Randomised Clinical Trial of Combined L-Carnitine Supplement and Exercise on Biochemical Markers and Exercise Performance: A Systematic Review

@#Aim and design: L-carnitine supplementation combined with exercise may enhance metabolic responses and improve exercise performance. Thus, this systematic review article aims to identify the effects of the L-carnitine supplement on biochemical markers, and exercise performance when combined with exercise. Data Sources: The articles are screened and reviewed based on titles, abstracts and keywords. Only peer-reviewed studies written in the English language, dated January 2000 to March 2021, were considered in this review. Review Methods: The PRISMA method is used for this study. PubMed, EBSCOHost, SpringerLINK, and Scopus databases were used to systematically search. Results: From a search 731 articles, 12 articles were identified related to effect of L-carnitine intake with exercises on biochemical markers and exercise performance. Studies showed that L-carnitine supplementation can be consumed daily during aerobic or anaerobic exercises by different population including patients. Its combination could improve serum lipid profiles, antioxidant properties, markers of metabolic, oxidative stress, and inflammatory, and exercise performance. Conclusion and Impact: This review provides information regarding the beneficial effects of L-carnitine supplement with recommended dosages and exercise prescriptions on overall body health in human.

Study of Knowledge, Motivational Factors, and Potential Barriers Concerning Blood Donation Between Lapsed and Regular Blood Donors

@#Introduction: Many countries struggle to supply enough blood while maintaining their quality and safety. Increasing the number of regular donors is expected to increase the donor pool and blood safety. Thus, this study describes lapsed and regular blood donors’ characteristics, knowledge, motivation, and barriers concerning blood donation. Methods: This observational cross-sectional study has adopted an assisted self-administered questionnaire, which was distributed to blood donors at the Department of Transfusion Medicine, Hospital Sultanah Bahiyah, Kedah. A total of 328 participants consisting of 164 lapsed and 164 regular donors were selected. Logistic regression tests were used to determine the factors that predict lapsed donors. Results: Out of the selected 328 respondents, 54.3% were in the 25–39 age group, 66.2% were males, and 85.1% were Malays. Most of the respondents (88.4%) showed adequate blood donation knowledge, and 99.7% cited altruism as a motivator for blood donation. About 47.0% of the respondents claimed they lack enough time as their donation barrier. Donors who were younger in age, had a moderate blood donation knowledge (adjusted OR, 3.60; 95% CI, 1.34-9.64), didn’t know where to donate (adjusted OR, 2.79; 95% CI, 1.47-5.29), lack enough time (adjusted OR, 1.83; 95% CI, 1.04-3.24), and insufficient information about blood donation campaigns (adjusted OR, 2.19; 95% CI, 1.23-3.91) were more likely to lapse. Conclusion: Donor education, convenient time and location, and sufficient information about blood donation campaigns targeted at young donors are critical for preventing lapsed donors, which could subsequently increase the regular donor pool.

What influences Indonesian medical educators’ intentions to teach public health? A qualitative study / 한국의학교육

Purpose@#Medical educators are central in ensuring future doctors have sufficient public health skills. Attitudes, norms, and perceived control about the significance of teaching a subject determines whether or not it is taught and how well. This qualitative study aims to explore medical educators’ perceptions about what factors influence their intention to teach public health in Indonesian undergraduate medical schools. @*Methods@#Semi-structured interviews were conducted with eighteen medical educators from different Indonesian medical schools. Interviews were analyzed thematically using the Theory of Planned Behavior domains: attitudes, subjective norms, and perceived behavioral control. @*Results@#Five subthemes emerged under these domains: attitudes (defining public health); subjective norms (room in the medical curricula; teaching and assessment); and perceived behaviour control (medical educator confidence; institutional support). Most participants had a limited understanding about the scope of public health. This coupled with an already overcrowded medical curriculum made it challenging for them to incorporate public health into the medical curriculum dominated by clinical and biomedical content. Although believing that public health is important, medical educators were reluctant to incorporate public health because they were not confident incorporating or assessing content. @*Conclusion@#Strong institutional support is to improve public health quality and content in the medical curriculum. Including public health educators in discussions is critical.

Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes in Malaysia / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.@*Methodology@#ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline to end of study (EOS).@*Results@#Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.@*Conclusion@#Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.

Evaluation of Anti-Hyperlipidaemic Activity of a Mixture of Zinger officinale, Allium sativum, Citrus Lemon, Honey, and Malus domestica Vinegar (ZACAH) Extracts in Rats Fed with High Cholesterol Diet

@#Introduction: The incidence and complications of hyperlipidemia associated co-morbidities and mortalities are grossly increasing globally. Intervention with natural products preparation has been identified as an alternative for the management of hyperlipidaemia and its related cardiovascular complications. This study investigated the anti-hyperlipidaemic activities of a mixture of Zinger officinale, Allium sativum, Citrus lemon, honey, and Malus domestica vinegar (ZACAH) extracts in in Sprague Dawley (SD) rats fed with high cholesterol diet. Methods: Thirty-six male SD rats were randomly distributed into 6 groups, including normal chow diet-fed (NC), high cholesterol diet (HCD), HCD+ Simvastatin (standard drug) while the remaining three groups were fed with HCD + ZACAH extracts at different doses (1, 3 and 5mg/kg body weight) for 18 weeks. Simvastatin at 10 mg/kg of bodyweight was used as control. High-performance liquid chromatography (HPLC) was used to determine phenolic compounds present in ZACAH extracts, elastase inhibitory assay was determined using spectrometric with a substrate (N-Succ-(Ala)3-pnitroanilide (SANA) while 2,2-diphenyl-1-picrylhydrazyl (DPPH) was performed based by the method described by Blois, 1958. Results: In vitro; ZACAH extracts had oxygen radical absorbance capacity (ORAC) value of 2000 µmol TE/100 mL, total phenolic content (TPC) of 7537 ± 54.5%, DPPH free radical scavenging activity of 27.34 ± 2.71%, elastase inhibitory assay of 29.29 ± 1.65% and lipoxygenase inhibitory assay of 98.58 ± 1.42%. In vivo, ZACAH extracts showed decreased bodyweight, adipose tissue, improved lipid profiles and hepatic biochemical enzymes. Conclusion: These results suggested that ZACAH extracts supplementation improved hyperlipidaemia in SD rats and might be a promising adjuvant for the treatment of hyperlipidaemia.

The Socio-economic and Psychological Impact of COVID-19 Pandemic on Malaysian Private Dentists: An Exploratory Study

@#The global COVID-19 Pandemic combined with nationwide economic depression and public fear had caused dental clinics in Malaysia to experience a significant reduction in patient visits with a potential impact on the socio-economic and psychological status of Malaysian private dentists. This study assesses the socio-economic and psychological impacts of the COVID-19 pandemic on Malaysian private dentists. A cross-sectional online questionnaire included demographic profile, socioeconomic factors and psychological status was used. Participation was voluntary. Descriptive statistics on the three variables were generated. Pearson Chi-square test was used to check for significant difference (p<0.05). In all, 95 private dentists voluntarily participated. Male and female participants were equally represented, mostly in the 22-25 group (62%). The Job Insecurity Scale measurement showed 58% and 48.5% participants respectively, were socio-economically and psychologically affected. The Financial Threat Scale showed 44.4% of respondents were financially affected, while 51% (measured by the General health questionnaire) displayed affected health. The socio-economicpsychological aspect was found to be statistically significant (p =0.018). Within the limitation of sample size, participating private dentists were found to be socio-economically and psychologically affected by the COVID19 pandemic.

A Case Report of Failure to Thrive Caused by Parental Intellectual Disability: The Invisible Population / 가정의학회지

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

A Case Report of Failure to Thrive Caused by Parental Intellectual Disability: The Invisible Population / 가정의학회지

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

Julat Rujukan Bagi Jumlah Homosisteina Dalam Plasma Di Kalangan Kanak-Kanak Di Malaysia (Reference range for plasma total homocysteine among Malaysian’s children) / Jurnal Sains Kesihatan Malaysia

@#Homocystineimia is an Inborn Errors of Metabolism (IEM) which can occur due to accumulation of homocysteine. Homocysteine is one of the sulfur-containing amino acid with thiol group that is formed by demethylation of methionine. Deficiency of enzymes involves in homocysteine metabolism can give rise to seven types of homocystinemia subject to total homocysteine level. Therefore reference ranges are needed to differentiate between normal and abnormal population as well as the type of homocystineimia depending on the enzymes defect in the pathway. Hence, homocysteine reference ranges in children for the Malaysian population were postulated. 3 mL of blood was collected from 86 normal individuals (52 boys and 34 girls) and then subsequently processed and analysed using High Performance Liquid Chromatogrphy – Ion Exchange Chromatography (HPLC-IEC). The calculated mean total homocysteine for the population was 8.1 ± 3.89 µM (95% confidence interval, l 7.3-8.9 µM). Reference range was 2.5 – 16.2 µM with lower and upper cut-off were 1.0 µM dan 21.0 µM, respectively. The newly developed reference range of total homocysteine for Malaysian children is able to reduce false negative cases in the laboratory.

Blood Glucose Response to Unilateral and Bilateral Resistance Training Among Trained Women (Respon Glukosa Darah ke atas Latihan Bebanan Satu Anggota Badan dengan Dua Anggota Badan dalam Kalangan Wanita Terlatih) / Jurnal Sains Kesihatan Malaysia

@#Exercise selection is one of crucial factors in designing a comprehensive training programme. The exposure of different exercise selection may stimulate the specific adaptation imposed demand. In the construction of any resistance training (RT) programme, it is important to choose whether to apply bilateral (BI) or unilateral (UNI) exercise. The present study aimed to look into the physiological responses of blood glucose (BG) between UNI and BI RT. Quantitative research method was used, RT (UNI versus BI training) as the independent variables whereas BG set as the dependent variable. In order to measure training effects following a single bout of different training intervention (UNI versus BI), a crossover experimental pre and post test design was implemented. A total of sixteen (n = 16) trained women with mean age of 23 (SD = 1.35) years old went through a single bout of RT involved a total body exercise using major muscles group with 80% of 1RM for each protocols (UNI and BI) for 10 repetitions to maximal effort (for 3 sets). Crossover design would be more accurate in exposing different training protocol to a similar characteristic of individuals as compared using different individuals. The results revealed that blood glucose (BG) were statistically changed (p < .001) across times (between PRE to IP, between PRE and 15P as well as between PRE and 30P), and finding shows there is no difference between training protocols (p = .39). Thus, similar responses of UNI and BI RT on BG concentration provides wide selection of exercise method to practitioners specifically to trained women. Future research on UNI versus BI RT could venture onto other types of hormones analysis including insulin, growth hormone and cortisol can be included. Besides, future research should consider a long run study that involve chronic adaptation of RT on human body in order to prevent and alleviate disease.

Impact of Transfusion Practice on the Occurrence of Acute Transfusion Reactions in a Malaysian Hospital: A Single-centre Retrospective Study

@#Introduction: Acute transfusion reactions (ATR) are commonly reported in clinical transfusion practice, which may result in significant morbidity and mortality. This study aims to explore the impact of transfusion practice on the prevalence, characteristics, and associated factors of ATR at Hospital Sultanah Bahiyah, Kedah, Malaysia. Methods: This was a retrospective study using records from haemovigilance forms of reported transfusion reactions, E-Delphyn (blood bank system), and E-His (hospital information system). A total of 118 cases of ATR from January 1, 2015 until December 31, 2017 were selected and analysed. For each case, a control was selected from a patient who did not develop ATR. Results: A total of 122,215 units of whole blood and blood component transfusions have been performed and 415 ATR were reported. The prevalence of ATR was 0.34% or one in 294 units transfused. There was a significant association between ATR and red cell concentrate (RCC) stored for more than 14 days (adj OR = 65.29, 95% CI 9.29-458.85). The most common ATR were allergic reactions with 63 cases (53.4%), followed by febrile non-haemolytic transfusion reactions (FNHTR) with 45 cases (38.1%). Allergic reactions were significantly associated with female patients (p = 0.038) and the paediatrics age group (p = 0.038). Multivariate analysis revealed a significant association between FNHTR and RCC stored more than 14 days (p = 0.002). Conclusion: The prevalence of ATR in this hospital was low and associated with RCC stored for more than 14 days. Implementation of pre-storage leucoreduction is recommended.

Cerebral venous thrombosis in multi-ethnic patients from Malaysia

@#Background & Objectives: The literature on cerebral venous thrombosis (CVT) in South East Asia is limited. The objectives were to evaluate the clinical profile, predisposing factors and clinical outcome of the CVT patients in Malaysia. Methods: We conducted a retrospective descriptive study of the CVT patients admitted to the neurology ward. The clinical presentation, predisposing factors, radiological findings, treatment and prognostic characteristics were evaluated from the charts. Clinical outcome on discharge and six months was measured by Modified Rankin Scale (mRS) scores. Poor outcome and good outcome was defined as Modified Rankin Scale (mRS) scores of 3-6 and 0-2 respectively. Results: Forty nine CVT patients who presented between 2007 and 2017 were recruited. The mean age was 43.51±16.52. The patients consisted of 39 Malaysians (13 Indians, 12 Malays, 12 Chinese, one Iban, one Eurasian descent), and ten non-Malaysians. Thirty (61.2%) patients were women. The most common presenting complaint was headache (75.5%). Six percent had multiple risk factors, whereas 51% had idiopathic CVT. The most common predisposing factors were oral contraceptive pill use (18.4%), followed by infection (12.2%), especially central nervous system (CNS) infection (6.1%); 11.8% had prothrombotic disorder. The most common location for CVT was superior sagittal sinus (83.7%). On neuroimaging, 77.6% had parenchymal lesions, 53.1% had venous infarcts and 38.8% had intracerebral haemorrhage, one patient had CVT complicated by rare venous collateral channels. Poor outcome on discharge and at six months was 38.8% and 33.3% respectively. On univariate analysis, female gender (p=0.002), seizures (p=0.037) and cerebral oedema (p=0.018) were associated with poor functional outcome. On binary logistic regression, female gender (OR=14.50, 95% CI 2.10-99.94,p=0.003) and seizures (OR=6.54, 95% CI 1.33-32.07, p=0.017) were associated with poor outcome. Conclusion: The CVT patients in this study had a higher proportion of CNS infections. Poor outcome was independently associated with female gender and seizures.

Effects of geraniin (rambutan rind extract) on blood pressure and metabolic parameters in rats fed high-fat diet / 中西医结合学报

OBJECTIVE@#A preliminary study showed that geraniin extracted from Nephelium lappaceum L. at 50 mg/kg caused reduction in blood glucose and insulin resistance. The present study serves to further investigate the effects of geraniin at increasing doses between 3.125 and 100 mg/kg in high-fat diet-treated rats.@*METHODS@#Geraniin (95% purity) was extracted and purified from rambutan rind. Two groups of male Sprague-Dawley rats were fed with 60% high-fat diet and standard rat chow, respectively, for 12 weeks. High-fat diet-treated rats were then administered geraniin at different doses. Body weight, blood pressure and blood glucose readings were measured. At the end of treatment, blood was collected for analysis of glycated haemoglobin A1c (HbA1c), insulin, advanced glycation end-product (AGE) levels, renin, aldosterone and electrolytes.@*RESULTS@#Within the first week of treatment, even the lowest dose of geraniin caused a significant reduction in blood pressure, which was comparable to control diet-treated rats. There were no changes in serum electrolytes, renin or aldosterone. Similarly, there was a significant reduction in serum insulin, insulin resistance and AGE levels at the lowest dose. However, there was no significant decrease in fasting blood glucose or HbA1c. The effects of decreasing insulin, insulin resistance and AGEs were observed only at the lower doses, unlike the results observed for blood pressure reduction.@*CONCLUSION@#Geraniin at lower doses improved blood pressure and other metabolic parameters. Secondary metabolites of geraniin, associated with antihypertensive activity, are relatively different to those involved in inhibiting AGE formation and increasing insulin sensitivity. The secondary metabolites of geraniin may be individually responsible for the bioactivities demonstrated.

Predictors of functional outcome in patients with stroke thrombolysis in a tertiary hospital in Malaysia

INTRODUCTION@#Intravenous (IV) thrombolysis with alteplase (rt-PA) is effective in ischaemic stroke. The primary objective was to evaluate predictors of functional outcome in acute ischaemic stroke (AIS) patients treated with IV rt-PA. The secondary objective was to assess the outcome with the modified Rankin scale (mRS). We also examined the predictive value of the Totaled Health Risks in Vascular Events (THRIVE) score.@*METHODS@#AIS patients treated with IV rt-PA from February 2012 to August 2016 were recruited. Demographic data, National Institutes of Health Stroke Scale (NIHSS) scores, timing and neuroradiological findings were recorded. Patients received a dose of 0.9 mg/kg IV rt-PA within 4.5 hours of symptom onset. mRS score was evaluated at discharge and three months, and good and poor clinical outcomes were defined as scores of 0-2 and 3-6, respectively. Baseline THRIVE scores were assessed.@*RESULTS@#36 patients received IV rt-PA. 20 (55.6%) patients had an mRS score of 0-2 at three months. Based on THRIVE score, 86.1% had a good or moderately good prognosis. On univariate analysis, poor outcome was associated with NIHSS score before rt-PA (p = 0.03), THRIVE score (p = 0.02), stroke subtype (p = 0.049) and diabetes mellitus (DM; p = 0.06). Multiple logistic regression showed that outcome was significantly associated with NIHSS score before rt-PA (p = 0.032) and DM (p = 0.010).@*CONCLUSION@#Our newly developed Malaysian IV rt-PA service is safe, with similar outcomes to the published literature. Functional outcome after thrombolysis was associated with baseline NIHSS score and DM.

Disseminated Takayasu arteritis with neurovascular small and medium vessel involvement

@#Takayasu arteritis is a rare granulomatous vasculitis that is commonly classified as a large vessel disease. Small and medium vessel involvement are extremely rare, with only a few case reports describing neurovascular, ocular and cutaneous involvement. We describe a 21 year old Malaysian woman with pre-existing Takayasu arteritis confined to the large vessels, presenting one year later to our centre with status epilepticus. Extensive radiologic studies revealed diffuse encephalopathic changes and multifocal neurovascular involvement, with the vasculitis progressing to encompass the large, medium and small vessels. The patient was treated with high dose steroid therapy and discharged well with long term steroid and immunosuppressive therapy. Follow up MRI with vessel wall imaging sequence (VW-MR) and arterial spin labelling (ASL) perfusion imaging demonstrated intra and extracranial vessel wall inflammation, with generalized reduction in left sided cerebral blood flow. This case demonstrates that Takayasu arteritis is not exclusively a large vessel vasculitis, and that small and medium vessel involvement does not preclude its diagnosis.

Biohythane production from palm oil mill effluent – a preliminary evaluation of a two-stage anaerobic digestion

@#Aims:This research aims to investigate the potential of biohythane (biohydrogen and biomethane) production from palm oil mill effluent (POME) in a two-stage anaerobic digestion (AD) system.Methodology and results:A two-stage AD system was configured with a thermophilic dark fermenter (TDF) for biohydrogen (H2) production and a thermophilic anaerobic contact digester (TACD) for biomethane (CH4) production. To adjust pH 5.5 for dark fermentation, the settled sludge was recirculated from TACD to TDF. The hydraulic retention time (HRT) applied in TDF and TACD was 3.75 and 6.25 day, respectively.Conclusion, significance and impact of study:The sludge recirculation from TACD was able to adjust the pH in TDF to the optimum value of 5.5. The total COD and TSSdegradation were 63.12 and 77.94 %, respectively. The H2production in TDF was 1.54 L H2/L POME and the CH4production in TACD was 19.87 L CH4/L POME. The H2and CH4yielded 0.085 L/g CODremovedand 0.339 L/g CODremoved, respectively, with total energy recovery equivalent to 661.02 MJ/m3POME. Only 2.28 % of this energy was contributed by H2and the remaining was dominated by CH4.

Association between Tooth Loss and Body Mass Index Among Older Adults in Kuala Pilah, Negeri Sembilan / Jurnal Sains Kesihatan Malaysia

@#Loss of teeth can affect masticatory efficiency in older adults. This may result in avoidance or modifications in foodchoices and lead to lower intake of important nutrients among older individuals. The aim of this study was to determinethe association between tooth loss and body mass index, BMI, among older adults in Kuala Pilah, Negeri Sembilan. Across-sectional study was carried out on 428 older adults aged 50 years and above from selected villages in district ofKuala Pilah. Respondents were interviewed to collect information on their demographic characteristics. Number of toothloss was determined through oral assessment, followed by anthropometric assessment to calculate the BMI of respondents.Findings showed that majority of the respondents were overweight and obese, 40.4% and 19.9% respectively, while onlya small proportion was underweight, 3.9%. The proportion of edentulism (total tooth loss) was 18.3% and majority ofthe older adults had lost more than 12 teeth (77.1%) and less than 4 pairs of occluding posterior teeth (86.0%). Totaland partial tooth loss was found to be not significantly associated with BMI. In relation to the arrangement of teeth,older adults with reduced number of posterior occluding pairs of teeth were more likely to experience unsatisfactoryBMI (OR = 3.61, 95% CI: 1.48, 8.76). This may suggest that functional arrangement of the tooth in the oral cavity is moreimportant than the number of tooth loss alone. Thus, maintaining an optimum number of teeth for chewing is essentialfor maintenance of ideal BMI.

Oral Status And Its Association With Oral Health-Related Quality Of Life In Community-Dwelling Older Adults

@#Poor oral conditions among older adults can cause significant impacts to their overall quality of life. Older adults with reduced number of functional teeth and dental diseases may experience difficulty in daily activities like chewing and eating. The aim of this study is to assess the association between oral health and oral health-related quality of life (OHRQoL) among a group of community-dwelling older adults in Negeri Sembilan, Malaysia. A cross-sectional study was carried out on 436 older adults aged 50 years and above from 20 randomly selected villages in the state. Respondents were interviewed using a structured questionnaire to collect information on their demographic characteristics. Clinical oral examination was carried out to determine the oral health conditions of older people. The validated Malay version of Geriatric Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. Total GOHAI score ranged from 12 to 60 with higher scores indicate better OHRQoL. Majority (77.1%) of the older adults had less than 20 teeth and about 18.3% were edentulous (total tooth loss). All dentate respondents had experienced dental caries. The median GOHAI score was 54.5 (IQR 50-57). About 25.5% of the older adults perceived their oral health as good, while 74.5% had poor perception on oral health. Bivariate analysis showed that less than 20 teeth and high dental caries experience were significantly associated with poor OHRQoL. A significantly higher proportion of older adults with less than 20 teeth limit the kinds of food intake, had trouble biting or chewing, and experienced tooth sensitivity. The physical functioning and well-being of the older people may be disrupted due to oral diseases. Measures of OHRQoL are important as to complement the clinical oral findings in identifying treatment needs of the geriatric patients.

Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis

Objective: The primary objective of this study was to describe the neuroimaging changes of tuberculous meningitis (TBM), and to determine the role of neuroimaging in the diagnosis of TBM. Methods: Between January 2009 and July 2015, we prospectively recruited TBM patients in two hospitals in Malaysia. Neuroimaging was performed and findings were recorded. The control consists of other types of meningo-encephalitis seen over the same period. Results: Fifty four TBM patients were recruited. Leptomeningeal enhancement was seen in 39 (72.2%) patients, commonly at prepontine cistern and interpeduncular fossa. Hydrocephalus was observed in 38 (70.4%) patients, 25 (46.3%) patients had moderate and severe hydrocephalus. Thirty four patients (63.0%) had cerebral infarction. Tuberculoma were seen in 29 (53.7%) patients; 27 (50.0%) patients had classical tuberculoma, 2 (3.7%) patients had “other” type of tuberculoma, 18 (33.3%) patients had ≥5 tuberculoma, and 11 (20.4%) patients had < 5 tuberculoma. Fifteen (37.2%) patients had vasculitis, 6 (11.1%) patients had vasospasm. Close to nine tenth (88.9%) of the patients had ≥1 classical neuroimaging features, 77.8% had ≥ 2 classical imaging features of TBM (basal enhancement, hydrocephalus, basal ganglia / thalamic infarct, classical tuberculoma, and vasculitis/vasospasm). Only 4% with other types of meningitis/encephalitis had ≥1 feature, and 1% had two or more classical TBM neuroimaging features. The sensitivity of the imaging features of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%. Conclusion: The classic imaging features of basal enhancement, hydrocephalus, basal ganglia/thalamic infarct, classic tuberculoma, and vasculitis are sensitive and specific to diagnosis of TBM.