Vertebrobasilar circulation hemorrhages in childhood primary angiitis of the central nervous system

ABSTRACT Childhood primary angiitis of the CNS (cPACNS) is a poorly understood, rare, and diagnostically challenging neurologic disease. We describe an unusual and autopsy-confirmed case of cPACNS presenting as vertebrobasilar circulation hemorrhagic strokes in a 4-year-old girl. The presentation and clinical features were inconsistent with primary CNS vasculitis and skewed the diagnosis. Autopsy and histopathological analyses revealed a progressive lymphocytic vasculitis affecting the medium to large vessels of vertebrobasilar circulation and sparing the anterior circulation. It is imperative to raise the index of suspicion for cPACNS in any case of unusual or unexplained neurological presentation, especially in the absence of cerebrovascular risk factors and/or coagulation disorders.

Synthesis of some novel pyrimidine, thiophene, coumarin, pyridine and pyrrole derivatives and their biological evaluation as analgesic, antipyretic and anti-inflammatory agents

Pyrimidine derivative 3 was afforded through the reaction of compound (1) with 5-ureidohydantion (2). Product 3 underwent a cyclization to produce fused pyrimidine derivative 7, although the latter product 7 was synthesized through one step via the reaction of compound (1) with 5-ureidohydantion (2) using another catalyst. Compound 3 was oriented to react with cyclic ketones 8a,b in the presence of elemental sulfur, salicylaldehyde (10), aryldiazonium chlorides 12a,b and ω-bromo-4-methoxy- acetophenone (14), which afforded, fused thiophene derivatives 9a,b, coumarin derivative 11, arylhdrazono derivatives 13a,b and 4-methoxyphenyl butenyl derivative 15, respectively. The latter product 15 was reacted with either potassium cyanide (16a) or potassium thiocyanide (16b) to form cyano and thiocyano derivatives 17a,b, respectively. Compound 17a underwent further cyclization to afford pyridopyrimidine derivative 19. Compound 15 was reacted with either hydrazine (20a) or phenylhydrazine (20b) to produce hydrazo derivatives 21a,b and these products were cyclize to produce pyrrole derivatives 23a,b. Finally, 5-ureidohydantion (2) was reacted with compounds 24a,b,c to afford pyrimidine derivatives 25a,b,c. The structures of the synthesized compounds were confirmed using IR, 1H NMR, 13C NMR and mass spectrometry techniques. Compounds 11 and 19 have promising as analgesic and antipyretic activities

Assessment of asthma knowledge among urban community pharmacists in Selangor, Malaysia

Objective: This study aimed to assess the knowledge of asthma among urban community pharmacists in Selangor, Malaysia. Study Design: Cross sectional study. Place and Duration of Study: Study was conducted at state of Selangor, Malaysia from Jan 2016 to Jul 2016

Material and Methods: One hundred fifty [150] community pharmacists in Selangor, Malaysia, were randomly selected and recruited for this baseline study. Self-administered questionnaires were directly distributed and collected by the investigators themselves. The extracted data from the completed questionnaires was analyzed using Statistical Package for Social Science [SPSS] version 19 [based on parametric/ non-parametric data]

Results: The mean average score of the pharmacists was 12.93 +/- 3.46 over a maximum possible score of 23 corresponding 56% of which was thought to be moderate performance. Respondents performed best in issues relating to features of asthma while areas of knowledge deficiency included recognizing the main symptoms of asthma, factors that can cause asthmatic attacks and proper mode of delivering asthma medications. The knowledge of asthma was related to age while gender and location of their premises had no influence on their knowledge

Conclusion: The key findings of this study indicated that the knowledge of asthma among community pharmacists surveyed was of average level. These results bring into focus the need for community pharmacists to undergo continuing professional education in order to update their knowledge and skills

Contribution of public places in proliferation of dengue vectors in Penang Island, Malaysia

Objective To determine abundance, distribution and diversity of potential breeding container habitats of the dengue vectors in public places including schools, restaurants, mosques and parks in southwest areas of Penang Island, Malaysia. Methods Premises at restaurants, schools, parks and mosques were surveyed simultaneously and inspected visually for container habitats and production of immature mosquitoes from March 2015 to March 2016. Abundance (mean ± SE) of breeding containers between sites was compared using One-way ANOVA. Independent sample t-test was used to compare total number of Aedes albopictus (Ae. albopictus) and Aedes aegypti (Ae. aegypti) surveyed. Results The surveyed locations yielded a total of 3 741 breeding containers and 19 537 immature mosquitoes from four areas. Concurrent artificial and natural containers produced 78.4% immature Ae. albopictus and 6.3% Ae. aegypti mosquitoes in wet season, with 14.2% Ae. albopictus and 1.1% Ae. aegypti mosquitoes in dry season. Artificial containers accounted for 98.1% of the total containers recorded, with restaurants being the most productive locations (8 012) and schools being the least productive (2 234). Conclusions It was concluded that public places are good sources of potential container habitats of Aedes mosquitoes in Penang Island, Malaysia and Ae. albopictus has exclusively replaced the home-grown Ae. aegypti even in urban areas. Therefore, treatment of artificial containers in such locations is critical in Aedes mosquito control campaigns during dengue outbreaks.

Impact of Rating Scale Categories on Reliability and Fit Statistics of the Malay Spiritual Well-Being Scale using Rasch Analysis

Background: Few studies have employed the item response theory in examining reliability. We conducted this study to examine the effect of Rating Scale Categories (RSCs) on the reliability and fit statistics of the Malay Spiritual Well-Being Scale, employing the Rasch model. Methods: The Malay Spiritual Well-Being Scale (SWBS) with the original six; three and four newly structured RSCs was distributed randomly among three different samples of 50 participants each. Results: The mean age of respondents in the three samples ranged between 36 and 39 years old. The majority was female in all samples, and Islam was the most prevalent religion among the respondents. The predominating race was Malay, followed by Chinese and Indian. The original six RSCs indicated better targeting of 0.99 and smallest model error of 0.24. The Infit Mnsq (mean square) and Zstd (Z standard) of the six RSCs were “1.1”and “-0.1”respectively. The six RSCs achieved the highest person and item reliabilities of 0.86 and 0.85 respectively. These reliabilities yielded the highest person (2.46) and item (2.38) separation indices compared to other the RSCs. Conclusion: The person and item reliability and, to a lesser extent, the fit statistics, were better with the six RSCs compared to the four and three RSCs.

Correlates Between Insomnia, Psychological Distress And Daytime Sleepiness Of Malaysian Adults With Symptoms Of Insomnia

Objective: The objective of this study is to identify the correlation between psychological factors and insomnia and the impact of insomnia on daytime sleepiness. Methods and Results: The participants were recruited through convenient sampling and consist of 173 working adults in Georgetown, Penang, aged 20 to 60 years. Participants completed the General Health Questionnaire (GHQ), Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS). The results revealed that the prevalent of insomnia was 34.7%. There was a positive correlation between psychological distress and insomnia r = .481, p < .001 and also a positive correlation between insomnia and daytime sleepiness r = .334, p < .001. Conclusion: It is concluded that psychological distress typically causes sleep difficulties, and sleep deprivation leads to daytime sleepiness.

Bcl-2 expression in CagA strain H. pylori gastritis [immunohistochemical and insitu hybridization study]

Carriage of Helicobacter Pylori in the human stomach is associated with increased risk of peptic ulcer disease, distal gastric adenocarcinoma and gastric B-cell mucosa associated lymphoid tissue lymphoma. To study the immunohistochemical expression of bcl-2, as apoptosis makers in the gastric mucosa of patients infected with cagA Helicobacter Pylori demonstrated by insitu hybridization method. Gastric antrum biopsies from 99 patients presented with dyspeptic symptoms [50 men, 49 women, median age 40] were analysed for the presence of H. pylori, and were classified according to updated Sydney system. Insitu hybridization technique was done to detect cagA H. pylori. Immunohistochemical expression of bcl-2 using [Avidin-Biotin method] was performed on paraffin embedded biopsy specimens. Forty four patients [44.44%] had H. pylori cagA positive starin. Atrophy of gastric mucosa was present in 14 [14.14%] patients. Intestinal metaplasia was present in 8 [8.08%] patients. The frequency of atrophy and intestinal metaplasia were significantly higher in cagA H. pylori gastritis than non-cagA H. pylori gastritis [p=0.023 and 0.041 respectively]. Bcl2 expression was not significantly higher in H. pylori gastritis than non-H. pylori gastritis [p=0.101]. Bcl2 expression was significantly higher in the presence of atrophy [p<0.001]. Bcl2 expression was significantly higher in the presence of intestinal metaplasia [p<0.001]. The rate of apoptosis decreases when lesions [gastric atrophy and intestinal metaplasia] are present

Perception of the learning environment by students in a new medical school in Saudi Arabia: areas of concern

The learning environment affects the learning of medical students and their practice as physicians. The objective of the present study was to assess the perceptions of medical students towards the learning environment in a new a Medical School in Saudi Arabia. This is a cross-sectional study, which used the self-administered validated Dundee Ready Education Environment [DREEM] questionnaire as a tool. The study was performed at the Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. The study population was all medical students enrolled in the academic year 2009/2010. The main outcome measure was the perception of students of the overall educational environment. The DREEM questionnaire, which consists of 50 items scored on a 0-4 Likert scale, was completed by 237 medical students [85% of total students]. The mean total score was 111.5 out of a maximum of 200, indicating a relatively low satisfaction with the perceived environment. There were no individual areas of excellence [item scoring >3.5 points]. Ten items scored consistently <50% indicating cause for concern. These included the long term atmosphere of learning, teaching methods, students' ability to concentrate and teachers' and students' attitudes. This study identified areas of concern in the educational environment within this new medical college. Corrective measures need to be considered. Upon the implementation of those measures, the DREEM tool can be used to re-evaluate the environment.

Household survey of container-breeding mosquitoes and climatic factors influencing the prevalence of Aedes aegypti (Diptera: Culicidae) in Makkah City, Saudi Arabia

<p><b>OBJECTIVE</b>To investigate the prevalence of container breeding mosquitoes with emphasis on the seasonality and larval habitats of Aedes aegypti (Ae. aegypti) in Makkah City, adjoining an environmental monitoring and dengue incidence.</p><p><b>METHODS</b>Monthly visits were performed between April 2008 and March 2009 to randomly selected houses. During each visit, mosquito larvae were collected from indoors and outdoors containers by either dipping or pipetting. Mosquitoes were morphologically identified. Data on temperature, relative humidity, rain/precipitations during the survey period was retrieved from governmental sources and analyzed.</p><p><b>RESULTS</b>The city was warmer in dry season (DS) than wet season (WS). No rain occurred at all during DS and even precipitations did fall, wetting events were much greater during WS. Larval survey revealed the co-breeding of Aedes, Culex and Anopheles in a variety of artificial containers in and around homes. 32 109 larvae representing 1st , 2nd, 3rd, and 4th stages were collected from 22 618 container habitats. Culicines was far the commonest and Aedes genus was as numerous as the Culex population. Ae. aegypti larval abundance exhibited marked temporal variations, overall, being usually more abundant during WS. Ten types of artificial containers were found with developing larvae. 70% of these habitats were located indoors. 71.42% of indoor containers were permanent and 28.58% was semi-permanent during WS. Cement tanks was the only container type permanent during DS. Ae. aegypti larval indices (CI, HI, BI) recorded were greater during WS.</p><p><b>CONCLUSIONS</b>Taken together, these results indicate a high risk of dengue transmission in the holy city.</p>

Dementia in Malaysia: Issues and Challenges

Objective: The number of people surviving until old age has been increasing worldwide. Reductions in both fertility and mortality rates, better living standards, nutrition and health care are claimed to be the key factors that increase the proportion of aged people within the population. Nevertheless, growing numbers of older adults also increases the susceptibility to diseases that commonly afflict the elderly, such as dementia. In this article, we discuss on the current issues of dementia in Malaysia and its challenge in providing a better management and services for this population. Methods and Results: Review of literature by searching the databases CINAHL, SCOPUS, MEDLINE and PsychINFO from June 2010 to November 2010 was done on the issues involving dementia patients in Malaysia such as ageing trend, awareness and availability of services. Conclusion: Despite a limited number of studies on dementia in Malaysia, literature revealed the importance of acknowledging the issues and improving the services for the patients. Efforts should be made by the government and private sectors to promote healthy ageing in Malaysia.

The biology and demographic parameters of Aedes albopictus in northern peninsular Malaysia

<p><b>OBJECTIVE</b>To generate life table characteristics for the dengue vector Aedes albopictus (A. albopictus) under uncontrolled conditions, incorporating both the aquatic and the adult stages.</p><p><b>METHODS</b>Ten females derived from wild pupae were allowed to fully blood-feed on restrained mice. 774 eggs were hatched in seasoned water. F1 larvae were followed for development until their F2 counterparts emerged as adults. Some population parameters were monitored (F1) or estimated (F2).</p><p><b>RESULTS</b>A. albopictus exhibited increased fecundity and egg hatch success. Immature development was quick. Immature survival was high, with lowest rate in the pupal stage. Adult emergence was about 81% and sex ratio was close to 1:1. Generational mortality (K) was about 28%. A high proportion of females completed a reproductive cycle and the obtained parity rate was predicted to lead to higher fecundity in the next generation.</p><p><b>CONCLUSIONS</b>It can be concluded that natural A. albopictus populations in Penang seem largely determined by quick development in combination with low immature loss and increased oviposition.</p>

Prevalence and correlates of snoring in medical and nursing students in University Malaysia Sarawak

Using a questionnaire, a snoring study was done in 400 medical and 78 nursing students of University Malaysia Sarawak in 2004 and 2005. The response rates were 72.5% for medical students and 83.3% for nursing students. The habitual snoring percentages for all years, first year and final year medical students were 7.2, 9.9 and 3.6 respectively; and for all years, first year and third year nursing students were 12.3, 13.3 and 8.3. These figures were lower than those found in Hong Kong and Germany, despite similar body mass index (BMI). In the combined group of student, positive correlation with snoring was found in male gender (p=0.011), BMI (p=0.002) and sleep apnoea (p=0.05). For medical students, positive correlation was found in male gender (p<0.0005), weight (p <0.001), height (p <0.001) and sleep apnoea (p<0.001), and for nursing students in BMI (p=0.008) and weight (p=0.033). No significant correlation was found in snoring with Epworth Sleepiness Scale and academic performance.

Correlation of apoptotic indices with clinical criteria in rheumatoid arthritis and osteoarthritis

Recent studies clarified the role of apoptosis in the pathophysiology of autoimmune diseases. To further clarify this point, the apoptotic indices, soluble Fas [s-Fas], lipid peroxides [LPER] representing oxygen free radical activity, nitric oxide [NO], interleukin-1B [IL-1B], cathepsin L and B were determined in the sera of patients with rheumatoid arthritis [RA] and osteoarthritis [OA] in comparison with controls. The study included 18 patients with RA, 32 patients with OA together with 10 age and sex matched healthy persons representing a control group. Serum from each participant was used for determination of apoptotic indices. The study revealed significantly increased levels of s-Fas, LPER, NO, IL-1B, cathepsin B and L in patients with RA and OA as compared with controls. Moreover, the levels were significantly higher in RA as compared with OA. The levels of these indices correlated with disease severity being higher though insignificantly so in cases associated with fever and advanced X-ray grading. Moreover, significant positive correlations were observed between articular index and LPER [r = 0.58 and p < 0.05] in RA and between ESR and NO [r = 0.39 and p < 0.05], IL-1B [r = 0.41 and p < 0.05], cathepsin B [r = 0.41 and p < 0.05] and cathepsin L [r = 0.38 and p < 0.05] in OA. Also, significant positive correlations were observed between IL-1B levels and NO, cathepsin B and cathepsin L in either RA or OA, clarifying the important role of IL-1B in the induction of NO cathepsin B and L synthesis. In conclusion, the present study further clarified the role of Fas dependent apoptotic pathway in RA and OA. Thus, the supply of Fas ligand could be a novel therapeutic technique in the future. Moreover, antisense oligonucleotides against IL-1B could also be used to control the deleterious effects of cytokine network in RA and OA