Effects of occupational sunlight exposure and monsoon season on vitamin D concentration among outdoor and indoor workers in Malaysia

@#Introduction: Despite abundant sunshine for cutaneous vitamin D synthesis, low levels of vitamin D have been documented among the Malaysian population. The aim of this study was to characterise the effects of occupational sunlight exposure and monsoon season on serum 25-hydroxyvitamin D [25(OH)D] concentration. Methods: A comparative cross-sectional study was performed among Malay outdoor (n=119) and indoor workers (n=119) in Kelantan. Two-point data were collected on the same participants, first during non-monsoon season and second during the northeast monsoon season. Data collection comprised of anthropometry measurements (body mass index and body fat), fasting blood test [serum 25(OH)D concentration], and questionnaire (physical activity level, sun exposure, sun protection use, and vitamin D intake). Vitamin D classification was based on the 2011 Endocrine Society Clinical Practice Guidelines. Results: This study found that serum 25(OH)D concentrations were significantly higher in outdoor compared to indoor workers irrespective of season (p<0.001) and sex (p<0.001). Monsoonal differences in serum 25(OH)D concentration was only observed in male outdoor workers (mean difference=10.39 nmol/l, p<0.001). Significant association between vitamin D status and occupation was also observed (p<0.001). However, no significant association was found between vitamin D status and monsoon season [χ2(1)=0.076, p=0.783]. Conclusion: Seasonal and occupational factors should be considered while evaluating individual serum 25(OH)D concentration and in comparing community studies, especially among workers.

Is smoking Shisha safer than cigarettes: comparison of health effects of Shisha and cigarette smoking among young adults in Kuwait

Objective: The aim of this study was to compare the health effects of shisha smoking with cigarette smoking among male college students in Kuwait

Subjects and Methods:This cross-sectional study was conducted on 525 male students in Kuwait from September to October 2013. A pretested questionnaire was used for information on demographics and health complaints. Peak expiratory flow rate [PEFR] was measured using a portable peak flow meter. The outcome variables of health status were compared between smoking shisha, cigarettes, or both, and nonsmoking

Results:The prevalence of current smoking was 243 of the 525 students [46%]; of them, 52 [10%] were shisha smokers, 69 were [13%] cigarette smokers and 122 [23%] were both shisha and cigarette smokers. There were significantly fewer shisha smokers than cigarette smokers with symptoms of persistent cough [4 vs. 13% or 2/52 vs. 15/69; p = 0.007], chest pain [4 vs. 23% or 2/52 vs. 16/69; p = 0.004] and rapid heart rate [12 vs. 28% or 6/52 vs. 19/69; p = 0.04]. Other complaints, including asthma, respiratory infections, shortness of breath, high blood pressure, increased blood sugar levels and sleep disturbances were similar in thE[2] groups. Values of PEFR for shisha smokers and cigarette smokers were not significantly different

Conclusion: This study produced evidence suggesting that shisha smoking is not safer than cigarette smoking except with regard to complaints such as cough, chest pain and rapid heart rate, and that people who smoke both experience worse health effects in terms of frequent symptoms of respiratory infections, persistent cough, rapid heartbeat and sleep disturbances

Perioperative management of patients with tricuspid atresia and univentriclular congenital cardiac defect

Complex congenital heart diseases like univentricular cardiac defects are relatively common. Tricuspid atresia [TA] with hypoplastic right ventricle is one such univentricular congenital defect which if not corrected surgically leads to fatality. Palliative bidirectional Glenn procedure is usually done as initial measure for such patients. We present this case report based discussion to enumerate the challenges faced by the anesthesiologists while managing such cases for bidirectional Glenn shunt surgery [BDGS] during perioperative period

Effect of Gender and Nutritional Status on Academic Achievement and Cognitive Function among Primary School Children in a Rural District in Malaysia

Introduction: The aim of this study was to investigate the relationship between gender, birth weight, nutritional status, and iron status of children with their academic performance and cognitive function. Methods: Two hundred and fortynine children, seven to nine years of age, were recruited by systematic sampling from six primary schools in a rural area in Malaysia. Cognitive function was assessed by using Raven’s Coloured Progressive Matrices (R-CPM). Academic performance of the children was recorded from their school final examination results in four subjects including Malay language, English, Mathematics, and Science. Birth weight was recorded from the birth certificate, and nutritional status was determined by weight-for-age z score and height-for-age z score. Results: Girls had a significantly higher score in all the academic tests, but a lower cognitive score compared to boys. Nutritional status was found to be correlated significantly with academic performance. Academic and cognitive function scores were also found to be correlated significantly with birth weight, parents’ education, and family income. In a multivariate analysis, gender remained the significant predictor of academic function, and iron status and haemoglobin were the significant predictors of cognitive function, after controlling for other variables. Conclusion: The study showed that girls performed better academically than boys in rural Malaysia. Nutritional status, parents’ education and family income could be additional modifiable factors to improve academic performance of the children. More attention is needed to improve academic achievements of boys at their early school years.

Association of Intracellular T(H)1-T(H)2 Balance in CD4+ T-cells and MIP-1alpha in CD8+ T-cells with Disease Severity in Adults with Dengue

BACKGROUND: We tested the hypothesis that dengue haemorrhagic fever (DHF) is associated with a T(H)1-skewed immune response as opposed to dengue fever (DF). METHODS: We estimated intracellular (in T-cells) and serum levels of designate T(H)1/T(H)2 cytokines [interferon-gamma (IFN-gamma), interleukin-4 (IL-4), and tumor necrosis factor-alpha] and macrophage inflammatory protein-1alpha (MIP-1alpha) at admission, 48 h, and day 5 in 20 adults with dengue (DF=10, DHF=10) and 10 dengue-naive healthy controls. RESULTS: At admission, intracellular IFN-gamma/IL-4 ratio in CD4+ T-cells and proportion of MIP-1alpha-positive CD8+ T-cells were significantly higher in patients with DHF [7.21 (5.36~10.81) vs. 3.04 (1.75~4.02); p=0.011 and 6.2% (3.2~8.2%) vs. 2.4% (2.0~3.6%); p=0.023]. The latter showed a significant positive correlation with IFN-gamma/IL-4 ratio in CD4+ T-cells (Spearman's rho=0.64; p=0.003), percentage-change in haematocrit (rho=0.47; p=0.048), and serum alanine aminotransferase level (rho=0.61; p=0.009). CONCLUSION: We conclude that DHF is associated with a T(H)1-skewed immune response. Further, MIP-1alpha in CD8+ T-cells is an important immunologic correlate of disease severity in dengue.

Association of Iron Deficiency with or without Anaemia and Cognitive Functions among Primary School Children in Malaysia

Iron deficiency and anaemia affect millions of children worldwide. This study aimed to investigate the effect of iron deficiency with or without anaemia on cognitive functions, specifically with short-term memory, attention and visualmotor coordination in children. A total of 173 primary school children was enrolled. Cognitive functions were assessed using the Wechsler Intelligence Scale for Children. Three sub-tests were selected to assess processing speed (coding test), immediate auditory memory (digit span test) and visual processing and problem solving ability (maze test). The results showed significant correlation between age and coding test (r =0.38, p<0.001), digit span test (r =0.16,p = 0.028), and maze test scores (r =0.28, p<0.001), and the total sub-test scores (r=0.43, p <.001). After age adjustment of the cognitive function tests, iron deficient children without anaemia scored significantly lower than the healthy children (p<0.001) on coding test, while iron deficient children with anaemia and iron deficient children without anaemia scored significantly lower (p<0.001) than the healthy counterparts on maze test. No significant differences were observed on digit-span score among the groups. This study confirms the negative effect of both iron deficiency and iron deficiency anaemia on processing speed and visualmotor coordination in children.

Diffuse idiopathic hyperplasia of the sternocleidomastoid muscle in a child

Unilateral diffuse or localized enlargement of the sternocleidomastoid muscle [SCM] is an event commonly seen in infancy, and is popularly known as 'sternocleidomastoid tumor'. The condition, which usually spontaneously resolves with or without physiotherapy, is due to a hematoma following a difficult labor. The muscle regains its elasticity and complete function. In some infants it resolves with fibromatous changes in the muscle leading to shortening, fibrosis and finally culminating in torticollis. We describe a case of idiopathic diffuse enlargement of unilateral SCM in a 12-year-old child without any functional compromise or torticollis. The histopathological and clinical characteristics differentiating it from more commonly described sternocleidomastoid tumor or fibromatosis coli are described. We believe this is the first case report of idiopathic hyperplasia of SCM

Cervical stabilization with halo fixation: Anesthetic implications-Case Reports

Halo fixation is often used to provide stability in patients with unstable cervical spine. These fixation devices pose unique challenges to the anesthesiologists encountered while securing an airway. Management of airway in patients with halo fixation is complicated by the fixed position, limited access to the face, and immobilization of neck. We managed two different patients, one in which halo fixation was done for atlanto-axial dislocation [AAD]; and the other, who came with halo fixation and underwent wound debridement under general anesthesia. In the former case, procedure was carried out with laryngeal mask anesthesia and patient breathing spontaneously whereas, in the later case, procedure was performed after securing the airway using awake fiberoptic intubation technique

study on validity of copper sulphate specific gravity method as a screening procedure to detect anaemia

Whether the Copper sulphate specific gravity method is a valid screening test to detect anaemia at the field level and if it is affected adversely by any common prevalent nutritional and physiological or obstetric factors of the women. To find out the validity of Copper sulphate specific gravity method to detect anaemia at 11 gm% and 12 gm% haemoglobin level among women. Cross-sectional, Observational, Epidemiological, Community-based study. Urban Health Clinic at Ghoshbagan slum of Kolkata, the field practice area of Dept. of Community Medicine, R G K M C and H. Women of 10 - 45 years of the area, selected by systematic random sampling. The study recruited 373 women from the slum area. For haemoglobin level of 12gm%, the sensitivity was 91.19%, specificity was 82.14%, Predictive value for positive test was 92.25% and that for negative test was 80.0%. Respective results for Haemoglobin level of 11gm% were 81.53%, 96.30%, 94.12% and 87.76%. Similar high values of validity were obtained for different physiological and nutritional status of the women. The results implied that copper sulphate specific gravity method is a valid screening procedure for detection of anaemia irrespective of differing physiological and nutritional statuses of women

Multiorgan involvement due to cytomegalovirus infection in AIDS

Cytomegalovirus (CMV) infection is a relatively late complication of AIDS. Like other viruses contributing to co-morbidity of HIV infection, cytomegalovirus has the propensity to cause multiorgan involvement. We report the case of a 34-year-old seropositive man who presented with bilateral lower limb weakness and symptomatic pallor. He was already on antiretroviral drugs for a month prior to presentation. Detailed clinical examination and laboratory investigations revealed cytomegalovirus polyradiculoneuropathy associated with bone marrow dysplasia. Dysplasia of haematopoeitic cell lines occurs in 30 percent to 70 percent of HIV infected patients, and is often indistinguishable from myelodysplastic syndrome. However, in our case, the bone marrow picture reverted back to normal with treatment of the CMV infection, pointing to a possible role of CMV as the causative agent of bone marrow dysplasia. Moreover, CMV has been incriminated as a pathogen producing the immune reconstitution inflammatory syndrome. The onset of the disease in our case one month after initiation of HAART strongly raises the possibility of this being a case of CMV related IRIS. This is the first reported case where IRIS has presented with CMV polyradiculoneuropathy and bone marrow dysplasia. We would like to highlight that in today's era of HIV care, clinicians should be aware of the possibility of multiorgan involvement by CMV, for appropriate management of this disease in the background of AIDS.

Bilateral absence of the arcuate artery on the dorsum of the foot. With anomalous origin of dorsal metatarsal arteries

Bilateral absence of the arcuate artery was observed during routine dissection of the lower limbs of a 60-year-old male cadaver. Running distally on the dorsal aspect of both feet and opposite the tarso-metatarsal joint, the dorsalis pedis artery diverged 2cm lateral to the tendon of the extensor hallucis longus. The 2nd dorsal metatarsal artery was found originating from the dorsalis pedis artery opposite the intermediate cuneiform bone. The 3rd and 4th dorsal metatarsal arteries originated from the lateral tarsal artery. Although absence of the arcuate artery has been previously described, the arterial variant described here is thought to be distinct from those previously reported. The variant 2[nd] dorsal metatarsal artery was found to originate from the dorsalis pedis artery. Knowledge of anatomical variations of arteries supplying the feet and toes has important clinical significance in reconstructive surgery and in determining associated pathology

Successful separation of thoracopagus conjoined twins

The first successful separation of thoracopagus conjoined twins in Eastern Saudi Arabia with 2-year follow up is presented. Physical examination and radiographic studies revealed a conjunction that extended from midsternum to a common umbilicus. The shared internal organs included liver and pericardium. The separation was performed at the age of 4 months. The resulting chest wall defects in both twins were covered by dacron-reinforced silastic prosthesis. The abdominal wall defect was primarily closed in the "left twin," and covered with a dacron reinforced silastic sheet in the "right". Primary skin closure was achieved in both, following extensive mobilization of the skin. The musculoskeletal deformities in the neck, chest and vertebral column showed marked improvement 20 months after separation