Comparison of Driving Difficulty Between Bilateral Cataract and Non-Cataract Elderly Drivers in Malaysia: A Preliminary Study (Perbandingan Kesukaran Memandu antara Pemandu Warga Emas dengan Bilateral Katarak dan Tanpa Katarak di Malaysia: Kajian Rintis) / Jurnal Sains Kesihatan Malaysia

@#An age-related ocular disease such as cataract that causes reduction of visual functions would affect the individual driving performance. The aim of this study was to compare driving difficulties between Malaysian drivers with bilateral cataracts and without cataract. This cross-sectional study involved measurement of visual functions [visual acuity (VA) and contrast sensitivity (CS)] and driving difficulty of 61 subjects who are actively driving with valid driving license. Subjects were divided into bilateral cataract group (n=30) and non-cataracts group as control group (n=31); which age and gender matched. Results showed that the mean±SD for composite driving difficulty score in the bilateral cataract group and in the control group were 72.08±15.95 and 87.50±12.60 respectively. It showed that both groups had lower mean composite score which indicates difficulty in driving. Results also showed significant mean difference composite driving difficulty score between cataract and control group (p<0.001). Drivers with bilateral cataracts were also found to have significant difficulty when driving the rain (p=0.034), at night (p=0.013) and when driving on local or highway (p=0.005) compared to drivers without cataract. Subsequent Spearman’s Rho showed significant moderate positive correlation between driving difficulty and binocular CS (rs =0.404, p=0.027). This study showed that drivers with cataract would experience driving difficulties compared to the drivers without cataract.

Development and validation of a new vision screening test algorithm for public use mobile application- A pilot study

@#algorithm for mobile application and perform a pilot study todetermine its validity and reliability as a tool for vision testin the community.Methods: A simple visual acuity test algorithm in the form ofa single letter E display was designed as the optotype fordevelopment of a mobile application. The standardisedoptotype is presented at random to test visual acuity forcorresponding level of 3/60, 6/60, 6/18, and 6/12. The finalresult is auto-generated based on the classification of theWHO for visual impairment and blindness. The Snellen chartwas used as the gold standard to determine its validity whilefive different users were involved to determine its inter-raterreliability. A pilot study was performed between April tillNovember 2019, in the Universiti Sultan Zainal AbidinMedical Centre (UMC) at Kuala Nerus and MoorisOptometrist Centre at Marang, Terengganu. A total of 279participants aged four years old and above were involved inthis study. Results: The highest sensitivity was found at the vision levelcut-off point of 6/12 with the percentage of 92.7% and 86.8%for the right and left eye, respectively. The specificity wasmore than 89% for all vision levels in both eyes. TheKrippendorff’s alpha value for the inter-rater reliability was0.87 and 0.83.Conclusion: The relatively high level of validity andreliability obtained indicate the feasibility of using thedesigned optotype to develop a valid and reliable mobile appfor vision test. The app can be used to screen vision by non-medical persons, at anytime and anywhere to help improvepublic awareness and capability to correctly determine theirvisual status.

Clinical and Biochemical Association between Single-Nucleotide Polymorphism of the Uromodulin Gene and Albuminuria in Patients with Type-2 Diabetes Mellitus

Objective: This study aimed to investigate the association of single nucleotide polymorphism (SNP) of UMOD gene (three SNP at promoter region; rs13333226, rs12917707, and rs4293393) with albuminuria and other renal function biomarkers in patients with type-2 diabetes mellitus. Methods: A case-control study design was employed to enroll 120 subjects, where 30 healthy subjects (as control group), 30 diabetic patients with normo-albuminuria (as first case group), 30 diabetic patients with microalbuminuria (as second case group) and 30 diabetic patients with macroalbuminuria (as third case group) were involved. Blood and urine samples were collected from the patients during their visits to diabetic clinics. Age, gender and BMI were taken for each participant. Fasting serum glucose (FSG), serum creatinine and blood urea were measured by a spectrophotometer, serum cystatin-c by ELISA technique, HbA1c was measured by the CLOVER A1c system, urinary albumin was measured by turbidimetric end-point method, (UACR) urinary albumin creatinine ratio were estimated, eGFR was also calculated. A whole blood sample was used for DNA extraction, finally, real time PCR technique was used for the determination of SNP genotype. Results: The results showed that the G minor allele of rs13333226 has a protective factor in patients with albuminuria. Also, the common variant AA of rs13333226 genotype was associated with a reduction in GFR. For the rs12917707 the common variant GG was associated with the development of albuminuria in diabetic patients and with the reduction in GFR. Finally, the frequency of (rs4293393) CC genotype was common and associated with the development of albuminuria in diabetic patients when compared with healthy controls. Conclusions: SNP in the regulatory region of the UMOD gene has a role in the protection from albuminuria in diabetes mellitus patients.

Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting

@#Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.

Visual Functions And Retinal Morphology In Patients With Polypoidal Choroidal Vasculopathy Seen In An Age Related Macular Degeneration Referral Centre Of Malaysia

@#The aim of the present study was to evaluate visual functions and retinal morphology of Polypoidal Choroidal Vasculopathy (PCV) patients seen in an AMD referral centre of Malaysia and to further explore association between visual functions and optical coherence tomography (OCT) parameters in PCV eyes. In this single centre, cross sectional study, best corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS) were measured in naïve PCV eyes. Selective parameters such as integrity of external limiting membrane (ELM), inner segment and outer segment junction (IS-OS), retinal pigment epithelium and Bruch’s membrane (RPE-BM) complex, average retinal thickness (ART) and volume (ARV), central retinal thickness (CT), centre maximum (CTmax) and centre minimum (CTmin) thickness were assessed using spectral-domain OCT. Forty-three new PCV eyes of 42 patients were evaluated. Mean (±SD) DVA, NVA, CS, RS were 0.83 ± 0.35 logMAR, 0.77 ± 0.3 logMAR, 0.69 ±.26 log CS and 59.56 ±14 words per minutes respectively. ART and CT showed good correlation with DVA (r=0.571& 0.546) and CS (r= 0.576 & 0.586). ARV and CTmax showed good correlation with CS (r=0.516 &, 0.513). The mean DVA, NVA and CS between three ELM and IS-OS status were significantly different (p=.002 & .000; p=.012 & .029; p=.005 & .001). In conclusion, present study reports visual functions and OCT characteristics of PCV patients in an AMD referral centre of Malaysia. Many of the quantitative and qualitative OCT parameters showed good association with the visual functions in eyes with PCV.

Primary care barriers to cataract surgery in the eastern zone of Peninsular Malaysia: an interpretative phenomenological analysis

Objective: Cataract is the leading cause of blindness inMalaysia. There is an alarming backlog of cataractextraction surgery as the majority believes they did notrequire surgery. This study aimed to explore the barriersat the primary care level to cataract surgery from theperspective of patients with severe cataract blindness.Methods: Eleven participants were involved in thisqualitative research which utilised the interpretativephenomenological analysis approach more renowned inhealth psychology research. All interviews conducted attheir home. The interviews were recorded, typedverbatim, and the transcripts were analysed using NVivosoftware version 8.0.Results: The main barriers identified at the primary carelevel were 1) nondisclosure of their visual problemsoriginated from their belated needs for better sight,delayed awareness of their visual status and socialstigma and 2) patient-provider-related issues namelymiscommunication and delayed referral. The first maintheme explains their belief for not requiring surgery. Thishas led to their delayed awareness and impededdisclosure of their visual problems to family members orprimary care providers. The second main theme reflectsthe provider-patient-related issues which retardedcataract detection and referral process required for earliercataract extraction surgery.Conclusion: Thus, the appropriate approach targeting thesespecific barriers at primary care level will be able to detect,motivate and assist patients for early uptake of cataractextraction surgery to improve their vision and prevent severeblindness.

Nutritional Compositions and Antiproliferative Activities of Different Solvent Fractions from Ethanol Extract of Cyphomandra betacea (Tamarillo) Fruit

Background: This study aims to examine various solvent extracts of Cyphomandra betacea (tamarillo) also known as the tree tomato, for their bioactive constituents and antioxidant activity. The study also aims to examine its effect on cancer cell death using two types of cancer cell lines (liver and breast cancer cell). Methods: The first part of the study evaluates the nutritional composition of tamarillo. Then, phytochemical profiling using GC-MS analysis in ethanolic tamarillo extract was conducted. Different fractions of n-butanol, ethyl acetate and aqueous fractions were obtained from the ethanolic extract of tamarillo. Then, the fractions were subjected to the quantification of total phenol (TPC) and flavonoid contents (TFC), free radical scavenging activity (SA) and also antioxidant activity (AOX) assayed by beta-carotene bleaching (BCB) assay. Finally, the capability of the ethanolic extract of tamarillo and different fractions were evaluated for their anticancer properties. Results: Findings from this study revealed that the nutritional composition (ash, protein, carbohydrate and total dietary fiber), and mineral levels (calcium, magnesium, potassium and iron) of tamarillo were moderate. The crude ethanol extract of tamarillo contained the highest phenolic and total flavonoid content. FT-IR analysis revealed the presence of alkanes, carboxylic acid, phenol, alkanes, carboxylic acids, aromatics and nitro compounds. Twelve bioactive constituents in tamarillo have been identified through GC-MS analysis. Cytotoxic activity suggests the potential of ethanolic extracts of tamarillo having a chemopreventive effect on breast and liver cancer cells. Conclusion: This study reveals that tamarillo has substantial antioxidant activity as well as anticancer properties.

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

Purpose: To evaluate corneal cell morphology in patients with keratoconus using an in vivo slit scanning confocal microscope. Methods: A cross-sectional study was conducted to evaluate the corneal cell morphology of 47 keratoconus patients and 32 healthy eyes without any ocular disease. New keratoconus patients with different disease severities and without any other ocular co-morbidity were recruited from the ophthalmology department of a public hospital in Malaysia from June 2013 to May 2014. Corneal cell morphology was evaluated using an in vivo slit-scanning confocal microscope. Qualitative and quantitative data were analysed using a grading scale and the Nidek Advanced Visual Information System software, respectively. Results: The corneal cell morphology of patients with keratoconus was significantly different from that of healthy eyes except in endothelial cell density (P = 0.072). In the keratoconus group, increased level of stromal haze, alterations such as the elongation of keratocyte nuclei and clustering of cells at the anterior stroma, and dark bands in the posterior stroma were observed with increased severity of the disease. The mean anterior and posterior stromal keratocyte densities and cell areas among the different stages of keratoconus were significantly different (P 0.05) among the three stages of keratoconus. Conclusion: Confocal microscopy observation showed significant changes in corneal cell morphology in keratoconic cornea from normal healthy cornea. Analysis also showed significant changes in different severities of keratoconus. Understanding the corneal cell morphology changes in keratoconus may help in the long-term monitoring and management of keratoconus.

Practice and barriers of family planning: A comparison among muslim women in three main cities, viz. New York City, Tehran and Kuala Lumpur

Background: There is a lack of information on the practice of family planning among Muslim women in New York City in the United States of America (USA) [hereinafter known as “Muslim women residing in the United States” (MWRIU)], Tehran in the Islamic Republic of Iran (IRI) and Kuala Lumpur, Malaysia. The limited figures on this issue are either outdated or mere estimates. The importance of sexual and reproductive health of Muslim women is expected to have massive effects on the social and economic progress of developing countries like the IRI and Malaysia. It is also expected to have imperative impacts on the attempts to empower the MWRIU community and enhance their health status to meet the national standards. Objective: The study objective is to explore and compare the practice of family planning, namely on contraceptive use and abortion among Muslim women in 3 major cities of different countries. Methodology: A survey of 379, 377 and 380 respondents from New York City, Tehran and Kuala Lumpur respectively was conducted in 2013 using self-administered questionnaires. Results: There were significant differences in contraceptive and abortion practices across these countries (P<0.01). While a significant 86.6% of Iranian and 66.2% of the MWRIU used contraception, only 22.9% of the Malaysian women did so. For abortion, 13.6% of the MWRIU and 6.3% of the Malaysian respondents had abortion at least once; while only 22% of Iranians revealed their abortion history, totaling 32.1% of them who had abortion. Financial problems and having an unsupportive husband were among the major factors hindering their practice of healthy family planning. Conclusion: Educational campaigns should be promoted to increase the awareness on the permissibility of family planning in Islam, as well as on sexual and reproductive rights.

Isolation and cloning of an aryl-aldehyde dehydrogenase gene from the white-rot fungus Pycnoporus cinnabarinus strain MUCL 39533

Aims: The white rot fungus Pycnoporus cinnabarinus MUCL 39533 is able to reduce vanillic acid to vanillin. Reduction of vanillic acid to vanillin catalysed by the key enzyme aryl-aldehyde dehydrogenase has been reported. Here we report the isolation and cloning of aryl-aldehyde dehydrogenase from P. cinnabarinus strain MUCL 39533. Methodology and results: An aryl-aldehyde dehydrogenase gene (PcALDH) was isolated from P. cinnabarinus by producing a partial cDNA sequence fragment of an aryl-aldehyde dehydrogenase gene through PCR. Degenerate PCR primers were designed based on codons corresponding to conserved amino acid regions of aryl-aldehyde dehydrogenases of several fungi and bacteria. The full-length PcALDH cDNA was obtained through ReverseTranscription-Polymerase Chain Reaction (RT-PCR) and Rapid Amplification cDNA Ends (RACE) PCR. PcALDH cDNA comprises an open reading frame of 1,506 bp that encodes a protein of 501 amino acids. The PcALDH predicted protein showed the highest amino acid sequence identity (84%) to ALDH from Trametes versicolor. In silico analysis of PcALDH indicated that it belongs to the ALDH super-family and Class 3 ALDH. Conclusion, significance and impact study: PcALDH cDNA was successfully isolated and characterized. Important motifs identified from the highly conserved PcALDH protein indicated that it belongs to the aldehyde dehydrogenase superfamily. The cDNA clone will be used in expression studies to confirm the catalytic function of the enzyme.

Development of welding fumes health index [WFHI] for welding workplace's safety and health assessment

This study aimed to develop an index that can rank welding workplace that associate well with possible health risk of welders. Welding Fumes Health Index [WFHI] were developed based on data from case studies conducted in Plant 1 and Plant 2. Personal sampling of welding fumes to assess the concentration of metal constituents along with series of lung function tests was conducted. Fifteen metal constituents were investigated in each case study. Index values were derived from aggregation analysis of metal constituent concentration while significant lung functions were recognized through statistical analysis in each plant. The results showed none of the metal constituent concentration was exceeding the permissible exposure limit [PEL] for all plants. However, statistical analysis showed significant mean differences of lung functions between welders and non-welders. The index was then applied to one of the welding industry [Plant 3] for verification purpose. The developed index showed its promising ability to rank welding workplace, according to the multiple constituent concentrations of welding fumes that associates well with lung functions of the investigated welders. There was possibility that some of the metal constituents were below the detection limit leading to '0' value of sub index, thus the multiplicative form of aggregation model was not suitable for analysis. On the other hand, maximum or minimum operator forms suffer from compensation issues and were not considered in this study

Protein and Microbial Determinations on Worn Contact Lenses Cleaned Conventionally Using the Lens2® Automatic Lens Cleaner / Jurnal Sains Kesihatan Malaysia

The accumulation of tear film proteins as well as microbes colonization onto worn contact lenses can be eliminated conventionally by mechanical rubbing during the cleaning process. Lens2® functions in rotation manner to loosen the deposits on the contact lens and has antimicrobial coating to keep lenses away from contamination. The objective of this study was to determine the efficiency of Lens2® to remove deposited protein and reduce microbial contamination compared to conventional method. Twenty-eight subjects each wore a pair of contact lens FDA Group 1 (Polymacon, SoftLens®38, Bausch & Lomb) for one month and cleaned them using multipurpose solution (COMPLETE® MoisturePLUSTM, Advanced Medical Optics) separately using two different methods. The right lens was cleaned conventionally while the left lens were cleaned using the Lens2®. The control group of thirteen subjects each wore a pair of contact lens for the same period and cleaned both conventionally. These lenses and its cases were then analyzed for protein deposition using Bichinchoninic Acid Assay (BCA) Kit (Sigma, USA) in 96-well plate. Microbial contamination was determined by culturing the samples on nutrient agar for bacteria and fungi and non-nutrient agar for amoeba isolation. The mean of total protein on control lenses (17.014 ± 13.246 μg/mL) was not significantly different from those on the Lens2® (21.623 ± 19.127 μg/mL). There were also low growth numbers of amoeba in each group of samples. Interestingly, there were no growths of amoeba from all Lens2® samples collected. There was also low growth numbers of bacteria in each sample group whereby Lens2® had the lowest growth of bacteria. No growth of fungi was obtained from all samples. The automatic lens cleaner, Lens2® was found to be as efficient as the conventional cleaning method. However, the Lens2® has additional advantage because of its antimicrobial material and need shorter time in the cleaning process as well as easy and effective.

Trace elements changes in Parkinson's disease

Copper and zinc levels in serum of thirty two patients with parkinsonism syndrome were estimated and were compared to those of thirty normal healthy individuals served as controls. Serum levels of copper but not that of zinc in patients with parkinson's disease were significantly lower than controls [P<0.001]. and this was reflected on the significant low ratio of copper to zinc. There was significant positive correlation between the serum copper and the duration of the disease. These results may give an indication of changes in serum trace elements associated with degenerative process in Parkinson's disease and reflect the duration and implying the prognosis

Myasthenia gravis, thymectomy: early outcome

This study was conducted on twenty four patients with myasthenia gravis [grade IIA and IIB], with a median duration of the disease of 12 weeks. All the patients were subjected to trans-sternal thymectomy because acetylcholine estirase inhibitors failed to give a favour clinical improvement. Our results showed that 87.5% 21 out of 24 and 8.33% 2 out of 24 of patients had thymic hyperplasia and malignant thymoma, respectively, Postoperatively, none of the patients required assisted respiration, corticosteroids, or excessive doses of acetylcholine esterate inhibitors. We conclude and advocate that thymectomy should be considered early and specifically for patients with grade IIA and IIB

Myasthenia gravis response to treatment. Clinical and physiological criteria.

Twenty three patients with myasthenia gravis, eight males and 65% respectively were admitted to Al-Yarmok Teaching Hospital in Baghdad. The most commonly affected age group was between 10-30 years[78%]. A complete clinical examination with special examination with special emphasis on the peripheral and central nervous systems was done. Laboratory investigations included electromyography, CT scanning for thymomas in addition to the routine work. By classification of the patients according to the clinical criteria presented seven patients were found to have stage I myasthenia gravis, six were stage IIA and eight stage IIB, while only two patients with stage IV is recorded. Investigations revealed that six patients only had enlarged thymus gland and two patients had increased immunoglobulins. The Tensilon test was positive in almost all the patients. All patients were treated with Mestinon [Pyridostigmine bromide 100-600 mg/day] eleven of them, any how needed prednisolone in addition. The response to medical treatment was good in 16 patients and moderate in six while poor in only one patient. One patient only needed tracheostomy and other needed surgical removal of the thymus gland [thymomectomy]. These two patients were both of stage III on clinical examination

Influence of duration of diabetes mellitus on the nerve conduction velocity.

150 known diabetic patients [7 males and 79 females] were divided into three groups according to the duration of the disease [below 5,5-9 and 10 and above years], the number of patients in each group was 62,6 and 2 respectively. The sensory conduction velocity of the sural nerve and the sensory and motor conduction velocities of the median, ulnar, peroneal and posterior tibial nerves were measured and compared in the three groups and also with results obtained from a control group of 40 nondiabetic subjects. Results from diabetic patients showed a significant reduction in the nerve conduction velocities, and a clear correlation between the duration of the disease and the severity of the neuropathy. The lower limb nerves were more severely affected, and the sensory conduction velocity was the most sensitive parameter which was affected earlier in diabetes mellitus

case of guillain bare syndrome complicating typhoid fever

In this report a case of Guillain Barre syndrome complicating typhoid fever is presented in a male patient 14 years of age complaining from fever, sweating and generalized weakness for 13 days. He developed later acute and severe weakness of the lower and upper limb muscles. Clinical and laboratory tests[including Widal test and blood culture] confirmed the diagnosis of typhoid fever. Clinical and electromyographic examinations proved Guillain Barre syndrome. The patient was discharged improving after being treated with chloramphenocil intravenously and physiotherapy. To our knowledge this is the first case of Guillain Barre syndrome complicating typhoid fever recorded in Iraq

Non steroidal management of patients with Guillain-barre syndrome

17 patients with Guillain- Barre syndrome were diagnosed on clinical electrophysiological and CSF grounds, observed over a period of 1.5 years. This group is composed of 13 males and four females, their age ranged from 6 to 64 years. All of the patients had areflexic flaccid weakness of the four limbs in an ascending fation. Nine patients had bilateral facial nerve weakness. All the patients included in this study received no steroids during the follow up period. One patient needed assisted respiration, and one died because of severe vasomotor collapse. Most of the others were ambulant, walking unaided after 1.5 years. Only three needed assistance of another person or article. This study demonstrates the good prognosis of the disease and the non relevance in its management