Placenta microRNA profile of patient with Obstetric Antiphospholipid Syndrome.

The onset of obstetric antiphospholipid syndrome (APS) occurs when antiphospholipid antibodies act upon the placenta. During pregnancy, APS exhibits traits such as vascular thrombosis, inflammation, and hindered trophoblast implantation. The involvement of microRNA expression has been proposed as a genetic factor contributing to the syndrome's development. MicroRNAs play a role in regulating gene expression in various cellular processes, including the formation of placental tissue. Therefore, additional research is needed to explore the control of placental miRNA in APS. In this study, we aimed to profile miRNA expressions from placenta tissue of patients with APS. Differentially expressed miRNAs were determined for its targeted genes and pathways. Agilent microarray platform was used to measure placental microRNA expressions between normal placental tissue and those obtained from patients with APS. Differentially expressed miRNAs were detected using GeneSpring GX software 14.2 and sequences were mapped using TargetScan software to generate the predicted target genes. Pathway analysis for the genes was then performed on PANTHER and REACTOME software. Selected miRNAs and their associated genes of interest were validated using qPCR. Microarray findings revealed, 9 downregulated and 21 upregulated miRNAs expressed in placenta of patients with APS. Quantitative expressions of 3 selected miRNAs were in agreement with the microarray findings, however only miR-525-5p expression was statistically significant. Pathway analysis revealed that the targeted genes of differentially expressed miRNAs were involved in several hypothesised signalling pathways such as the vascular endothelial (VE) growth factor (VEGF) and inflammatory pathways. VE-cadherin, ras homolog member A (RHOA) and tyrosine kinase receptor (KIT) showed significant downregulation while Retinoblastoma gene (RET), Dual specificity protein phosphatase 10 (DUSP10) and B-lymphocyte kinase (BLK) genes were significantly upregulated. These preliminary findings suggest the involvement of miRNAs and identified novel associated genes involvement in the mechanism of obstetric APS, particularly through the alteration of vascular-associated regulators and the inflammatory signalling cascade.

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit.

BACKGROUND: Patients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents. OBJECTIVE: This study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit. METHODS: This was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test. RESULTS: The oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p=.004) respectively, while in the intervention group 11.89 and 8.33 (p<.001). Mean differences in both groups were 4.95 (p<.001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p<.05). CONCLUSION: Oral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit / Efecto del cuidado bucal con miel como agente tópico adicional sobre el estado de salud bucal de pacientes intubados en la unidad de cuidados intensivos

Background: Patients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents. Objective: This study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit. Methods: This was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test. Results: The oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p=.004) respectively, while in the intervention group 11.89 and 8.33 (p<.001). Mean differences in both groups were 4.95 (p<.001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p<.05). Conclusion: Oral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.(AU)

Antecedentes: Los pacientes en los que se emplean tubos endotraqueales tienen un alto riesgo de padecer afectación de su salud bucal debido a la deficiencia de la defensa natural de la vía aérea, los cambios en la composición de la flora bucal y las sustancias protectoras de los dientes, ya que la medicación causa xerostomía. Los cuidados bucales no han sido suficientes para manejar la sequedad de la mucosa oral, por lo que es preciso un agente tópico para proteger dicha mucosa con vistas a mantener la salud bucal. La miel es uno de dichos agentes tópicos. Objetivo: El objetivo de este estudio es identificar el efecto de los cuidados bucales con miel como agente tópico en el estatus de la salud bucal de los pacientes en los que se han empleado tubos endotraqueales en la unidad de cuidados intensivos. Métodos: Estudio experimental con un diseño aleatorizado de pretest y postest. La muestra se compuso de 36 pacientes adultos intubados. Los datos fueron analizados utilizando una prueba paramétrica y la prueba «t» independiente. Resultados: La puntuación de la salud bucal en el grupo control reflejó una media pretest y postest de 11,94 y 13,28 (p=0,004) respectivamente, mientras que en el grupo de intervención fue de 11,89 y 8,33 (p<0,001). La media de las diferencias en ambos grupos fue de 4,95 (p<0,001), pudiéndose apreciar las diferencias de la subescala BOAS en los labios, encías y mucosa y en la lengua (p<0,05). Conclusión: Los cuidados bucales con miel como agente tópico pueden mejorar la salud bucal de los pacientes intubados en la subescala de labios, encías y mucosa y lengua. Por tanto, la miel como agente tópico adicional puede ser un agente hidratante para mantener la mucosa bucal en los pacientes intubados de la unidad de cuidados intensivos. Además, la buena salud de la mucosa ayudará a prevenir las infecciones y la colonización de microorganismos.(AU)

Distinct microRNA expression pattern in breast cancer cells following anti-neoplastic treatment: A systematic review and functional analysis of microRNA target genes.

Breast cancer remains a significant cause of mortality in females worldwide, despite advances in technology and treatment. MicroRNA expression in breast cancer is studied both as potential biomarkers and for therapeutic purposes. Accumulated evidence revealed microRNA profile of various types of cancer cells following antineoplastic treatment. The progression of research in this area provides better understanding on the anti-cancer mechanism of various natural compounds and drugs specifically on the microRNA regulation. Hence, we aim to systematically review differentially expressed microRNA in MCF-7, a commonly studied breast cancer cell line, after treatment with anti-neoplastic agents. Relevant keywords were used to screen for research articles that reported on the differentially expressed microRNAs in experimental models of MCF-7 before and after anti-neoplastic treatment. Target genes of microRNAs were identified from MiRTarbase and further in silico functional analysis of the target genes were performed using DAVID bioinformatic resources. Two upregulated microRNAs (mir-200c and let-7d) and 3 downregulated microRNAs (mir-27a, mir-27b and mir-203) were identified by highest number of studies. Three microRNAs (let-7a, mir-23a and mir-7) showed inconsistent direction of expression. Genes functional analysis revealed the regulatory effect of microRNA on genes related to angiogenesis, hypoxia, P53, FoxO and PI3K-AKT signalling. Clusters of genes associated to the pathway of angiogenesis, cancers, cell proliferation and apoptosis were noted through protein-protein interaction analysis. MicroRNAs, especially the mir-200c, let-7d, mir-27a, mir-27b and mir-203 from this review could be further validated experimentally to serve as molecular target or biomarkers for anti-neoplastic therapy.

Chronic histiocytic intervillositis in consecutive miscarriages: A potential pitfall in routine examination of conceptus.

INTRODUCTION: Chronic histiocytic intervillositis (CHI) is a rare placental lesion strongly associated with recurrent miscarriages and fetal losses. It requires histopathological diagnosis and can only be made after delivery of the products of conception (POC). We describe a case of CHI in a 41-yearold lady with a 16-year history of thirteen recurrent consecutive first trimester miscarriages. CASE REPORT: The patient is a 41-year-old lady who suffered first trimester miscarriages in all her thirteen pregnancies. The relevant clinical investigations revealed neither significant nor helpful findings in determining the cause of recurrent miscarriages. Histological findings in each except one of the submitted conceptual tissue showed similar features of histiocytic aggregates primarily within the intervillous spaces, a characteristic description of CHI. One of the samples showed degenerative changes. DISCUSSION: Practicing pathologists are not familiar with the histological features of CHI and this may be a potential pitfall in routine examination of POCs. Recognising this entity allows for accurate diagnosis and hence better management. The aetiology remains unclear, although an immunopathological basis are being explored.

Analysis of power from palm oil solid waste for biomass power plants: A case study in Aceh Province.

Nowadays, the solid waste produced from palm oil has become one of the essential oils in the world in general and especially in Indonesia. Biomass waste is processed through substantial quantities of palm oil extraction. With the reduction in fossil fuels in recent years, it has had an impact on the deterioration of electricity supply at the National and International levels. Biomass is a renewable energy that can replace conventional energy. Besides, power generation from biomass is environmentally friendly and sustainable. This simulation was conducted to analyze the maximum power from the burning of oil palm biomass for the electricity generation. The novelty of the article is the performance and behavior of palm oil biomass-based co-fuel in the power generation process. The biomass wastes used in this simulation include OPF, EFB, PKS, and OPM. The results of this simulation indicate that the maximum power produced with OPF can produce 49.54 MW with variations in the flow rate of biomass at 8 kg/s. While at the time of recycling up to 100% OPM biomass produces 61.05 MW higher than OPF, EFB and PKS. Meanwhile, the OPF-PKS mixed biomass can produce 106.15 MW of power plants when the airflow rate reaches 171 kg/s. The overall results of the simulation for the analysis of the maximum power that can be used as a power station show suitability and can apply in rural/remote areas. Besides, the availability of oil palm biomass in Aceh Province is also sufficient to overcome electricity shortages and reduce dependence on conventional energy.

Biomechanical and radiological assessment of immediate implants for alveolar ridge preservation.

BACKGROUND: The aim of this study was to evaluate the stability of immediate implant placement for alveolar bone augmentation and preservation with bovine bone graft following atraumatic tooth extraction. MATERIALS AND METHODS: This was a prospective interventional study with convenient sampling (n = 10). Thirty patients aged between 18 and 40 years, who needed noncomplicated tooth extraction of mandibular premolar tooth, were sequentially divided equally into three groups. In Group I, simple extraction was done and the empty extraction socket left to heal conventionally. In Group II, extraction sockets were filled with lyophilized bovine granules only. In Group III, immediate implants were placed into extraction sockets, and the buccal gap was also filled with bovine granules. All groups were subjected to cone beam computed tomography scan for radiological evaluation. Assessment of biomechanical stability (radiofrequency analysis [RFA] was performed at 9 months postoperative for Group III to assess the degree of secondary stability of the implants using Osstell. Repeated measure analysis of variance (ANOVA) test was applied when comparing within each group at three different time intervals, whereas one-way ANOVA was applied followed by post hoc-tukey test when comparing between groups. P < 0.05 was considered statistically significant. RESULTS: Radiological assessment reveals a significant difference of bone resorption in alveolar dimension within Group I; 1.49 mm (P = 0.002), and 0.82 mm (P = 0.005), respectively, between day 0 and 3 months. Comparison between Group I and III showed a highly significant difference of bone resorption in ridge width at 3 months 2.56 mm (P = 0.001) and at 9 months interval 3.2 mm (P < 0.001). High RFA values demonstrating an excellent biomechanical stability were observed in Group III at 9 months postoperatively. CONCLUSION: The insertion of immediate implants in extraction sockets with bovine bone augmentation of the buccal gap was able to preserve a greater amount of alveolar ridge volume.

The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation: A Clinical Evaluation Using Three-Dimensional Cone Beam Computerized Tomography and Resonance Frequency Analysis Value.

The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way.Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine.A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P ≤ 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P ≤ 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II.In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.

Gene expression in obstetric antiphospholipid syndrome: a systematic review.

BACKGROUND: Antiphospholipid syndrome (APS) is a multisystem disease that may present as venous or arterial thrombosis and/or pregnancy complications with the presence of antiphospholipid antibodies. Until today, heterogeneity of pathogenic mechanism fits well with various clinical manifestations. Moreover, previous studies have indicated that genes are differentially expressed between normal and in the disease state. Hence, this study systematically searched the literature on human gene expression that was differentially expressed in Obstetric APS. METHODOLOGY: Electronic search was performed until 31st March 2015 through PubMed and Embase databases; where the following Medical Subject Heading (MeSH) terms were used and they had been specified as the primary focus of the articles; gene, antiphospholipid, obstetric, and pregnancy in the title or abstract. From 502 studies retrieved from the search, only original publications that had performed gene expression analyses of human placental tissue that reported on differentially expressed gene in pregnancies with Obstetric APS were included. Two reviewers independently scrutinized the titles and the abstracts before examining the eligibility of studies that met the inclusion criteria. For each study; diagnostic criteria for APS, method for analysis, and the gene signature were extracted independently by two reviewers. The genes listed were further analysed with the DAVID and the KEGG pathways. RESULTS: Three eligible gene expression studies involving obstetric APS, comprising the datasets on gene expression, were identified. All three studies showed a reduction in transcript expression on PRL, STAT5, TF, DAF, ABCA1, and HBEGF in Obstetric APS. The high enrichment score for functionality in DAVID had been positive regulation of cell proliferation. Meanwhile, pertaining to the KEGG pathway, two pathways were associated with some of the listed genes, which were ErBb signalling pathway and JAK-STAT signalling pathway. CONCLUSION: Ultimately, studies on a genetic level have the potential to provide new insights into the regulation and to widen the basis for identification of changes in the mechanism of Obstetric APS.

MicroRNA expression in antiphospholipid syndrome: a systematic review and microRNA target genes analysis.

INTRODUCTION: Antiphospholipid antibodies (aPL) are autoantibodies that attack phospholipid through anti-beta 2-glycoprotein 1. The actions of aPL are associated with events leading to thrombosis and morbidity in pregnancy. Antiphospholipid syndrome (APS) is diagnosed when a patient is persistently positive for aPL and also has recognised clinical manifestations such as recurrent pregnancy losses, arterial or venous thrombosis and in a catastrophic case, can result in death. Unfortunately, the pathogenesis of APS is still not well established. Recently, microRNA expressed in many types of diseased tissues were claimed to be involved in the pathological progression of diseases and has become a useful biomarker to indicate diseases, including APS. OBJECTIVE: This systematic review aims to search for research papers that are focussing on microRNA expression profiles in APS. METHOD: Three search engines (Ebcohost, ProQuest and Ovid) were used to identify papers related to expression of specific microRNA in antiphospholipid syndrome. RESULTS AND DISCUSSION: A total of 357 papers were found and screened, out of which only one study fulfilled the requirement. In this particular study blood samples from APS patients were tested. The microRNAs found to be related to APS were miR-19b and miR-20a. No data was found on specific microRNA being expressed in obstetric antiphospholipid syndrome. Analysis on the microRNA target genes revealed that most genes targeted by miR-19b and miR-20a involve in TGF-Beta Signalling and VEGF, hypoxia and angiogenesis pathways. CONCLUSION: In view of the limited data on the expressions of microRNA in APS we recommend further research into this field. Characterization of microRNA profile in blood as well as in placenta tissue of patients with APS could be useful in identifying microRNAs involved in obstetric APS.

Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review.

Penile fracture is a well-recognized and relatively uncommon clinical entity. It was previously reported that the incidence of penile fracture varies according to various geographic regions. In order to determine whether marital status or culture other than geographic region is involved in the etiology of penile fracture in our country, the charts of 122 men diagnosed with penile fracture were retrospectively reviewed. Detailed history including cause, symptoms, country of origin and a single-question self-report of erectile dysfunction was used for all cases. Diagnosis of our cases was mainly based on history and physical examination and ultrasonography. Immediate or delayed surgical repair of penile fracture included a degloving circumferential, and an additional direct incision, if the site of the tear could not be reached via degloving, was performed. The patients were evaluated after 1 week and 1, 3, and 6 months follow-up by penile examination, recording complications, and with a single-question self-report questionnaire after 3 and 6 months. The most common cause of penile fracture was manual bending of the erected penis in 66 out of 122 (54.1%) of our study patients. In our study, we believe that the prime causes of bending the penis are single status and culture, which are influencing factors irrespective of the geographic distribution.

Poliomyelitis vaccination status among children in the Federal Territory of Kuala Lumpur 2007.

INTRODUCTION: Polio vaccination rates remain low in certain regions of Malaysia. The Federal Territory of Kuala Lumpur (FTKL) reported coverage of only 29.3% in 2005 and 61.2% in 2006, despite a Department of Health campaign to provide free three-round immunizations. The estimated numbers of live births used to calculate these rates may have artificially lowered the reported coverage percentages. METHODS: A descriptive, cross-sectional household survey was conducted throughout the FTKL in 2007 to assess the actual polio vaccination status of children aged 9 to 24 months. Minimum sample size was calculated and proportionately divided among the 11 FTKL parliamentary constituencies. Residential areas were then randomly selected for in-person interviews. We used the gathered information, verified by medical records, to calculate the actual vaccination coverage and to compare the rates determined by using estimated or registered live births for the region. RESULTS: Of the 1713 study participants, 98.3% had completed their polio vaccination schedule. Only 21 children had been partially vaccinated, and nine children were completely unvaccinated. FTKL residents had 20 431 live births registered for 2006, as opposed to the official estimate of 28 400. When the registered value of live births was used to calculate vaccination coverage, the 2006 coverage increased (to 85.1%). CONCLUSION: Actual vaccination coverage in Kuala Lumpur was much higher than the estimated coverage previously reported, reflecting the expected success of the Department of Health immunization campaign. Estimated values of live births are insufficient to accurately determine vaccine status and should be avoided.

Tracheal agenesis: a rare cause of unsuccessful tracheal intubation during resuscitation.

Tracheal agenesis is a rare congenital airway anomaly that usually results in a fatal outcome. The diagnosis is usually made through post-mortem examination. In the current literature, there has been no reported long-term survival although a few reports claimed prolongation of life of several hours to days. This condition is commonly associated with premature birth, polyhydramnios and a male predominance. In 90% of the cases, it is associated with multiple cardiovascular, gastrointestinal and genitourinary tract anomalies which are incompatible with life. We report a case of a premature newborn with severe respiratory distress, absent cry and cyanosis soon after birth. Attempts at endotracheal intubation failed as it was no possible to negotiate the tube beyond the vocal cords. Needle cricothyrotomy and attempted tracheostomy also failed to secure the airway. The diagnosis was confirmed at post-mortem examination.

The National Mental Health Registry (NMHR).

The National Mental Health Registry (NMHR) collects information about patients with mental disorder in Malaysia. This information allows us to estimate the incidence of selected mental disorders, and to evaluate risk factors and treatment in the country. The National Mental Health Registry (NMHR) presented its first report in 2004, a year after its establishment. The report focused on schizophrenia as a pioneer project for the National Mental Health Registry. The development of the registry has progressed with data collected from government-based facilities, the academia and the private sector. The 2003-2005 report was recently published and distributed. Since then the registry has progressed to include suicides and other mental illnesses such as depression. The NMHR Report 2003-2005 provides detailed information about the profile of persons with Schizophrenia who presented for the first time to various psychiatry and mental health providers throughout Malaysia. More detailed description regarding pharmacotherapy is reported and few cross tabulations done in an effort to provide better understanding and more clinically meaningful reports.

National Suicide Registry Malaysia (NSRM).

To create a nationwide system to capture data on completed suicide in Malaysia i.e. the morbidity, geographic and temporal trends and the population at high risk of suicide. Data from this registry can later be used to stimulate and facilitate further research on suicide. This paper describes the rationale and processes involved in developing a national suicide registry in 2007. The diagnosis of suicide is based on the ICD-10 codes for fatal intentional self-harm (X60-X84). A case report form with an accompanying instruction manual had been prepared to ensure systematic and uniform data collection. State Forensic Pathologist's offices are responsible for data collection in their respective states, and in turn will submit the data to a central data management unit. Data collection began in July 2007 and currently in data cleaning process. Training for source data producers is ongoing. In 2008, the NSRM plans to involve university hospitals into its network as currently only Ministry of Health hospitals are involved. The NSRM will be launching its online application for case registration this year while an overview of results will be available via its public domain at www.nsrm.gov.my beginning 20 April 2008. To efficiently capture the data on suicide, a concerted effort between various agencies is needed. A lot of conceptual work and data base development remains to be done in order to position preventive efforts on a more solid foundation.

MTHFR C677T polymorphism as a risk factor of neural tube defects in Malay: a case control study.

Major congenital malformations occur in about 3% of newborn. Several studies have suggested that homozygosity for the C677T methylenetetrahydrofolate reductase (MTHFR) variant is a potential risk factor for neural tube defects (NTDs). It has been hypothesized that the maternal folic acid supplementation prevents NTDs by partially correcting reduced MTHFR activity associated with the variant form of the enzyme. This association has not been found in some ethnic groups. In this study, we attempted to assess the association between NTDs and MTHFR C677T in Malaysian Malay population. Results show that MTHFR 677TT genotype was absent in both patient and control groups.

Metastatic penile cancer presenting as hypercalcemia and pathological fracture of the humerus: a rare event.

Distant haematogenous metastasis in penile cancer is rare. A patient who had total penectomy and bilateral inguinal lymphadenectomy for penile cancer but later presented with hypercalcemia of malignancy and pathological fracture of the humerus is reported.

Umbilical artery resistance index in diabetic pregnancies: the associations with fetal outcome and neonatal septal hypertrophic cardiomyopathy.

AIM: To determine the incidence of an abnormal umbilical artery resistance index (UARI) in diabetic pregnancies and the relation to fetal outcome and the development of neonatal septal hypertrophic cardiomyopathy. METHODS: A case-control study with subjects comprising 50 randomly selected diabetic mothers and a matched control group of 50 non-diabetic pregnancies. Doppler studies of the UARI were carried out at least once per week, beginning from 36 weeks' gestation for both groups. Within 48 h post delivery, echocardiograms were carried out on the newborn infants to identify those with hypertrophic cardiomyopathy, particularly asymmetrical septal hypertrophy. RESULTS: The numbers of patients with abnormal UARI were similar in both the diabetic and control groups. A higher proportion of operative deliveries for intrapartum fetal distress was seen in patients with an abnormal UARI in the diabetic group. However, the groups did not differ in the numbers of infants who were small for gestational age, who had low Apgar scores or umbilical artery acidosis, and who required admission to the special care nursery. Six infants of diabetic mothers (12%) had septal hypertrophy, but none of these were associated with abnormal antenatal UARI. CONCLUSION: Diabetic pregnancy is not associated with a significantly higher incidence of abnormal UARI on Doppler study than non-diabetic pregnancy. UARI is not a useful single indicator by which to predict subsequent fetal outcome or the development of neonatal septal hypertrophic cardiomyopathy in diabetic pregnancies.

The pattern of completed suicides seen in Kuala Lumpur General Hospital 1999.

UNLABELLED: A study was done on 76 suicide cases managed by the Forensic Pathology Department of Hospital Kuala Lumpur (HKL) from January till December 1999 to explore the pattern of suicide and psychiatric history. The Chinese contributed 52% (n=40) of cases followed by the Indians (29%, n=22) and the Malays (12%, n=9). After the age of sixty, 84.6% of the subjects were Chinese. The common methods of suicide were poisoning (39%), hanging (34%) and jumping from height (22%). Four out of 12 case-notes traced had documented psychiatric history i.e. schizophrenia. CONCLUSION: the suicide rate for Kuala Lumpur is estimated at 7.4 per 100,000. The Indians has the highest suicide rate of 21.1 per 100,000 in keeping with other local studies. The suicide rate for the Chinese is 8.6 per 100,000, but it increased to 23 per 100,000 among the elderly Chinese. The suicide rate for Malays is 2.6 per 100,000, higher than what was cited in previous local studies. The incidence of jumping from height as a suicide method had doubled over the last 2 decades.

The role of serum insulin-like growth factor I (IGF-I) in neonatal outcome.

AIMS: To determine the role of serum insulin-like growth factor I (IGF-I) in predicting the occurrence of septal hypertrophic cardiomyopathy in infants of mothers with diabetes. METHODS/MATERIALS: In this prospective study, 100 pregnant women (50 with diabetes and 50 controls), matched for age and race, were studied. One intrapartum blood sample was taken at 28 weeks of gestation from both groups of mothers and another sample at delivery. All samples were analysed for maternal IGF-I by an enzyme linked immunosorbent assay method. A chest radiograph and an electrocardiogram were performed on the babies of the mothers with diabetes within the first 24 hours of life. An echocardiogram was performed in the first 3 days of life to look for septal hypertrophy and to measure the myocardial thickness. RESULTS: In the six cases of neonatal septal hypertrophic cardiomyopathy, all the mothers had greatly raised IGF-I concentrations of more than 400 ng/ml at the time of delivery compared with a mean (SD) of 302 (25) ng/ml in control mothers. CONCLUSIONS: In the present study a crude analysis revealed that increased IGF-I concentrations correlate with neonatal septal hypertrophic cardiomyopathy.