Tumour lysis syndrome in a neonate with transient abnormal myelopoiesis.

BACKGROUND: Tumor lysis syndrome (TLS) is an oncological emergency associated with hematological malignancies or highly proliferative solid tumors, commonly after chemotherapy. It is rarely associated with transient abnormal myelopoiesis. OBSERVATION: We report a rare case of a neonate with transient abnormal myelopoiesis and tumor lysis syndrome, complicated with concomitant heart failure due to an underlying atrioventricular septal defect. Hyperhydration was contraindicated due to heart failure. The patient was managed conservatively with full recovery. CONCLUSION: Tumor lysis syndrome should be suspected in neonates with transient abnormal myelopoiesis with electrolyte abnormalities. Treatment options should be considered carefully for their risks and benefits.

Evaluation of quantitative point-of-care test for measurement of glucose-6-phosphate dehydrogenase enzyme activity in Malaysia.

INTRODUCTION: The treatment of Plasmodium vivax malaria with 8-aminoquinolines is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals due to the risk of acute haemolytic anaemia. Effective G6PD screening is paramount to avoid adverse drug reactions. This study aimed to evaluate the performance of novel quantitative point-of-care (POC) tests as a new screening method for G6PD deficiency in Malaysia. MATERIALS AND METHODS: A total of 153 neonatal cord blood, 99 peripheral blood of older children aged between 1 month to 12-years old, and 62 peripheral adult blood were screened for G6PD deficiency using two quantitative POC tests, CareStartTM biosensor (Carestart) and CareStartTM Biosensor 1 (S1). The results were compared with OSMMR2000D kit as a reference assay. Two statistical analyses were performed in this study to evaluate the POC test performances, the Spearman's correlation test and the Cohen's kappa method. RESULTS: Both Carestart and S1 tests showed significant positive correlations to OSMMRS000D with r2 = 0.7916 and r2 = 0.7467. Their measurement of agreement showed a kappa (κ) value of 0.805 (p<0.001, 95% CI), and 0.795 (p<0.001, 95% CI), respectively. Analysis of the area under the Receiver Operating Curve (ROC) at 60% cut-off illustrated that the Carestart had 90.2% sensitivity, 98.9% specificity, 98.3% positive predictive value (PPV), and 93.8% negative predictive value (NPV). The corresponding values for the S1 were 95.2%, 100%, 100%, and 96.8%, respectively. CONCLUSION: This study showed that the Carestart and S1 biosensors have high-performance reliability for screening of G6PD deficiency, which can guide safe prescriptions of anti-malaria medications and hence, eradication of Plasmodium vivax malaria.

CuO improved energy band of AgO/fibrous SiO2-ZrO2 for optimized simultaneous photocatalytic redox of chromium (VI) and p-cresol using response surface methodology.

Ternary CuO/AgO/FSZr photocatalysts were fabricated via the hydrothermal and electrochemical methods with three different CuO loading (1, 3 and 5 wt%), indicated as 1CuO/AgO/FSZr, 3CuO/AgO/FSZr and 5CuO/AgO/FSZr. The photocatalytic reaction was tested towards simultaneous chromium (VI) photoreduction and p-cresol photooxidation and the performance in order as follow: 3CuO/AgO/FSZr > 5CuO/AgO/FSZr > 1CuO/AgO/FSZr > AgO/FSZr > FSZr. CuO/AgO/FSZr photocatalysts showed an improvement in photocatalytic activity compared to AgO/FSZr and FSZr due to the reduction potential of chromium (VI) aligned closer to the conduction band of CuO and provided abundant free active electrons (e-) and holes (h+) with efficient transportation and migration. Interestingly, the 3CuO/AgO/FSZr was established as the best photocatalyst with 98% reduction of chromium (VI) and 83% oxidation of p-cresol simultaneously, owing to its strong corporation between the metal oxides and support and higher total pore volume. The Langmuir-Hinshelwood model were employed for kinetics which followed the pseudo-first-order kinetics model well. Based on the simultaneous photocatalytic mechanism, chromium (VI) and p-cresol were directly reduced and oxidized by e- and h+, respectively. The response surface methodology (RSM) discovered that the quadratic term initial concentration of chromium (VI) is the main significant factor in photocatalytic performance. The optimum parameters for simultaneous photoredox of chromium (VI) and p-cresol predicted from RSM are 9.6 mg L-1 of chromium (VI) concentration, 9.8 mg L-1 of p-cresol concentration and 0.32 g L-1 of catalyst dosage. Under these conditions the error between the predicted and experimental values is only 3.7%. The 3CuO/AgO/FSZr sustained the photocatalytic performance after reused for five cycles and could oxidized various organic pollutants as well as reduced chromium (VI) simultaneously.

Promoting a well-dispersion of MoO3 nanoparticles on fibrous silica catalyst via one-pot synthesis for enhanced photoredox environmental pollutants efficiency.

The coexistence of pharmaceutical compounds and heavy metals in the aquatic environment has resulted in complications in the treatment process and thus, causing uproar among the citizens. The radical-based photocatalysis technology has aroused as an excellent method to eliminate both heavy metal and pharmaceutical compounds in the water. Herein, reported the utilization of the microemulsion technique for the preparation of nanoporous fibrous silica-molybdenum oxide (FSMo) towards simultaneous photocatalytic abatement of hexavalent chromium (Cr(VI)) and tetracycline (TC). The FESEM analysis showed the spherical morphology of the FSMo catalyst with dendrimeric silica fiber. The synthesized FSMo catalyst exhibited narrowed bandgap, high crystallinity, and well Mo element dispersion for enhanced photo-redox of Cr(VI) and TC. Remarkably, simultaneous remediation of the Cr(VI) and TC over FSMo demonstrated superior photocatalytic efficiency, 69% and 75%, respectively, than in the individual system, possibly due to the effective separation of photoinduced charges. The introduction of the Mo element to the silica framework via microemulsion technique demonstrated better dispersion of Mo compared to the incipient wetness impregnation method and thus, yielded higher photocatalytic activity towards simultaneous removal of TC and Cr(VI). Besides, quenching experiments revealed the electrons and holes as the active species that play a dominant role in the simultaneous photo-redox of Cr(VI) and TC. Lastly, the FSMo catalyst demonstrated high stability after four continuous cycles of simultaneous photocatalysis reactions, implying its potential as a suitable material for practical wastewater treatments.

An intriguing Z-scheme titania loaded on fibrous silica ceria for accelerated visible-light-driven photocatalytic degradation of ciprofloxacin.

A novel Z-scheme titania loaded on fibrous silica ceria (Ti-FSC) was triumphantly fabricated via hydrothermal followed by electrolysis method and evaluated for the visible-light degradation of ciprofloxacin (CIP). Noticeably, Ti-FSC exhibits as an efficient photocatalyst for CIP photodegradation with 95% as followed by titania loaded on fibrous silica (Ti-FS) (68%), Ti-CeO2 (35%), FSC (47%), FS (22%), and CeO2 (17%). The combination of the inherent merits of Ti loaded on FSC is able to realize the crucial role of Ce in harnessing the high dispersion of Ti, which could beneficial for improving the performance proven by XRD, FESEM, TEM and FTIR. Consequently, high dispersion of Ti on FSC has worthwhile towards the interaction of the Si-O-Ti, Ce-O-Ti, and Si-O-Ti, which could enhance the CIP photodegradation by providing more surface defects, narrowing the band gap, improving electron-hole separation and suppressing electron-hole recombination that revealed by XPS, UV-vis/DRS, Nyquist plots and PL studies, respectively. The scavenger study revealed that the controlling species in the system was hydroxyl radical and holes. A potential Z-scheme heterojunction mechanism for Ti-FSC was deduced from the band structure analysis. The possible photodegradation pathway was proposed based on GCMS analysis. Besides, the acceptable reusability, which exceeded 90% of degradation indicated the great application potential of Z-scheme Ti-FSC in wastewater treatment and others application.

A review on synergistic coexisting pollutants for efficient photocatalytic reaction in wastewater remediation.

With the tremendous development of the economy and industry, the pollution of water is becoming more serious due to the excessive chemical wastes that need to remove thru reduction or oxidation reactions. Simultaneous removal of dual pollutants via photocatalytic redox reaction has been tremendously explored in the last five years due to effective decontamination of pollutants compared to a single pollutants system. In a photocatalysis mechanism, the holes in the valence band can remarkably promote the oxidation of a pollutant. At the same time, photoexcited electrons are also consumed for the reduction reaction. The synergistic between the reduction and oxidation inhibits the recombination of electron-hole pairs extending their lifetime. In this review, the binary pollutants that selectively removed via photocatalysis reduction or oxidation are classified according to heavy metal-organic pollutant (HM/OP), heavy metal-heavy metal (HM/HM) and organic-organic pollutants (OP/OP). The intrinsic between the pollutants was explained in three different mechanisms including inhibition of electron-hole recombination, ligand to metal charge transfer and electrostatic attraction. Several strategies for the enhancement of this treatment method which are designation of catalysts, pH of mixed pollutants and addition of additive were discussed. This review offers a recent perspective on the development of photocatalysis system for industrial applications.

A state of the art review on electrochemical technique for the remediation of pharmaceuticals containing wastewater.

Pharmaceutical wastewater is a frequent kind of wastewater with high quantities of organic pollutants, although little research has been done in the area. Pharmaceutical wastewaters containing antibiotics and high salinity may impair traditional biological treatment, resulting in the propagation of antibiotic resistance genes. The potential for advanced oxidation processes (AOPs) to break down hazardous substances instead of present techniques that essentially transfer contaminants from wastewater to sludge, a membrane filter, or an adsorbent has attracted interest. Among a variety of AOPs, electrochemical systems are a feasible choice for treating pharmaceutical wastewater. Many electrochemical approaches exist now to remediate rivers polluted by refractory organic contaminants, like pharmaceutical micro-pollutants, which have become a severe environmental problem. The first part of this investigation provides the bibliometric analysis of the title search from 1970 to 2021 for keywords such as wastewater and electrochemical. We have provided information on relations between keywords, countries, and journals based on three fields plot, inter-country co-authorship network analysis, and co-occurrence network visualization. The second part introduces electrochemical water treatment approaches customized to these very distinct discarded flows, containing how processes, electrode materials, and operating conditions influence the results (with selective highlighting cathode reduction and anodic oxidation). This section looks at how electrochemistry may be utilized with typical treatment approaches to improve the integrated system's overall efficiency. We discuss how electrochemical cells might be beneficial and what compromises to consider when putting them into practice. We wrap up our analysis with a discussion of known technical obstacles and suggestions for further research.

A critical review on relationship of CeO2-based photocatalyst towards mechanistic degradation of organic pollutant.

Nanostructured photocatalysts commonly offered opportunities to solve issues scrutinized with the environmental challenges caused by steep population growth and rapid urbanization. This photocatalyst is a controllable characteristic, which can provide humans with a clean and sustainable ecosystem. Over the last decades, one of the current thriving research focuses on visible-light-driven CeO2-based photocatalysts due to their superior characteristics, including unique fluorite-type structure, rigid framework, and facile reducing oxidizing properties of cerium's tetravalent (Ce4+) and trivalent (Ce3+) valence states. Notwithstanding, owing to its inherent wide energy gap, the solar energy utilization efficiency is low, which limits its application in wastewater treatment. Numerous modifications of CeO2 have been employed to enhance photodegradation performances, such as metals and non-metals doping, adding support materials, and coupling with another semiconductor. Besides, all these doping will form a different heterojunction and show a different way of electron-hole migration. Compared to conventional heterojunction, advanced heterojunction types such as p-n heterojunction, Z-scheme, Schottky junction, and surface plasmon resonance effect exhibit superior performance for degradation owing to their excellent charge carrier separation, and the reaction occurs at a relatively higher redox potential. This review attends to providing deep insights on heterojunction mechanisms and the latest progress on photodegradation of various contaminants in wastewater using CeO2-based photocatalysts. Hence, making the CeO2 photocatalyst more foresee and promising to further development and research.

Polyphosphate (PolyP) for alveolar cleft repair: study protocol for a pilot randomized controlled trial.

OBJECTIVE: Bone grafting is an important surgical procedure to restore missing bone in patients with alveolar cleft lip/palate, aiming to stabilize either sides of the maxillary segments by inducing new bone formation, and in bilateral cleft cases also to stabilize the pre-maxilla. Polyphosphate (PolyP), a physiological polymer composed of orthophosphate units linked together with high-energy phosphate bonds, is a naturally existing compound in platelets which, when complexed with calcium as Ca-polyP microparticles (Ca-polyP MPs), was proven to have osteoinductive properties in preclinical studies. AIM: To evaluate the feasibility, safety, and osteoinductivity of Ca-polyP MPs as a bone-inducing graft material in humans. METHODS: This prospective non-blinded first-in-man clinical pilot study shall consist of 8 alveolar cleft patients of 13 years or older to evaluate the feasibility and safety of Ca-PolyP MPs as a bone-inducing graft material. Patients will receive Ca-polyP graft material only or Ca-polyP in combination with biphasic calcium phosphate (BCP) as a bone substitute carrier. During the trial, the participants will be investigated closely for safety parameters using radiographic imaging, regular blood tests, and physical examinations. After 6 months, a hollow drill will be used to prepare the implantation site to obtain a biopsy. The radiographic imaging will be used for clinical evaluation; the biopsy will be processed for histological/histomorphometric evaluation of bone formation. DISCUSSION: This is the first-in-man study evaluating the safety and feasibility of the polyP as well as the potential regenerative capacity of polyP using an alveolar cleft model. TRIAL REGISTRATION: Indonesian Trial Registry INA-EW74C1N . Registered on 12 June 2020.

Simultaneous photocatalytic reduction of hexavalent chromium and oxidation of p-cresol over AgO decorated on fibrous silica zirconia.

The co-existence of heavy metals and organic compounds including Cr(VI) and p-cresol (pC) in water environment becoming a challenge in the treatment processes. Herein, the synchronous photocatalytic reduction of Cr(VI) and oxidation of pC by silver oxide decorated on fibrous silica zirconia (AgO/FSZr) was reported. In this study, the catalysts were successfully developed using microemulsion and electrochemical techniques with various AgO loading (1, 5 and 10 wt%) and presented as 1, 5 and 10-AgO/FSZr. Catalytic activity was tested towards simultaneous photoredox of hexavalent chromium and p-cresol (Cr(VI)/pC) and was ranked as followed: 5-AgO/FSZr (96/78%) > 10-AgO/FSZr (87/61%) > 1-AgO/FSZr (47/24%) > FSZr (34/20%). The highest photocatalytic activity of 5-AgO/FSZr was established due to the strong interaction between FSZr and AgO and the lowest band gap energy, which resulted in less electron-hole recombination and further enhanced the photoredox activity. Cr(VI) ions act as a bridge between the positive charge of catalyst and cationic pC in pH 1 solution which can improve the photocatalytic reduction and oxidation of Cr(VI) and pC, respectively. The scavenger experiments further confirmed that the photogenerated electrons (e-) act as the main species for Cr(VI) to be reduced to Cr(III) while holes (h+) and hydroxyl radicals are domain for photooxidation of pC. The 5-AgO/FSZr was stable after 5 cycles of reaction, suggesting its potential for removal of Cr(VI) and pC simultaneously in the chemical industries.

Green carbonaceous material‒fibrous silica-titania composite photocatalysts for enhanced degradation of toxic 2-chlorophenol.

In this work, fibrous silica-titania (FST) was successfully prepared by the microemulsion method prior to the addition of three types of carbonaceous materials: graphitic-carbon nitride, g-C3N4 (CN), graphene nanoplatelets (GN), and multi-wall carbon nanotubes, MWCNT (CNT), via a solid-state microwave irradiation technique. The catalysts were characterized using XRD, FESEM, TEM, FTIR, UV-Vis DRS, N2 adsorption-desorption, XPS and ESR, while their photoactivity was examined on the degradation of toxic 2-chlorophenol (2-CP). The result demonstrated that the initial reaction rate was in the following order: CNFST (5.1 × 10-3 mM min-1) > GNFST (2.5 × 10-3 mM min-1) > CNTFST (2.3 × 10-3 mM min-1). The best performance was due to the polymeric structure of g-C3N4 with a good dispersion of C and N on the surface FST. This dispersion contributed towards an appropriate quantity of defect sites, as a consequence of the greater interaction between g-C3N4 and the FST support, that led to narrowed of band gap energy (2.98 eV to 2.10 eV). The effect of scavenger and ESR studies confirmed that the photodegradation over CNFST occurred via a Z-scheme mechanism. It is noteworthy that the addition of green carbonaceous materials on the FST markedly enhanced the photodegradation of toxic 2-CP.

Enhanced visible-light driven multi-photoredox Cr(VI) and p-cresol by Si and Zr interplay in fibrous silica-zirconia.

Multiple contaminants including heavy metals and phenolic compounds are normally co-exist in wastewater, which caused the treatment process is rather complicated. Herein, the synergistic photoredox of Cr(VI) and p-cresol (pC) by innovative fibrous silica zirconia (FSZr) photocatalyst was reported. The high surface area of FSZr comprised of microspheres with a bicontinuous concentric lamella structure morphology consisted of silica, while its core consisted of ZrO2 structure. The rearrangement of FSZr framework increased the crystallinity, formed Si-O-Zr bonds and narrowed the band gap of ZrO2 for enhanced of photoredox of Cr(VI) and pC. Compared to the reaction, the photoredox efficiency of FSZr for removing Cr(VI) and pC in simultaneous system was found to be 96 % and 59 %, respectively which are higher than that in its single system owing to the efficient electron-hole charge separation. Phenolic compound with high degree of electron donating group gave beneficial effect to photoreduction of Cr(VI). Consequently, a proposed mechanism involving multi-photoredox pathway were proposed based on photoredox reaction and scavengers studies. FSZr sustained the simultaneous photoredox activities after five runs demonstrating its possibility to be use in the wastewater treatment of various pollutants.

Anti-diabetic medication burden amongst older persons with diabetes and associated quality of life.

BACKGROUND: Older persons with diabetes are the major demographic of diabetic patients followed up in primary health clinics. Despite their increasing age and morbidities, they are still being managed strictly towards good sugar control in order to achieve the ideal HbA1c level without taking their quality of life into consideration. This study aimed to determine the prevalence in the use of antidiabetic drugs among older persons with diabetes and its association with their quality of life. METHODOLOGY: A cross-sectional study was conducted among 269 older persons with diabetes in all government health clinics in Kuantan using Diabetes Quality of Life questionnaire. SPSS version 23 was used for the statistical analysis. RESULTS: Majority of the respondents were females (61%), Malays (84.8%), pensioners (54.3%) with education up to primary school (52%) and are staying with family members (93.7%). Most of the patients were on two antidiabetic agents (48%) followed by a single antidiabetic agent (32%). Despite the risk of hypoglycaemia, 0.4% of them are on glibenclamide. The use of insulin is still common among 21% of them that are on intermediate-acting insulin, 15.6% on premixed insulin and 7.8% on short-acting insulin. Those taking a higher number of antidiabetic agents were found to be associated with poorer quality of life (p=0.001) compared to those taking one or two antidiabetic medications. Those on insulin also have significantly poorer quality of life score (p=0.012). CONCLUSION: Despite aiming for controlled diabetes, older persons suffer poor quality of life with further intensification of their antidiabetic medications according to the guidelines. This includes the complexity of insulin usage and polypharmacy, which contribute to the low quality of life score.

The Influence of Ficus deltoidea in Preserving Alveolar Bone in Ovariectomized Rats.

Ficus deltoidea has been shown to possess antioxidant properties that could prevent the development of chronic inflammatory bone diseases. In this study, the efficacy of F. deltoidea in preventing alveolar bone resorption in osteoporotic rats induced by ovariectomy (OVX) was investigated. Twenty-four female Wistar rats were divided into four groups (n = 6) consisting of sham-operated (SO), ovariectomized control (OVXN), ovariectomized treated with estrogen (OVXP), and ovariectomized treated with F. deltoidea extract (OVXF). At the beginning of the study, two nonovariectomized, healthy rats were sacrificed to serve as baseline (BL). Treatment of the rats commenced two weeks after ovariectomy-the OVXP rats that served as positive control received Premarin® (64.5 µg/kg body weight), while OVXF rats were given F. deltoidea (800 mg/kg body weight); both agents were administered orally for two months. The negative control group of rats (OVXN) and the SO group received deionized water, also administered via oral gavage. At necropsy, morphometric assessment of the interradicular bone of the first molar was carried out using a micro-CT scanner, while quantification of osteoclasts and osteoblasts was performed histologically. The results showed that no statistically significant differences among the groups (p > 0.05) for bone morphometric assessment. However, trabecular thickness in the OVXF group was similar to BL, while trabecular separation and alveolar bone loss height were lower than those of the OVXN group. Histologically, the OVXF group demonstrated a significantly lower number of osteoclasts and a higher number of osteoblasts compared with OVXN (p=0.008 and p=0.019, respectively; p < 0.05). In conclusion, F. deltoidea has the capacity to prevent alveolar bone loss in ovariectomy-induced osteoporosis rats by potentially preserving trabecular bone microarchitecture and to decrease osteoclast and increase osteoblast cell count.

Altering fiber density of cockscomb-like fibrous silica-titania catalysts for enhanced photodegradation of ibuprofen.

Fibrous silica-titania (FST) catalysts were synthesized by microemulsion followed by silica seed-crystal crystallization methods under various molar ratios of toluene to water (T/W). The catalysts were characterized by XRD, UV-DRS, FESEM, TEM, AFM, N2 adsorption-desorption, FTIR, and ESR. The results revealed that altering the T/W ratio affected the growth of the silica and titania and led to different size, fiber density, silica-titania structure, and number of hydroxyl groups, as well as oxygen vacancies in the FSTs, which altered their behavior toward subsequent application. Photodegradation of ibuprofen (IBP) are in the following order: FST(6:1) (90%) > FST(5:1) (84%) > FST(7:1) (79%) > commercial TiO2 (67%). A kinetics study using Langmuir-Hinshelwood model illustrated that the photodegradation followed the pseudo-first-order and adsorption was the rate-limiting step. Optimization by response surface methodology (RSM) showed that the pH, initial concentration, and catalyst dosage were the remarkable parameters in photodegradation of IBP. The FST (6:1) maintained its photocatalytic activities for up to five cycles reaction without serious catalyst deactivation, and was also able to degrade other endocrine-disrupting chemicals, indicating its potential use for the treatment of those chemicals in wastewater.

International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project [IDAPP].

STUDY DESIGN: Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database. OBJECTIVES: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies. SETTING: Nine centers from Asia. METHODS: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers. RESULTS: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%). CONCLUSIONS: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: comparison of weight gain, sputum conversion and chest radiograph.

BACKGROUND: Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in resource-limited countries where sophisticated and expensive tests are not readily available. Sputum culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum acid-fast bacilli (AFB) smear alone can be misinterpreted in the presence of unviable bacilli or non-tuberculous mycobacteria. Hence the search for a cheaper but reliable monitoring tool, or a combination of several tools, continues. Interesting reports from studies in third world nations have considered weight gain/loss as one such monitoring tool. Since pulmonary tuberculosis is endemic in this country, we take the opportunity to evaluate weight gain and chest radiograph, compared to sputum AFB smear in monitoring patient's response. METHODS: This was a retrospective study of confirmed positive sputum AFB smear patients from January 1999 to December 2004 who attended the Chest Clinic at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia. Data on weight, chest radiograph and sputum AFB smear from initiation of therapy to end of treatment and follow-up were collected and analyzed. RESULTS: 201 patients were included. At week-4 of anti-tuberculous treatment, only 14.7% had positive sputum smear. At completion of therapy 93.1% had improved chest radiographs. 90% had weight gain, 5% had weight loss and the remaining had no change in weight. Amongst patients with weight loss, there were no significant differences in the underlying illnesses (p=0.376), sputum smear at 4 weeks (p=0.697) and chest X-ray changes (p=0.731). Three patients who initially showed sputum smear conversion had reappearance of positive smear results towards the end of treatment. One of them was diagnosed as treatment failure while the other two remained well after discontinuation of therapy. CONCLUSION: Weight gain is very common among smear-positive tuberculosis patients after treatment even though weight gain does not correlate well with underlying disease, sputum conversion and chest X-ray changes. Reappearance of smear-positive sputum must be interpreted with caution and not to be regarded as treatment failure without other evidence.

Defaulters among lung cancer patients in a suburban district in a developing country.

INTRODUCTION: This study was carried out to determine the prevalence, patient's characteristic and reasons for defaulting follow-up and treatment among patients with lung cancer. METHODS: Patients with histologically confirmed lung cancer were recruited. Patient's detailed demographic data, occupation, socioeconomic status, and educational level of both the patients and their children were recorded. Defaulters were classified as either intermittent or persistent defaulters. By using Chi-square test, defaulter status was compared with various demographic and disease characteristic factors. The reasons for default were determined. RESULTS: Ninety five patients were recruited. Among them, 81.1% patients were males; 66.3% were Malays. The mean age (SD) was 60 ± 10.5 years. About 46.3% of the patients had Eastern Cooperation Oncology Group (ECOG) functional status 0/1 and 96.8% of the patients presented with advanced stage (Stage 3b or 4). Overall, 20 patients (21.1%) were defaulters (35.0% intermittent defaulters; 65.0% persistent defaulters). Among the intermittent defaulters, 8 patients defaulted once and one patient defaulted 3 times. Among the 20 defaulters, only 2 (10%) patients turned up for the second follow-up appointment after telephone reminder. Two main reasons for default were 'too ill to come' (38.5.5%) and logistic difficulties (23.1%). No correlation was found between patient education, children education, income, ECOG status, stage of the disease, race, and gender with the defaulter rate. CONCLUSION: Defaulter rate among lung cancer patients was 21.1%. Children education level is the only significant factor associated with the defaulter rate.

The man with the boggy head: cranial melioidosis.

Melioidosis is known to cause abscesses in various organs, including the cranium, though less commonly. We present a patient with scalp abscess and subdural empyema that was visible on computed tomography of the brain. The neurosurgical drainage grew Burkholderia pseudomallei. Despite our best effort to treat the patient using parenteral antibiotics and surgical drainage, the patient did not survive.