Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients.

OBJECTIVE: To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. METHODS: This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. RESULTS: Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. CONCLUSION: Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

Hemophagocytic lymphohistiocytosis secondary to hemodialysis catheter-related blood stream infection.

A 57-year-old man on dialysis presented with fever due to Pseudomonas septicemia. Workup revealed very high triglycerides and serum ferritin levels. A bone marrow examination showed hemophagocytosis. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made and steroids were started. He was put on automated peritoneal dialysis. Patients' condition continued to deteriorate and he succumbed to his illness. This case illustrates the development of HLH secondary to infections which are increasingly being recognized in the literature. Often this diagnosis is missed as it becomes difficult to differentiate between sepsis and HLH. The presence of high ferritin, hypertriglyceridemia, and hemophagocytosis in the bone marrow confirms the diagnosis.

Molecular epidemiology of Cryptosporidium in HIV/AIDS patients in Malaysia.

Cryptosporidiosis is a particular concern in immunocompromised individuals where symptoms may be severe. The aim of this study was to examine the epidemiological and molecular characteristics of Cryptosporidium infections in HIV/AIDS patients in Malaysia in order to identify risk factors and facilitate control measures. A modified Ziehl-Neelsen acid fast staining method was used to test for the presence of Cryptosporidium oocysts in the stools of 346 HIV/AIDS patients in Malaysia. Standard coproscopical methods were used to identify infections with other protozoan or helminths parasites. To identify the species of Cryptosporidium, DNA was extracted and nested-PCR was used to amplify a portion of the SSU rRNA gene. A total of 43 (12.4%) HIV-infected patients were found to be infected with Cryptosporidium spp. Of the 43 Cryptosporidium-positive HIV patients, 10 (23.3%) also harboured other protozoa, and 15 (34.9%) had both protozoa and helminths. The highest rates of cryptosporidiosis were found in adult males of Malay background, intravenous drug users, and those with low CD4 T cell counts (i.e., < 200 cells/mm3). Most were asymptomatic and had concurrent opportunistic infections mainly with Mycobacterium tuberculosis. DNA sequence analysis of 32 Cryptosporidium isolates identified C. parvum (84.3%), C. hominis (6.3%), C. meleagridis (6.3%), and C. felis (3.1%). The results of the present study revealed a high prevalence of Cryptosporidium infection in hospitalized HIV/AIDS patients. The results also confirmed the potential significance of zoonotic transmission of C. parvum in HIV infected patients, as it was the predominant species found in this study. However, these patients were found to be susceptible to a wide range of Cryptosporidium species. Epidemiological and molecular characterization of Cryptosporidium isolates provides clinicians and researchers with further information regarding the origin of the infection, and may enhance treatment and control strategies.

Cytotoxicity, Antiproliferative Effects, and Apoptosis Induction of Methanolic Extract of Cynometra cauliflora Linn. Whole Fruit on Human Promyelocytic Leukemia HL-60 Cells.

Methanolic extract of Cynometra cauliflora whole fruit was assayed for cytotoxicity against the human promyelocytic leukemia HL-60 and the normal mouse fibroblast NIH/3T3 cell lines by using the MTT assay. The CD(50) of the extract for 72 hours was 0.9 µg/mL whereas the value for the cytotoxic drug vincristine was 0.2 µg/mL. The viability of the NIH/3T3 cells was at 80.0% when treated at 15.0 µg/mL. The extract inhibited HL-60 cell proliferation with dose dependence. AO/PI staining of HL-60 cells treated with the extract revealed that majority of cells were in the apoptotic cell death mode. Flow cytometry analysis of HL-60 cells treated at CD(50) of the extract showed that the early apoptotic cells were 31.0, 26.3 and 19.9% at 24, 48, and 72 hours treatment, respectively. The percentage of late apoptotic cells was increased from 62.0 at 24 hours to 64.1 and 70.2 at 48 and 72 hours, respectively. Meanwhile, percent of necrotic cells were 4.9, 6.6, and 8.5 at 24, 48, and 72 hours, respectively. This study has shown that the methanolic extract of C. cauliflora whole fruit was cytotoxic towards HL-60 cells and induced the cells into apoptotic cell death mode, but less cytotoxic towards NIH/3T3 cells.

How common is intestinal parasitism in HIV-infected patients in Malaysia?

Human immunodeficiency virus (HIV)-infected individuals have greater susceptibility to infections by a myriad of microorganisms which can cause significant morbidity and mortality compared to immunocompetent individuals. Of these microbial infections, intestinal parasitic infections (IPIs) however are receiving less attention than bacterial and viral infections, hence, the lack of information of parasitic infections in HIV individuals. Prevalence of IPIs among 346 HIV-infected individuals in Malaysia was determined in this study. The overall prevalence of intestinal parasitic infections (IPIs) was 37.9% (131 of 346) with protozoa infections (18.8%) being more common compared to helminth infections (7.5%). Observed protozoa include Entamoeba histolytica/dispar (16.8%), Cryptosporidium parvum (12.4%), Isospora belli (10.1%), Cyclospora cayetanensis (4.9%) and Giardia duodenalis (intestinalis) (3.2%) whilst helminthes which were detected comprised of Ascaris lumbricoides (13.9%), Trichuris trichiura (6.4%) and hookworms (0.6%). Among those 131 infected, 50.4% had multiple infections and 48.9% had single parasitic infection. The CD4 counts were significantly lower (i.e., 200 cells/mm³) in patients harbouring IPIs. Of those individuals infected with intestinal parasites, 49% were intravenous drug users and 58% were not on any antiretroviral therapy. Most were asymptomatic and had concurrent opportunistic infections (OIs) mainly with Mycobacterium tuberculosis infection. These results confirmed that IPIs are ubiquitous among HIV-infected individuals, especially those presenting with low CD4 T cells counts, and provide useful insights into the epidemiology of these infections among HIV-infected patients in Malaysia. It is therefore recommended, that diagnosis of these intestinal parasitic pathogens should be conducted on a routine basis for better management of gastrointestinal illnesses among HIV individuals.

A mathematical model of inactivation kinetics for a four-strain composite of Salmonella Enteritidis and Oranienburg in commercial liquid egg yolk.

The goal of this study was to develop a general model of inactivation of salmonellae in commercial liquid egg yolk for temperatures ranging from 58°C to 66°C by studying the inactivation kinetics of Salmonella in liquid egg yolk. Heat-resistant salmonellae (three serovars of Enteritidis [two of phage type 8 and one PT 13] and one Oranienburg) were grown to stationary phase in Tryptic Soy Broth and concentrated 10-fold by centrifugation. Each inoculum was added to liquid egg yolk and mixed thoroughly, resulting in a final population of ca. 7 log CFU/ml egg yolk. Inoculated yolk was injected into sterile glass capillary tubes, flame-sealed and heated in a water bath at 58, 60, 62, 64, and 66°C. Capillary tubes were ethanol sanitized, rinsed, and contents were extracted. Yolk was diluted, surface plated onto Tryptic Soy Agar+0.1% sodium pyruvate and 50 µg/ml nalidixic acid and incubated at 37°C for 24 h before colonies were enumerated. Decimal reduction values were calculated from survivor curves with a minimum inactivation of 6 log CFU/ml at each temperature. Survival curves (except for 66°C) featured initial lag periods before first order linear inactivation. Estimated asymptotic D-values were 1.83 min at 58°C, 0.69 min at 60°C, 0.26 min at 62°C, 0.096 min at 64°C and 0.036 min at 66°C. The estimate of the asymptotic z-value was ca. 4.7°C with standard error of 0.07°C. A linear relationship between the log(10) of the lag times and temperature was observed. A general kinetic model of inactivation was developed. The results of the study provide information that can be used by processors to aid in producing safe pasteurized egg yolk products and for satisfying pasteurization performance standards and developing industry guidance.

How common is intestinal parasitism in HIV-infected patients in Malaysia?

Human immunodeficiency virus (HIV)-infected individuals have greater susceptibility to infections by a myriad of microorganisms which can cause significant morbidity and mortality compared to immunocompetent individuals. Of these microbial infections, intestinal parasitic infections (IPIs) however are receiving less attention than bacterial and viral infections, hence, the lack of information of parasitic infections in HIV individuals. Prevalence of IPIs among 346 HIV-infected individuals in Malaysia was determined in this study. The overall prevalence of intestinal parasitic infections (IPIs) was 37.9% (131 of 346) with protozoa infections (18.8%) being more common compared to helminth infections (7.5%). Observed protozoa include Entamoeba histolytica/dispar (16.8%), Cryptosporidium parvum (12.4%), Isospora belli (10.1%), Cyclospora cayetanensis (4.9%) and Giardia duodenalis (intestinalis) (3.2%) whilst helminthes which were detected comprised of Ascaris lumbricoides (13.9%), Trichuris trichiura (6.4%) and hookworms (0.6%). Among those 131 infected, 50.4% had multiple infections and 48.9% had single parasitic infection. The CD4 counts were significantly lower (i.e., 200 cells/mm3) in patients harbouring IPIs. Of those individuals infected with intestinal parasites, 49% were intravenous drug users and 58% were not on any antiretroviral therapy. Most were asymptomatic and had concurrent opportunistic infections (OIs) mainly with Mycobacterium tuberculosis infection. These results confirmed that IPIs are ubiquitous among HIV-infected individuals, especially those presenting with low CD4 T cells counts, and provide useful insights into the epidemiology of these infections among HIVinfected patients in Malaysia. It is therefore recommended, that diagnosis of these intestinal parasitic pathogens should be conducted on a routine basis for better management of gastrointestinal illnesses among HIV individuals.

Breakfast Skipping and Its Associated Factors among Undergraduates in a Public University in Kuala Lumpur.

An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 - 30.3)%. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents' age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 - 0.99). Malays (OR: 1.94; 1.48 - 2.54), Indians (OR: 1.70; 1.08 - 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 - 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 - 3.84), hostel with cafeteria (OR: 2.92; 1.74 - 4.91) or in rented houses (OR: 2.08; 1.25 - 3.46). Respondents majoring in Arts and Economics had 1.40 (1.07 - 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 - 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.

Severe traumatic brain injury: outcome in patients with diffuse axonal injury managed conservatively in Hospital Sultanah Aminah, Johor Bahru--an observational study.

Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion may be treated safely without cerebral resuscitation and intracranial pressure (ICP) monitoring. Seventy two patients were divided into three groups of patients receiving treatment based on ICP-CPP-targeted, or conservative methods either with or without ventilation support. The characteristics of these three groups were compared based on age, gender, Glasgow Coma Scale (GCS), pupillary reaction to light, computerized tomography scanning according to the Marshall classification, duration of intensive care unit (ICU) stays, Glasgow Outcome Score (GOS) and possible complications. There were higher risk of mortality (p < 0.001), worse GCS improvement upon discharge (p < 0.001) and longer ICU stays (p = 0.016) in ICP group compared to Intubation group. There were no significant statistical differences of GOS at 3rd and 6th months between all three groups.

Breakfast Skipping and Its Associated Factors among Undergraduates in a Public University in Kuala Lumpur

An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 – 30.3) %. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents’ age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 – 0.99). Malays (OR: 1.94; 1.48 – 2.54), Indians (OR: 1.70; 1.08 – 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 – 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 – 3.84), hostel with cafeteria (OR: 2.92; 1.74 – 4.91) or in rented houses (OR: 2.08; 1.25 – 3.46). Respondents majoring in Arts & Economics had 1.40 (1.07 – 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 – 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.

Acute cholecystitis caused by Clonorchis sinensis.

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.

Trophic status of Chatri Lake in the vicinity of Amravati city.

Chatri lake is situated a bit away from the busy city. This lake is famous by the name Chatri Talaw. This lake was once used for drinking water purpose. Since 'Upper Wardha Project' came into existence the lake water is not used for drinking purpose. Site is such that it can otherwise be developed as an ecological spot and will be a place of attraction for the people. The present situation is such that, the lake is very fastly receding and becomes shallow due to heavy sedimentation. It appeared from our observations that low sodium and potassium content and reduction of photic zone due to high turbidity resulted in low phytoplankton density in the lake. Thus lake is oligotrophic in nature.

Comparison of calpain and calpastatin activities in skeletal muscle of broiler and layer chickens.

1. The objective of this study was to estimate the difference between broiler and layer chicks in the activities of calpain and calpastatin (inhibitor of calpain) in breast muscle. Differences between broilers and layers in body weight, daily gain at 3 weeks of age and fractional growth rate (FGR) during 2 and 3 weeks of age were statistically significant (P < 0.01). 2. Calpain and calpastatin activities were measured at three weeks of age with alkali-denatured casein as a substrate. The m-calpain (calpain activated by millimolar calcium concentration) activities in units/g muscle and units/mg extractable muscle protein were 0.779 and 0.353 for broilers, and 1.042 and 0.440 for layers, respectively. The calpastatin activities in units/g muscle and units/mg extractable muscle protein were 0.332 and 0.153 for broilers, and 0.262 and 0.112 for layers, respectively. 3. Broilers with high FGR showed low m-calpain and high calpastatin activities. In contrast, layers with low FGR showed high m-calpain and low calpastatin activities. 4. These results suggest that m-calpain and calpastatin activities in skeletal muscle vary between breeds which have different rates of muscle production.