviour during the period of postpartum adaptation, the influence of blue light did not play a significant role under the above conditions.

[Hyperbilirubinemia in normal neonates]. / Hyperbilirubinémie fyziologických novorozencu.

In a group of 13,449 neonates with a birth weight of 2500 g or more and without an incompatible constellation with the mothers in the Rh and ABO system in 17.7% of the children a rise od serum bilirubin above 205 mumol/l was found and 5.3% of the children were treated by phototherapy. The frequency of hyperbilirubinaemias and phototherapy in the course of the ten-year investigation rose significantly. Among neonates with hyperbilirubinaemia and those having phototherapy boys predominate significantly. The development of serum bilirubin levels differs as to the course, maximum value and period of the peak and suggests that also in normal mature neonates the rate of adaptation of the bilirubin metabolism displays great individual variations.

ABO haemolytic disease: sex ratio and blood groups in the newborns requiring treatment.

In our group of newborns we have observed that the rate of occurrence of incompatibility states between blood group 0 mothers and their blood group A or B offspring amounted to 14%. It was in every tenth newborn that this incompatibility became manifest as a haemolytic disease requiring treatment. There were no significant differences between blood group A or B newborn infants, either in the frequency rates of hyperbilirubinaemia or in the uniformly indicated therapeutical measures. Among the neonates treated successfully by phototherapy boys prevailed significantly. In contrast, among the most severe forms of the ABO haemolytic disease, requiring blood exchange transfusion, there was a significantly higher prevalence of girls. In relationship to the time of institution of phototherapy as a method of treatment, there occurred a significant decrease of the rates of newborns treated by exchange transfusion. This was due specially to a significant decrease of the necessity of performing this procedure in blood group A boys.