Activation of Nrf2/HO-1/NQO1 Signaling Pathway by Shenqi Tangluo Pill Improves Oxidative Stress Injury of Skeletal Muscle of Type 2 Diabetes Mellitus Mice / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of Shenqi Tangluo pill （SQTLP） on oxidative stress injury of skeletal muscle of type 2 diabetes mellitus （T2DM） mice based on nuclear factor erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1）/NAD（P）H quinone oxidoreductase 1 （NQO1） pathway. MethodA total of 60 7-week-old male db/db mice ［specific pathogen-free （SPF） grade］ were selected and fed for one week for adaption. They were divided into the model control group， SQTLP low-， medium- and high-dose （19， 38， and 76 g·kg-1） groups and metformin group （0.26 g·kg-1） by gavage. Each group consisted of 12 mice. Twelve male db/m mice of the same age were selected as the blank group. The intervention was implemented continuously for 8 weeks. Fasting blood glucose （FBG） was detected. Fasting serum insulin （FINS） levels were detected by enzyme-linked immunosorbent assay （ELISA）， and the homeostasis model assessment-insulin resistance （HOMA-IR） index and the homeostasis model assessment-insulin sensitivity index （HOMA-ISI） were calculated. Oral glucose tolerance test （OGTT） and insulin tolerance test （ITT） were conducted. The activities of superoxide dismutase （SOD） and glutathione peroxidase （GSH-Px） and the contents of malondialdehyde （MDA） and reduced nicotinamide adenine dinucleotide phosphate （NADPH） in skeletal muscle tissues were detected by biochemical kits. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in skeletal muscle tissues. The levels of reactive oxygen species （ROS） and 4-hydroxynonenal （4-HNE） in skeletal muscle tissue were detected by immunofluorescence （IF）. The expression levels of Nrf2， HO-1， NQO1 and glutamate-cysteine ligase catalytic subunit （GCLC） proteins in skeletal muscle tissues were detected by Western blot. ResultCompared with those in the blank group， FBG， FINS and HOMA-IR in the model group were significantly increased （P<0.05）， while HOMA-ISI was decreased （P<0.05）. The results of OGTT and ITT showed that blood glucose was significantly increased at all time points （P<0.05）， and glucose tolerance and insulin tolerance were significantly impaired. SOD and GSH-Px activities in skeletal muscle tissues were significantly decreased （P<0.05）， and MDA and NADPH contents were significantly increased （P<0.05）. In skeletal muscle tissues， the arrangement of muscle fibers was loose， the nucleus was disordered， and inflammatory cells were infiltrated. The expression levels of ROS and 4-HNE in skeletal muscle tissues were significantly increased （P<0.05）. The protein expression levels of Nrf2， HO-1， NQO1 and GCLC in skeletal muscle tissues were significantly decreased （P<0.05）. Compared with those in the model group， FBG， FINS and HOMA-IR in the metformin group were significantly decreased （P<0.05）， while HOMA-ISI was increased （P<0.05）. The results of OGTT and ITT showed that blood glucose in the metformin group was significantly decreased at all time points （P<0.05）. The activities of SOD and GSH-Px in skeletal muscle tissues were significantly increased （P<0.05）， while the contents of MDA and NADPH were significantly decreased （P<0.05）. No obvious abnormality was found in the skeletal muscle tissue of the metformin group. The expressions of ROS and 4-HNE in skeletal muscle tissues were decreased （P<0.05）. The protein expression levels of Nrf2， HO-1， NQO1 and GCLC in skeletal muscle tissues were significantly increased （P<0.05）. Compared with those in the model group， FBG， FINS and HOMA-IR in the SQTLP medium- and high-dose groups were significantly decreased （P<0.05）， while HOMA-ISI was increased （P<0.05）. The results of OGTT and ITT showed that the glucose tolerance and insulin tolerance of mice were improved in each dose group of SQTLP. The GSH-Px activity in the SQTLP low-dose group was significantly increased （P<0.05）， and the NADPH content was decreased （P<0.05）. The activities of SOD and GSH-Px in the SQTLP medium- and high-dose groups were significantly increased （P<0.05）， while the contents of MDA and NADPH were significantly decreased （P<0.05）. The skeletal muscle tissue injury of mice in each dose group of SQTLP was ameliorated to different degrees. In the SQTLP medium- and high-dose groups， the expressions of ROS and 4-HNE were decreased （P<0.05）， and the protein expression levels of Nrf2， HO-1， NQO1 and GCLC were significantly increased （P<0.05）. Compared with those in the SQTLP low-dose group， FBG and HOMA-IR in the SQTLP high-dose group were significantly decreased （P<0.05）， while HOMA-ISI was increased （P<0.05）. The results of OGTT and ITT showed that the SQTLP high-dose group significantly improved the glucose tolerance and insulin tolerance of mice. The activities of SOD and GSH-Px in skeletal muscle tissues were significantly increased （P<0.05）， while the contents of MDA and NADPH were significantly decreased （P<0.05）. No obvious abnormality was found in the skeletal muscle tissue， the expressions of ROS and 4-HNE were decreased （P<0.05）， and the protein expression levels of Nrf2， HO-1， NQO1 and GCLC were significantly increased （P<0.05） in the skeletal muscle tissue of the SQTLP high-dose group. ConclusionSQTLP can significantly improve IR in T2DM mice， and the mechanism is related to SQTLP activating the Nrf2/HO-1/NQO1 signaling pathway， promoting the expression of antioxidant enzymes， and thus improving the oxidative stress injury in the skeletal muscle.

Análisis de casos de araneísmo a nivel global en el período 2000-2020 / Analysis of cases of araneism at a global level in the period of 2000-2020

RESUMEN INTRODUCCIÓN Aunque son temidas, sólo algunas arañas han sido asociadas con una clínica severa en humanos. Este estudio se propuso revisar los informes de casos y series de casos sobre mordeduras de arañas para informar el estado actual del problema. MÉTODOS Se realizó una revisión sistemática de la literatura en varias bases de datos, sin umbral de fecha para la búsqueda. Se limitó la estrategia de búsqueda a los artículos publicados en portugués, francés, inglés y español. Los estudios elegibles fueron informes de casos y series de casos que reportaron desenlaces en humanos causados por mordeduras de arañas. Se extrajo información a nivel de paciente y a nivel de estudio. RESULTADOS La búsqueda arrojó 10 683 estudios. Se incluyeron 248 artículos, que reportaban 351 pacientes; de ellos, un 54% eran hombres. Los síntomas más frecuentes fueron locales. Se documentó la muerte de 17 pacientes (4,85%). Las arañas de los géneros Loxosceles y Latrodectus causaron la mayoría de los accidentes. Al comparar el uso o no de antiveneno en los géneros Loxosceles o Latrodectus, no hubo diferencias entre la longitud de estancia hospitalaria. DISCUSIÓN La mordedura de diferentes especies de arañas de todo el mundo puede causar graves consecuencias para la salud humana, especialmente las de los géneros Loxosceles y Latrodectus. Aunque la mortalidad no es elevada, estos casos deben ser rápidamente diagnosticados y tratados.

ABSTRACT INTRODUCTION Although spiders are feared, only a few of them have been associated with severe outcomes in humans. This study aimed at reviewing case reports and case series on spider bites to inform the current state of the problem. METHODS A systematic literature review was conducted in several databases, without search date limit. The search strategy was limited to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by spider bites. Patient-level and study-level information was extracted. RESULTS The literature search yielded 10 683 studies. A total of 248 articles were included, reporting 351 patients; 54% of them were male. The most frequently reported signs and symptoms were local. The death of 17 patients was documented (4.85%). Spiders from the genera Loxosceles and Latrodectus caused most of the accidents. No difference in hospital stay length in Latrodectus or Loxosceles envenomation with or without antivenom was found. DISCUSSION The bite of different species of spiders around the world can cause serious consequences to human health, especially spiders from the genera Loxosceles and Latrodectus. Even as mortality is not high, spider bites must be quickly diagnosed and treated properly

Mucopyocele in the oral region: an unusual case

Mucopyoceles are rare lesions defined as infected mucoceles. They have been reported only in the paranasal sinuses and appendix. Our case is the first to be reported in the oral region. A 58-year-old male presented with complaint of a painless swelling of two years duration in the right buccal sulcus with associated pus discharge. Radiographic examination ruled out pulpal and periodontal foci of infection and histopathology confirmed an underlying mucopyocele in the right buccal mucosa.

Assessment of microleakage of few restorative materials after erosion by acidic solution

Some restorative materials are susceptible to erosion but whether it also causes microleakage is still questionable. The aim of this study was to assess the microleakage of few restorative materials after immersion in acidic solution. Standardized ‘U’ shaped cavity of 4mm diameter and 2mm depth were prepared on buccal or lingual surface of 52 human premolar and molar teeth. The teeth were divided into 4 groups which contains 13 samples and 3 controls for each and were restored either with Filtek Z250 (Group 1), Fuji IX (Group 2), Fuji II LC (Group 3), or Silverfill amalgam (Group 4). All surfaces were painted with nail varnish leaving only 2mm of tooth structure surrounding the restoration before the study samples were immersed in acidic solution, lemon juice (pH 2.74) and control samples in deionised distilled water for 24 hours. Surface photos for erosion were taken before immersion in methylene blue for 7 days. After sectioning, the assessment of dye penetration was done using Leica Imaging System DMLM (Germany). Photos showed that Fuji IX demonstrated severe erosion but no obvious changes were seen on other materials. Kruskal-Wallis test indicated that microleakage between all four groups were statistically significant. The most significant difference was between Filtek Z250 and Fuji IX (p<0.05). Fuji IX was the most affected by the erosion process and its degree of microleakage was the most among all the materials tested.

Dental caries experience and treatment needs in the mixed dentition in North East Malaysia

Dental caries is an important community dental health problem with limited studies in the mixed dentition stage. The aim of this study was to determine the caries prevalence and treatment needs among 7- 9 year old school children in Kelantan which is situated in North East Malaysia. A retrospective dental record review of fully documented dental records belonging to primary school children attending a paediatric dental clinic was conducted. Dental caries was recorded using dmft index and DMFT index for deciduous teeth and permanent teeth respectively. Three hundred and nineteen dental records of 175 (54.9%) boys’ and 144 (45.1%) girls’ were selected and subjected to a ‘dental record study’. The prevalence of dental caries was 93% (95% CI : 89,97) in primary dentition and 50.5% (95% CI : 42.2, 58.8) in permanent teeth. Mean dmft and DMFT was 6.2(SD 3.39) and 1.04(SD 1.34) respectively. Regarding treatment needs in the primary dentition, 35.4% of teeth needed one surface filling, 34.7% needed extraction, 24.5% needed two or more surfaces filling and 5.6% needed pulp care. In the permanent dentition, 54.7% required sealants and 21.9% required one surface restoration. The caries prevalence and treatment needs were high among this study population in the mixed dentition stage, particularly showing the early involvement of newly erupted permanent teeth. It appears that high caries prevalence in the primary dentition is a risk factor for caries in newly erupted permanent teeth. Oral health promotions programmes are required in the mixed dentition stage and may reduce the risk of caries in permanent dentition.

Inflammatory dentigerous cyst associated with an endodontically treated primary second molar: a case report

Primary teeth with periapical inflammation induced by dental caries are treated through pulp therapy. Thus in pediatric dentistry, pulpectomy is considered the most common and successful treatment procedure for primary teeth with periapical inflammation. Dentigerous cyst is an epithelial lined cavity that develops from the reduced enamel epithelium related to the crown of an unerupted tooth. This report describes a case of an inflammatory dentigerous cyst associated with an endodontically treated primary second molar in a 12-year-old female patient with mixed dentition. The relation between endodontic treatment and development of dentigerous cyst is discussed.

Root-crown ratios of permanent teeth in Malay patients attending HUSM Dental Clinic

The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p<0.05 for right and left lateral incisors and right first premolars in male; p<0.001 for all other teeth). In both gender, the highest R/C ratio was mandibular second premolars and the lowest R/C ratio were maxillary central incisors. The rootcrown ratio could be used as a baseline data and reference to help in orthodontic diagnosis, treatment planning and prognosis as well as evaluation developmental root deficiency.

Genotoxicity assessment of locally produced dental nanocomposite using Comet assay

The aim of this study was to determine the genotoxicity of a locally produced nanocomposite by Universiti Sains Malaysia, Malaysia using Comet assay. Stem cells from human exfoliated deciduous teeth (SHED) were treated with the nanocomposite at five different concentrations (0.006, 0.0125, 0.025, 0.05, and 0.1 mg/ml) along with concurrent negative (medium alone) and positive control (zinc sulfate heptahydrate) and incubated at 37°C for 24 hours in an incubator at 5% CO2. The tail moment was used to assess the extent of DNA damage. The tail moment for the group of SHED treated with nanocomposite (for all the five different concentrations) was not statistically significant as compared to the negative control, suggesting that the locally produced dental nanocomposite did not induce any DNA damage. Hence, it can be concluded that the locally produced nanocomposite is non-genotoxic on stem cells from human exfoliated deciduous teeth.

Effects of resin cements on hardness and thickness around titanium post: an intraradicular assessment

The purpose of this study was to evaluate hardness (indicator for polymerization) and thickness of two types of resin cement at coronal, middle and apical level of tooth root canal. Ten extracted maxillary incisors were instrumented and post space was prepared for cementation of titanium post. Samples were divided into two groups and each group was cemented either of the two types of resin cements; Panavia F [dual-cured (PF)] and Rely X Luting 2 [self-cured (RL)]. The teeth were longitudinally sectioned; hardness and thickness was measured using Vickers hardness tester and a microscope (Leica DMLM). SEM observations along the cement line at the 3 different root levels were performed. Statistical analysis was performed to test significance of differences in hardness and thickness of the two types of cement (t-test; p= 0.05) and at different levels of the same type (one-way ANOVA followed by multiple comparison; p= 0.05). Significant difference of hardness was found at the apical level between the two groups and between the coronal and apical level of PF (p0.05). Moreover, voids were more obvious within the dual-cured group of cement. Dual-cured resin cement was found to be less polymerized than self-cured type at apical level. Increased thicknesses of resin cements in comparison to post space size were observed in both groups. Use of metallic post with resin cements needs further evaluation.

Human hydatidosis in Tehran, Iran: A retrospective epidemiological study of surgical cases between 1999 and 2009 at two university medical centers

This study was conducted to evaluate retrospectively 203 patients diagnosed with hydatid cyst disease and treated surgically at two university medical centers between 1999 and 2009 in Tehran, the capital of Iran. Cystic echinococcosis (CE) affected more females 117 (57.6%) than males 86 (42.4%). A remarkable gender difference skewed towards females was observed, and the male/female ratio among CE cases 61 years old was 1.18 and 0.52, respectively. The age of the patients ranged from 8 to 82 years, and the age group 21– 40 years (42.8%) was the most affected. A significantly higher number of hydatid cysts were recorded in the liver than in other sites (P40 years of age (liver/lung ratio >43) than in those <40 years of age (liver/lung ratio 2.8–7.6). Unusual cyst locations in kidneys, brain and pelvic area, followed by spleen and spine was also observed. Single organ involvement was found in 95% of the patients, and was more common in females (55.2%) than in males (39.9%). Housewives had the highest rate of infection (53.5%) followed by labourers with 14.8%, which showed a significant difference (P<0.001). Similarly, urban dwellers was also over-represented among the cases (87% urban vs. 13% rural; P<0.001). In 69.5% of cases there was only one cyst, 16.3% had two cysts, 4.7% with three cysts, and 9.5% had four cysts or more. The results showed that further studies are needed to determine the prevalence, economic impact and risk factors of the disease in the area.

The Expectation and Perception of Anesthetic Service Quality of Orthopedic Patient, Police General Hospital

non

The Effect of Intravenously Dexamethasone in Alleviating Post-tonsillectomy Pain

non

Intestinal microsporidiosis: A new entity in Malaysia?

Intestinal microsporidia is an emerging human disease caused by microsporidia. A study was conducted to determine the prevalence of microsporidia in patients with gastro-intestinal symptoms and to examine the clinical manifestations associated with intestinal microsporidiosis. A descriptive cross-sectional study using a well-structured questionnaire; a review of medical records was also undertaken. Positive stool samples were defined as presence of one or more pinkish-violet ovoid structures with a belt-like stripe under high power field (100x) using modified gram-chromotrope stain (MGC). A total of 353 faecal specimens of patients was examined and 100 patients were found to have positive stool samples for microsporidia. The overall prevalence of microsporidia was 28.3%. Acute and chronic diarrhoea were seen in 49.0% and 36.0% patients, respectively. The commonest clinical presentations were diarrhoea (85.0%) with 83.0% of patients having loose or watery stools, vomiting (75.0%), foul-smelling stools (60.0%), nausea (59.0%) and cramping abdominal pain (39.0%). The least common symptoms were fever (15.0%), mucous in stool (5.0%) and blood in stool (4.0%). This study concludes that the prevalence of microsporidia is still high (28.3%) and the majority of patients (93.0%) are symptomatic; the most common gastro-intestinal symptom is diarrhoea with loose or watery stools. Hence, it is recommended that a stool screening for microsporidia be done in selected patients presented with gastrointestinal symptoms.

Eating perception and psychiatric morbidity in secondary school and medical students in Kelantan

A significant concern about body weight and shape is the pathognomonic feature of eating disorders. According to the cognitive view, ideation and belief component is the primary cause for the development and maintenance of eating disorders. Higher psychiatric morbidity and psychological stress increases the development of eating disorders. This study was conducted to examine whether there is a relationship between psychological stress and cognitive aspect of eating, and between secondary and tertiary students. A cross-sectional study was carried out to determine beliefs about weight and shape concerns among secondary and tertiary level students. A total of 1253 students consisting of 13-18 years old secondary school students and 19-24 years old medical students were involved in this study. The students completed a questionnaire assessing psychopathology on beliefs and attitudes towards weight and shape and General Health Questionnaire (GHQ-30). The results indicate a high prevalence of psychiatric morbidity among university students compared to secondary students. Year 1 medical students appear to have a higher frequency of psychiatric morbidity (53.9%) than year 4 medical students (28.4%). Eating beliefs relating to weight and shape were significantly higher in secondary school students than medical students. The results of multiple linear regression on the eating belief questionnaire were a significant predictor of psychiatric morbidity. Higher GHQ scores were negatively related to eating belief question 28 of bulimic component. It would be useful to conduct future studies to explore the possible causal factors for weight and shape concerns among secondary school students and higher psychiatric morbidity among medical students in Kelantan.

Human bone marrow-derived mesenchymal stem cells suppress T cell proliferation by inducing cell cycle arrest

Mesenchymal stem cells (MSC) are common residents of bone marrow and are defined by their higher self-renewal ability and multilineage differentiation. MSC play an important role in supporting haematopoiesis and therefore are implicated in influencing immune responses. In line with this, MSC have been utilized to treat graft-versus-host disease (GVHD) in order to suppress unwanted T cell proliferation. In this study, we investigated the immune-suppressive effect of bone marrow derived MSC on T cell proliferation at the cell cycle level. MSC were generated from human bone marrow and confirmed by their immune-phenotyping. Resting or PHA stimulated allogeneic peripheral blood mononuclear cells (PBMC) were co- cultured in the presence or absence of MSC. T cell proliferation was accessed by trypan-blue exclusion assay at day three. Consequently cell cycle analysis was carried out to determine the mechanism of antiproliferation. MSC failed to elicit proliferation at resting T cell. However, proliferation of PHA-stimulated T cells was dramatically inhibited in the presence of MSC in a dose dependent manner (p<0.05). Following the inhibitory activity, MSC prevented activated T cells from entering the S phase of cell cycle by arresting them in the G1 phase. Our findings indicate that MSC escape recognition by T cells and inhibit T cell proliferation by cell cycle arrest at G1 phase. This immune-suppressive effect is most probably mediated by cell-to-cell contact and/or secreted soluble factors.

The effects of repeatedly heated frying oil and high cholesterol diet on the bone in ovariectomised rats

The use of repeatedly heated frying oils and intake of high cholesterol diet have been linked to bone damage. The aim of this study is to determine the combined effects of taking repeatedly heated frying oils (palm or soy oil) and high cholesterol diet on the dynamic histomorphometric parameters of bone. Ovariectomised rats were used as animal model of post-menopausal osteoporosis. After six months of treatment, Double-labeled Surface (dLS/BS), Mineralising surface (MS/BS) and Bone Formation Rate (BFR/BS) of ovariectomised rats (OvxC) were significantly reduced compared to the normal control group. Additions of fresh or once-heated palm or soy oil into high cholesterol diet seem to have improved the dynamic parameters towards the normal control values. However, when these oils were repeatedly heated, the protective effects were lost and the dynamic parameters except MS/BS dropped back towards the ovariectomised-control values.

Chemical composition and biological activity of the Centipeda minima (Asteraceae)

The antimicrobial activity of the Centipeda minima L. (Asteraceae) extract was evaluated against seven microorganisms using the disc diffusion method. The extract showed a broad spectrum of antimicrobial activity against all the tested bacterial strains, especially Enterobacter aerogenes, Klebsiella pneumonia, Staphylococcus aureus and Yersinia enterocolitica. The chemical composition of the extract obtained from Centipeda minima was analysed by GC–MS. Twenty three compounds, constituting about 84.75 % of the total extract, were identified. The main constituents were palmitic acid (7.47%), (Z,Z)-9-,12-octadecatrienoic acid (6.52%), (Z,Z,Z)-9-,12-octadecatrienoic acid (7.01%), phytol (7.01%), naptho[2.3-b]furan-2-(3H)-on (6.21%), 1-(1,2,3,4,7,7a-hexahydro-1,4,4,5-tetramethyl-1,3a-ethano-3aH-inden-6-yl)etanon (7.95%), 1,3,5-tri-tertbutyl-benzene (4.52%), (3Z)-2-methyl-3-octen-2-ol (5.95%) and artemisia ketone (4.98%). The extract was also tested against brine shrimp for toxicity. There was no significant toxicity as it only recorded a LC50 value of 4.92 mg/ml. The study shows that the extract is a good antimicrobial agent with potential applications in public health against diseases.

The effectiveness of nutrition education programme for primary school children

This study was conducted to determine changes in nutrition knowledge, attitude and practice of 8-year-old school children after receiving a nutrition education package. A total of 418 school children from urban and rural areas participated in this study. The intervention group consisted of 237 children while 181 children who did not receive the nutrition education package acted as controls. The nutrition education programme that was conducted for 3 weeks comprised of a video viewing session and a comic reading session followed by exercise questions as reinforcement for each session, and also classroom activities. Knowledge, attitude and practice questionnaires were distributed to the children before (pre-intervention) and after (post intervention) receiving the nutrition education programme. A follow-up visit was conducted six months after the programme had elapsed. The results obtained indicated that the nutrition knowledge score increased significantly in the intervention group from 48.3±13.2 at pre-test to 54.6±16.2 in post-test and 55.0±14.3 in follow-up test (p<0.05). The nutrition attitude score also increased significantly from 68.7±15.5 at pre-intervention to 72.6±15.0 and 74.7±15.8 during post-test and follow-up test respectively (p<0.05). However, the nutrition practice score had no significant improvement in both groups throughout the study period. There were no significant changes in the control group in knowledge, attitude and practice scores at pre, post and follow-up tests. In conclusion, this study showed that a good nutrition education programme had a positive impact whereby better nutrition knowledge, attitude and healthy eating habits in children were seen. It is hoped that the improvements would be sustained throughout their lives.

A qualitative study on malnutrition in children from the perspectives of health workers in Tumpat, Kelantan

Underlying causes of most nutrition related problems are diverse, including biological, social, cultural, and economic factors. Qualitative approaches complement quantitative methods in identifying the underlying meanings and patterns of relationships involved in managing malnutrition. This study examined perceptions regarding malnutrition among health workers from 7 clinics (community and health clinics) in Tumpat, Kelantan. A total of 18 nurses and 2 doctors, who were involved in monitoring child health and nutrition, were included in the study. These health workers were interviewed using a semi-structured questionnaire adapted from Sastry’s framework on malnutrition (Sastry, 1996). The questionnaire included biological, behavioral and environmental factors that influence child health and nutrition. All the health workers perceived that mothers/caregivers play the main role in improving the health of malnourished children. The quality of childcare was rated as moderately satisfactory by the health workers. Most of the affected families who were given the Food Baskets did not fully use all the items for the malnourished child. Child feeding practice was based on the needs of the whole family rather than according to the target child’s needs. Most of the mothers preferred processed cereals than rice porridge because the former is easier to prepare for the child. Although they were from a low socioeconomic background, most of the mothers were not earning additional income for the family. The qualitative methodology provided information that can be used as a basis for the designing of quantitative questionnaires to assess malnutrition among children. The induction characteristic of qualitative methods was used to gain an understanding of the underlying reasons or phenomena such as behaviours that are directly observable.

Antimicrobial susceptibility of community-acquired uropathogens in general practice

Antibiotic resistance of urinary tract pathogens has increased worldwide. The purpose of this study is to provide information regarding local resistance pattern of urinary pathogens to the commonly used antibiotics. One hundred and seventeen cases of community-acquired urinary tract infections were studied. The most common group of patients was the uncomplicated acute cystitis in women. E. coli was the most common isolate. Overall, antimicrobial susceptibility test on the organisms isolated showed a resistance of 63.0% to ampicillin, 40.1% to sulfamethoxazole-trimethoprim (S-T), 14.3% to pipemidic acid, 8.6% to norfloxacin, 3.8% to cephalexin, 3.7% to amoxicillin-clavulanate, 1.0% to cefuroxime, and 1.0% to fosfomycin. Three out of five patients on ampicillin as well as two out of five patients on S-T were likely to be inadequately treated.