The effect of hypoxic ischemic encephalopathy towards multi-organ complications and its early outcome at a Malaysian district hospital.

INTRODUCTION: Hypoxic ischemic encephalopathy (HIE) is a clinically defined syndrome of disturbed neurologic function in the newborn with evidence of perinatal asphyxia. Stages of HIE are categorised into mild, moderate or severe based on the Sarnat classification. Neurological dysfunction constitutes a part of the wide spectrum of hypoxic ischemic insult as affected infants can have co-existing multi-organ dysfunction which further contributes to morbidities and mortality. This study aims to determine the relationship between the severity of HIE with multi-organ complications and early clinical outcomes. MATERIALS AND METHODS: All neonates who were admitted to the NICU at Hospital Sultan Abdul Halim between January 2018 to December 2022, who fulfilled the inclusion criteria were included. Demographic data, clinical course and investigation results were retrospectively obtained from the medical records. RESULTS: From a total of 90 infants (n = 90) who fulfilled our inclusion criteria, 31 (34%) were mild, 31 (34%) were moderate and 28 (31%) were severe HIE. The mean maternal age was 27 years. Common antenatal issues include diabetes mellitus (37.8%) and anaemia (22.2%). The Apgar scores at 1 and 5 minutes, initial resuscitation requiring intubation, chest compression and adrenaline were associated with higher severity of HIE (p < 0.05). Coagulation dysfunction was the most common complication (79.7%), followed by respiratory dysfunction (33.3%), cardiac dysfunction (28.9%), renal dysfunction (16.1%), haematological dysfunction (15.6%) and hepatic dysfunction (12%). Respiratory and haematological dysfunctions were significantly associated with higher mortality (p < 0.05). There was a significant longer hospital stay (p = 0.023), longer duration of ventilation (p < 0.001) and increase in frequency of seizures (p < 0.001) when comparing moderate and severe HIE patients to mild HIE patients. With increasing severity of HIE, there was also statistically significant higher mortality (p < 0.001). CONCLUSIONS: There is a significant relationship between multiorgan dysfunction, the severity of HIE and mortality. Early anticipation of multi-organ injury is crucial for optimal early management which would reduce the mortality and improve the neurological outcome of the patients.

Anterior tooth autotransplantation: a case series.

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. It is relatively common for the anterior segment of the mouth to be affected by traumatic tooth injuries, impacted and/or congenitally missing permanent teeth. Autotransplantation of teeth into the anterior dental arch can provide unrivalled biological solutions when such issues arise in this critical aesthetic zone, particularly for adolescent patients. The combination of meticulous pre-surgical assessment, synergistic interdisciplinary collaboration and carefully performed anterior tooth autotransplantation has been demonstrated to achieve impressive outcomes, with respect to both transplant survival and clinical success. © 2023 Australian Dental Association.

Electrochemical quantification of atrazine-fulvic acid and removal through bismuth tungstate photocatalytic hybrid membranes.

Herbicides such as atrazine and humus substances such as fulvic acid are widely used in agricultural sector. They can be traced in surface and groundwater around the agriculture field at concentrations beyond the approved limit due to their mobility and persistence. Bismuth-based photocatalysts activated by visible light are potential materials for removing various organic pollutants from water bodies. These photocatalysts can also be suitable candidates for developing a hybrid membrane with anti-fouling properties. In this study, Bi2WO6 nanoparticles were synthesized via the hydrothermal method and integrated into the cellulose acetate (CA), polyetherimide (PEI), polysulfone (PSF) and polyvinylidene fluoride (PVDF) polymers via physical blending approach. The hybrid membranes were then characterized by FTIR, XPS and FESEM to confirm the chemical bonding, chemical composition and surface morphology of Bi2WO6. Thus, the pure water flux of CA (35.6 L m-2 h-1), PEI (46.56 L m-2 h-1), PSF (6.84 L m-2 h-1), and PVDF (68.47 L m-2 h-1) hybrid membranes has significantly enhanced than the pristine CA, PEI, PSF and PVDF membranes. The significant rejection of atrazine-fulvic acid was observed with hybrid membranes in the order of CA (84.1%) > PVDF (72.7%) > PEI (47.8%) > PSF (37.2%), and these membranes have shown an excellent flux recovery ratio than pristine membranes. Further, electrochemical quantification studies were performed to analyze the removal efficiency of atrazine-fulvic acid from water. In this present work, GO-modified SPE was employed for electrochemical sensing studies. The resultant CA hybrid membrane achieved removal efficiency of 84.08% for atrazine. It was observed that the Bi2WO6 established strong bonding with CA, and PVDF membranes, thus showing a significant removal efficiency and FRR than other hybrid and pristine membranes.

Membrane technology for pesticide removal from aquatic environment: Status quo and way forward.

The noxious side effects of pesticides on human health and environment have prompted the search of effective and reliable treatment techniques for pesticide removal. The removal of pesticides can be accomplished through physical, chemical and biologicals. Physical approaches such as filtration and adsorption are prevailing pesticide removal strategies on account of their effectiveness and ease of operation. Membrane-based filtration technology has been recognized as a promising water and wastewater treatment approach that can be used for a wide range of organic micropollutants including pesticides. Nanofiltration (NF), reverse osmosis (RO) and forward osmosis (FO) have been increasingly explored for pesticide removal from aquatic environment owing to their versatility and high treatment efficiencies. This review looks into the remedial strategies of pesticides from aqueous environment using membrane-based processes. The potentials and applications of three prevailing membrane processes, namely NF, RO and FO for the treatment of pesticide-containing wastewater are discussed in terms of the development of advanced membranes, separation mechanisms and system design. The challenges in regards to the practical implementation of membrane-based processes for pesticide remediation are identified. The corresponding research directions and way forward are highlighted. An in depth understanding of the pesticide nature, water chemistry and the pesticide-membrane interactions is the key to achieving high pesticide removal efficiency. The integration of membrane technology and conventional removal technologies represents a new dimension and the future direction for the treatment of wastewater containing recalcitrant pesticides.

The state-of-the-art development of photocatalysts for the degradation of persistent herbicides in wastewater.

Herbicides are one of the most recurring pollutants in the aquatic system due to their widespread usage in the agriculture sector for weed control. Semiconductor-based photocatalysts have gained recognition due to their ability to degrade and mineralize pollutants into harmless by-products completely. Lately, many studies have been done to design photocatalysts with efficient separation of photogenerated charge carriers and enhanced light absorption. Photocatalyst engineering through doping with metal and non-metal elements and the formation of heterojunction are proven effective for minimizing the recombination of electron-hole pairs and enlarging the absorption in the visible light region. This review focuses on discussing and evaluating the recent progress in the types of photocatalysts and their performance in the remediation of herbicides in wastewater. The development of innovative hybrid technologies is also highlighted. The limitations and challenges of photocatalysis technology in the present literature have been identified, and future studies are recommended.

Nanomaterials for microplastic remediation from aquatic environment: Why nano matters?

The contamination of microplastics in aquatic environment is regarded as a serious threat to ecosystem especially to aquatic environment. Microplastic pollution associated problems including their bioaccumulation and ecological risks have become a major concern of the public and scientific community. The removal of microplastics from their discharge points is an effective way to mitigate the adverse effects of microplastic pollution, hence has been the central of the research in this realm. Presently, most of the commonly used water or wastewater treatment technologies are capable of removing microplastic to certain extent, although they are not intentionally installed for this reason. Nevertheless, recognizing the adverse effects posed by microplastic pollution, more efforts are still desired to enhance the current microplastic removal technologies. With their structural multifunctionalities and flexibility, nanomaterials have been increasingly used for water and wastewater treatment to improve the treatment efficiency. Particularly, the unique features of nanomaterials have been harnessed in synthesizing high performance adsorbent and photocatalyst for microplastic removal from aqueous environment. This review looks into the potentials of nanomaterials in offering constructive solutions to resolve the bottlenecks and enhance the efficiencies of the existing materials used for microplastic removal. The current efforts and research direction of which studies can dedicate to improve microplastic removal from water environment with the augmentation of nanomaterial-enabled strategies are discussed. The progresses made to date have witnessed the benefits of harnessing the structural and dimensional advantages of nanomaterials to enhance the efficiency of existing microplastic treatment processes to achieve a more sustainable microplastic cleanup.

Interocular optical biometry differences as predictors of postoperative cataract surgery refractive outcomes: A retrospective cohort study.

INTRODUCTION: Few studies have reported the impact of preoperative interocular discrepancy in optical biometry (axial length, corneal power, white-to-white, central corneal thickness) on postoperative refractive outcomes. This study aims to investigate any predictive value of preoperative optical biometry differences between eyes on postoperative refractive outcomes. MATERIALS AND METHODS: A retrospective cohort study of patients who have undergone optical biometry measurement before unilateral phacoemulsification in the Queen Elizabeth Hospital, Sabah, Malaysia from 2018 to 2020. Biometry data of interest includes axial length (AL), keratometry(K), white-to-white (WTW) and central corneal thickness (CCT). The postoperative outcomes of interest were the patient's preoperative refractive target, postoperative best-corrected visual acuity (BCVA), postoperative refractive outcomes, and optical biometry prediction error. RESULTS: The interocular biometry discrepancies which were associated with higher odds of prediction error >0.5D from the refractive target were Interocular Corneal Power Difference (IKD)-average≥0.8 D (Odds Ratio, OR=1.97; 95% Confidence Intervals, 95%CI: 1.06, 3.67) and Interocular WTW Difference ≥1.5 mm (OR=2.77; 95%CI: 1.11, 6.92). In cases with prediction error >1.0D, the measurements were Interocular AL Difference ≥0.4 mm (OR=2.99; 95%CI: 1.11, 8.06), IKD flat≥0.4D (OR=2.76; 95%CI: 1.31, 5.82) and Interocular CCT Difference ≥15µm (OR=3.53; 95%CI: 1.29, 9.64). CONCLUSION: Interocular axial length difference ≥0.4mm and interocular central corneal thickness difference ≥15µm are associated with refractive error >1.0D from the pre-operative target. Interocular average corneal power difference ≥0.8D and interocular white-to-white difference ≥1.5mm have higher odds of refractive drift >0.5D from the refractive aim. The above cutoff values help clinicians to identify which patients have a higher risk of refractive shift post-cataract surgery and counsel the patient before cataract operation.

COVID-19: Four Paediatric Cases in Malaysia.

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

How should front-line general practitioners use personal protective equipment (PPE)?

The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases. GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE. The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern.

Facile synthesis of GO and g-C3N4 nanosheets encapsulated magnetite ternary nanocomposite for superior photocatalytic degradation of phenol.

In this study, the synthesis of Fe3O4@GO@g-C3N4 ternary nanocomposite for enhanced photocatalytic degradation of phenol has been investigated. The surface modification of Fe3O4 was performed through layer-by-layer electrostatic deposition meanwhile the heterojunction structure of ternary nanocomposite was obtained through sonicated assisted hydrothermal method. The photocatalysts were characterized for their crystallinity, surface morphology, chemical functionalities, and band gap energy. The Fe3O4@GO@g-C3N4 ternary nanocomposite achieved phenol degradation of ∼97%, which was significantly higher than that of Fe3O4@GO (∼75%) and Fe3O4 (∼62%). The enhanced photoactivity was due to the efficient charge carrier separation and desired band structure. The photocatalytic performance was further enhanced with the addition of hydrogen peroxide, in which phenol degradation up to 100% was achieved in 2 h irradiation time. The findings revealed that operating parameters have significant influences on the photocatalytic activities. It was found that lower phenol concentration promoted higher activity. In this study, 0.3 g of Fe3O4@GO@g-C3N4 was found to be the optimized photocatalyst for phenol degradation. At the optimized condition, the reaction rate constant was reported as 6.96 × 10-3 min-1. The ternary photocatalyst showed excellent recyclability in three consecutive cycles, which confirmed the stability of this ternary nanocomposite for degradation applications.

Novel synergistic hydrous iron-nickel-manganese (HINM) trimetal oxide for hazardous arsenite removal.

A novel hydrous iron-nickel-manganese (HINM) trimetal oxide was successfully fabricated using oxidation and coprecipitation method for metalloid arsenite removal. The atomic ratio of Fe:Ni:Mn for this adsorbent is 3:2:1. HINM adsorbent was identified as an amorphous nanosized adsorbent with particle size ranged from 30 nm to 60 nm meanwhile the total active surface area and pore diameter of HINM area of 195.78 m2/g and 2.43 nm, respectively. Experimental data of arsenite adsorption is best fitted into pseudo-second order and Freundlich isotherm model. The maximum adsorption capacity of arsenite onto HINM was 81.9 mg/g. Thermodynamic study showed that the adsorption of arsenite was a spontaneous and endothermic reaction with enthalpy change of 14.04 kJ/mol and Gibbs energy of -12 to -14 kJ/mol. Zeta potential, thermal gravimetric (TGA) and Fourier transform infrared (FTIR) analysis were applied to elucidate the mechanism of arsenite adsorption by HINM. Mechanism of arsenite adsorption by HINM involved both chemisorption and physisorption based on the electrostatic attraction between arsenite ions and surface charge of HINM. It also involved the hydroxyl substitution by arsenite ions through the formation of inner-sphere complex. Reusability of HINM trimetal oxide was up to 89% after three cycles of testing implied that HINM trimetal oxide is a promising and practical adsorbent for arsenite.

Introducing a collection of reviews on major diseases in malaysia.

No abstract available.

Benign oesophageal diseases: a review of the CT findings.

A variety of benign conditions can affect the oesophagus, both primarily and secondarily. Traditionally fluoroscopic oesophagography and endoscopy have formed the mainstay for investigating oesophageal diseases. Increasing use of cross-sectional imaging means that many such diseases and their thoracic complications are now detected at computed tomography (CT), which is very often the first imaging tool. This review describes the CT manifestations of a range of benign oesophageal conditions and discusses the role of CT in their evaluation.

Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial.

BACKGROUND: Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS: This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS: The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS: Patients who received CORFIS care demonstrated significant improvements in achieving target BP.

Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry.

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).

Pre-treatment of multi-walled carbon nanotubes for polyetherimide mixed matrix hollow fiber membranes.

Mixed matrix hollow fibers composed of multi-walled carbon nanotubes (MWCNTs) and polyetherimide (PEI) were fabricated. Pre-treatment of MWCNTs was carried out prior to the incorporation into the polymer matrix using a simple and feasible two stages approach that involved dry air oxidation and surfactant dispersion. The characterizations of the surface treated MWCNTs using TEM and Raman spectroscopy have evidenced the effectiveness of dry air oxidation in eliminating undesired amorphous carbon and metal catalyst while surfactant dispersion using Triton X100 has suppressed the agglomeration of MWCNTs. The resultant mixed matrix hollow fibers were applied for O(2)/N(2) pure gas separation. Interestingly, it was found that removal of disordered amorphous carbons and metal particles has allowed the hollow structures to be more accessible for the fast and smooth transport of gas molecules, hence resulted in noticeable improvement in the gas separation properties. The composite hollow fibers embedded with the surface modified MWCNTs showed increase in permeability as much as 60% while maintaining the selectivity of the O(2)/N(2) gas pair. This study highlights the necessity to establish an appropriate pre-treatment approach for MWCNTs in order to fully utilize the beneficial transport properties of this material in mixed matrix polymer nanocomposite for gas separation.

Ocular biometric measurements in emmetropic and myopic malaysian children - a population-based study.

This is the first population based study on ocular biometric measurements (OBMs) conducted in Malaysia. Its objective is to measure and compare among children of different ethnicity who have myopia and emmetropia. Subsets of children aged between 7 and 8 years old who participated in a larger population based refractive error study had their axial length, anterior chamber depth, lens thickness and vitreous depth measured using A scan and vertical and horizontal corneal curvature measured using an autokeratorefractometer. Eighty eight of the 870 children (10.1%) examined had myopia. Boys, Chinese and children with myopia had significantly longer axial length and vitreous depth compared to girls, Malay and Indian and children who were emmetropic respectively. Girls and children with myopia had steeper corneal curvature. The baseline OBMs in Malaysian children of different ethnicity are valuable for studies in myopia progression. Like other studies, children with myopia have longer axial length (P <0.001). and vitreous depth (P <0.001) compared to children who are emmetropia (without myopia).

Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006.

INTRODUCTION: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown. METHODS: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older. RESULTS: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations. CONCLUSION: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.

Contact lens--related corneal ulcer: a two-year review.

To create a national registry of contact-lens related corneal ulcers (CLRCU) patients in Malaysia with the aim of detecting outbreaks, identifying pattern of causative organisms, determining patient demography, risk factors, wearing patterns and monitoring outcome of treatment. The CLRCU registry is an ongoing patient registry established in 2007 as a surveillance tool used by Malaysian Ministry of Health ophthalmology departments. Notification of patients clinically suspected of CLRCU was performed online through the National Eye Database (NED). Data collected included patient demography, contact lens type, causative organism and treatment outcome. During 2007-2008, a total of 202 patients were notified to the CLRCU registry with a mean age of 26.7 years (71.8% female). All registered patients wore soft contact lens and monthly disposable lenses were the most popular (83.5%). The majority of patients had bacterial CLRCU and the most common causative organism was Pseudomonas (79.7% of bacterial cases). No epidemics were identified during the period of data examination. Use of contact lenses, which is increasing during modern times, may lead to CLRCU as a severe complication. The CLRCU registry is an effective tool which uses a web-based notification system that allows quick and up to date reports of CLRCU cases. This provides the ability to monitor outbreaks of disease and identify important causative and associated factors of the disease which may be used to reduce future incidence.

The National Medical Research Register--a vital link between current and future research.

Registration of research proposal to a publicly accessible website with searchable function allows information sharing and ensures research transparency. The National Institutes of Health Malaysia, realising the importance of research registration, established the National Medical Research Register (NMRR) in 2007. The NMRR functions more than just a local register: it also links to ethics approval and MOH medical research grant application. It thus facilitates researchers in their application to the Ministry of Health Research and Ethics Committee (MREC) and for Ministry of Health research grant. In addition, MREC committee members can review research protocol on NMRR website, thus saving much time and resources. From May 2007 till December 2009, more than 3000 people have registered as NMRR public users and more than 1000 research proposals have been uploaded in NMRR. The number of registration of research proposals, clinical trials and industrial sponsored trials steadily increased from year 2007 to year 2009. The web-based NMRR is the first research register in the world that links research proposal registration to ethical review and research grant application. Its future plan is to be linked with publication. Therefore, it is indeed an innovation that Malaysians should be proud of.