Effect of solvent pre-treatment on the physicochemical, thermal profiles and morphological behavior of Mangifera pajang seed fat.

In this work, the effect of solvent pre-treatment (hexane, petroleum ether and ethanol) on the physicochemical, thermal and morphology behavior of Mangifera pajang seed fat (MPSF) were investigated. Fat extraction was performed using Soxhlet method, and results showed that the yield, physicochemical, and crystalline structures of the MPSF were significantly (p < 0.05) influenced by the extraction solvents. Hexane gave the highest fat yield (7.67 %) with low unsaturation value (52.13 g iodine/g) compared with petroleum ether and ethanol. Hexane MPSF also had low oxidation rate (peroxide value of 1.1 mEq/g). Both non-stabilized and stabilized hexane MPSF showed a single melting endothermic peak at high temperature with onset, maximum peak and offset temperature of 16.23 ˚C-18.21 °C, 28.22 ˚C-31.25 °C and 34.85 ˚C-39.58 °C, respectively. Hexane MPSF crystallized rapidly at high temperature with single maximum peak starting at 16.51 ˚C-16.68 °C and ending at 0.23 ˚C-1.13 °C. In comparison with ethanol extract, hexane MPSF demonstrated a compact crystalline structure with a large densely packed center. Therefore, MPSF obtained from hexane presented better overall quality than those obtained from other extraction solvents. MPSF exhibited similar melting and morphological behavior to mango kernel fat and commercial cocoa butter. These results suggested that hexane was the best solvent for the extraction of MPSF. This fat also has the potential to be applied as a cocoa butter alternative fat or functional fat.

Medical Students’ Perceptions on the Adequacy and Effectiveness of Pharmacology Teaching during Preclinical Years

@#Pharmacology teaching during preclinical years is important for medical students to make rational choices in choosing suitable treatment for patients in future. Therefore, the present study determined the adequacy and effectiveness of pharmacology teaching in the undergraduate medical program at the Universiti Kebangsaan Malaysia Medical Center (UKMMC). Suggestions for improvement of the curriculum were also identified. An online questionnaire on the perceptions of pharmacology teaching methodology was distributed to a total of 459 medical students in 4th and 5th year at UKMMC. The questionnaire covered demographics, perceptions about pharmacology teaching, the ideal teaching learning methodology for learning pharmacology, pharmacology topics which are useful for future clinical practice, the pharmacology topic which was most interesting and recommendations for improvement. The response rate was 46.4% and majority of the participants were females (65.7%). Most of the students agreed that interactive learning was more helpful than didactic lectures (88.0%). Seventy percent of the students reported that pharmacology lectures in the preclinical years were helpful during the clinical years. Percentage of students who agreed that pharmacology teaching in their preclinical was adequate for their clinical practice was 47.0%. There was no association between demographic variables (gender, race, year of study and medical family background) and interest in pharmacology (p>0.05). In conclusion, the pharmacology teaching during preclinical years was perceived to be effective and useful for students’ clinical practice. More pharmacology teaching sessions in clinical years was suggested which may improve adequacy of pharmacology teaching.

Protective Effects of Palm Tocotrienol Against Glucocorticoid Induced Osteoporosis via Regulation of Gene Expressions

Long term glucocorticoids administration induces oxidative stress which leads to alteration of bone structure and strength. Palm oil is rich in tocotrienol, an antioxidant. It can be used for the prevention of oxidative stress related diseases. The main objective of this study was to determine the mechanism of palm tocotrienol in maintaining the bone structure and strength in glucocorticoid-induced osteoporosis. Thirty two adult male Sprague-Dawley rats, aged 3 months, weighing 300-320 g rats were used in this study. Sixteen rats undergone adrenalectomy and were administered with 120μg/kg/day intramuscular injection of dexamethasone. Eight rats were supplemented with oral palm tocotrienol 60 mg/kg/day (Adrx+Dex+PTT) and the other eight rats were given oral vehicle palm olein 0.1 ml/kg/day (Adrx+Dex). Eight rats underwent sham procedure and were given vehicle palm olein 0.05 ml/kg/day by intramuscularly and oral 0.1 ml/kg/day (Sham). The rats were euthanized after two months of treatments. Eight rats were euthanized after acclimatic action without receiving any treatment (Baseline). The right femurs were used for bone biomechanical strength and histomorphometry analysis while the left for gene expression and oxidative stress enzymes activities. The results indicated that long-term glucocorticoid treatment significantly increased bone resorption marker, CTX (6060.7 ± 410 pg/ml) and decreased bone structure and strength. Osteoblast and osteoclast related genes expressions indicated an increase in bone turnover. Supplementation of palm tocotrienol had maintained serum resorption (2619.4 + 209 pg/ml) marker level and preserved bone structure and strength. Gene expression analysis showed decrease in bone resorption. The findings suggested that palm tocotrienol has potential benefits against glucocorticoid-induced osteoporosis by regulating osteoblast and osteoclast related gene expression

Quantification of Bone Histomorphometric Parameters Using the Weibel Technique in Animals

Bone histomorphometric measurements are required to understand the efficacy of treatment on bone remodelling. Previous studies used the Weibel technique as a quantitative stereological method to determine bone cellular and dynamic changes. However, there was no description on how this technique was applied. This studyaimed to provide a full picture about the utilization of the Weibel technique to measure static and dynamic bone histomorphometric indices. Technical expertise, processing of bone samples, randomization of the trabecular sections and an adequate number of analysed images for each section are required to achieve reliable results with a low possibility of errors.

The Anti-Inflammatory, Phytoestrogenic, and Antioxidative Role of Labisia pumila in Prevention of Postmenopausal Osteoporosis.

Osteoporosis is characterized by skeletal degeneration with low bone mass and destruction of microarchitecture of bone tissue which is attributed to various factors including inflammation. Women are more likely to develop osteoporosis than men due to reduction in estrogen during menopause which leads to decline in bone-formation and increase in bone-resorption activity. Estrogen is able to suppress production of proinflammatory cytokines such as IL-1, IL-6, IL-7, and TNF-α. This is why these cytokines are elevated in postmenopausal women. Studies have shown that estrogen reduction is able to stimulate focal inflammation in bone. Labisia pumila (LP) which is known to exert phytoestrogenic effect can be used as an alternative to ERT which can produce positive effects on bone without causing side effects. LP contains antioxidant as well as exerting anti-inflammatory effect which can act as free radical scavenger, thus inhibiting TNF-α production and COX-2 expression which leads to decline in RANKL expression, resulting in reduction in osteoclast activity which consequently reduces bone loss. Hence, it is the phytoestrogenic, anti-inflammatory, and antioxidative properties that make LP an effective agent against osteoporosis.

The anti-inflammatory role of vitamin e in prevention of osteoporosis.

There is growing evidence that inflammation may be one of the causal factors of osteoporosis. Several cytokines such as IL-1, IL-6, RANKL, OPG, and M-CSF were implicated in the pathogenesis of osteoporosis. These cytokines are important determinants of osteoclast differentiation and its bone resorptive activity. Anticytokine therapy using cytokine antagonists such as IL-receptor antagonist and TNF-binding protein was able to suppress the activity of the respective cytokines and prevent bone loss. Several animal studies have shown that vitamin E in the forms of palm-derived tocotrienol and α-tocopherol may prevent osteoporosis in rat models by suppressing IL-1 and IL-6. Free radicals are known to activate transcription factor NFκB which leads to the production of bone resorbing cytokines. Vitamin E, a potent antioxidant, may be able to neutralise free radicals before they could activate NFκB, therefore suppressing cytokine production and osteoporosis. Vitamin E has also been shown to inhibit COX-2, the enzyme involved in inflammatory reactions. Of the two types of vitamin E studied, tocotrienol seemed to be better than tocopherol in terms of its ability to suppress bone-resorbing cytokines.

Effect of 11ß-HSD1 dehydrogenase activity on bone histomorphometry of glucocorticoid-induced osteoporotic male Sprague-Dawley rats.

INTRODUCTION: Glucocorticoids cause osteoporosis by decreasing bone formation and increasing bone resorption activity. Glucocorticoid action in bones depends on the activity of 11-beta-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) enzyme, which plays an important role in regulating corticosteroids. 11ß-HSD1 is expressed by human and rat osteoblasts. We aimed to investigate the relationship between 11ß-HSD1 dehydrogenase activity and bone histomorphometric changes in glucocorticoid-induced osteoporotic bone in rats. METHODS: A total of 30 male Sprague-Dawley rats (aged three months, weighing 200-250 g) were divided into three groups of ten each. Group 1 rats were the baseline control, which were sacrificed untreated at the beginning of the study. Group 2 rats underwent sham operation and were administered with vehicle olive oil intramuscularly at 0.05 ml/kg. Group 3 rats were adrenalectomised and administered with an intramuscular injection of dexamethasone 120 µg/kg body weight/day. The treatment was started two weeks after the operation, for a duration of two months. Plasma osteocalcin, plasma pyrodinoline, plasma corticosterone and 11ß-HSD1 were measured, and bone histomorphometry analysis was performed. RESULTS: Dexamethasone treatment caused an increase in plasma corticosterone level, together with a significant reduction in 11ß-HSD1 dehydrogenase activity of the bone, along with a higher plasma level of the bone resorption marker, pyridinoline. Dexamethasone treatment also caused a reduction in trabecular volume, number and thickness, and an increase in trabecular separation. CONCLUSION: Long-term glucocorticoid treatment reduces the 11ß-HSD1 dehydrogenase activity in the bone, which can otherwise lead to bone loss due to the increased level of active glucocorticoids.

Piper sarmentosum prevents glucocorticoid-induced osteoporotic bone resorption by increasing 11ß-hydroxysteroid dehydrogenase type 1 activity.

AIMS: Osteoporosis is a proven complication of long-term glucocorticoid therapy. Concern on glucocorticoid induced osteoporosis has increased dramatically in recent years with the widespread use of synthetic glucocorticoids. Glucocorticoid action in bone depends upon the activity of 11ßhydroxysteroid dehydrogenase type 1 enzyme (11ßHSD1). This enzyme plays an important role in regulating corticosteroids by locally interconverting cortisone into active cortisol. This has been demonstrated in primary cultures of human, mouse or rat osteoblasts. Therefore, inhibition of this enzyme may reduce bone resorption markers. Piper sarmentosum (Ps) is a potent inhibitor of 11ßHSD1 in liver and adipose tissue. In this study we determined the effect of Ps on 11ßHSD1 activity in bones of glucocorticoid-induced osteoporotic rats. MATERIALS AND METHODS: Three-month old male Sprague-Dawley rats were adrenalectomised to remove the main source of circulating glucocorticoids. The animals were administered with dexamethasone 120 µg/kg body weight/day. Treatment with Ps 125 mg/kg body weight and glycirrhizic acid (GCA) 120 mg/kg body weight were given simultaneously. RESULTS: The results showed that Ps extract reduced plasma corticosterone concentration (1.05+0.02 µg/ml) and induced 11ßHSD1 dehydrogenase activity in bone (87.69+1.41%). Consequently, it also reduced the bone resorption marker, pyridinoline, in dexamethasone-treated adrenalectomised rats (2.07+0.62/L). Despite that, our data showed an inverse relationship between the plasma corticosterone level and the dehydrogenase activity of 11ßHSD1 in the bone. CONCLUSIONS: This suggests that 11ßHSD1 acts as the local regulator of glucocorticoid and its activity in bone was not correlated to systemic corticosterone level.

Low dose of tocotrienols protects osteoblasts against oxidative stress.

AIMS: Vitamin E is an antioxidant that may protect bone against oxidative stress-induced osteoporosis. This in vitro study was conducted to determine the protective effects of a-tocopherol and γ-tocotrienol on osteoblasts, the bone forming cells, against oxidative stress. MATERIALS AND METHODS: Toxicity tests were carried out on hydrogen peroxide (H(2)O(2)), a-tocopherol and γ-tocotrienol and their inhibitory concentration 50 (IC(50)) on osteoblasts were determined if any. Osteoblast cultures were then pretreated with different concentrations of a-tocopherol or γ-tocotrienol for 24 hours before incubated with the IC50 of H(2)O(2) for 2 hours. Cell viability was determined by using MTS assay to compare the protective effects of both vitamin E on osteoblast exposed to H(2)O(2). RESULTS: The IC(50) after 2 hours and 24 hours incubation time for H(2)O(2) were 490 µM and 280 µM respectively. γ-Tocotrienol was found to be toxic to osteoblasts with the IC(50) of 290 µM after 24 hours incubation time while a-tocopherol was not toxic to osteoblasts at any doses. However, γ-tocotrienol was able to protect osteoblasts from H(2)O(2) toxicity at low concentration (1 µM), whereras a-tocopherol was not able to offer protection against H2O2 toxicity. CONCLUSIONS: γ-tocotrienol was found to be toxic to osteoblasts at high concentrations but at much lower concentration, it has better antioxidant activity than a-tocopherol to protect osteoblasts from oxidative stress.

Effects of Phytosterol Supplementation on Lipid Peroxidation Induced by Carbon Tetrachloride in a Rat Model

Phytosterols are plant sterols with a chemical structure similar to cholesterol. It has anti-cholesterol, anti-cancer and anti-oxidant properties which are probably mediated by suppression of lipid peroxidation. However, there are limited studies on the effects of phytosterols on lipid peroxidation. The aim of this study is to determine the effects of phytosterols on plasma and tissue malondialdehyde (MDA) of rats exposed to carbon tetrachloride. The rats were divided into four groups of normal control (NC), carbon tetrachloride (CCl4), phytosterol (P) and phytosterol+carbon tetrachloride (P+CCl4). The P and P+CCl4 groups were pretreated with subcutaneous phytosterol at 140 mg/kg once weekly for 5 weeks while the NC and CCl4 groups only received olive oil (vehicle). A single oral dose of carbon tetrachloride was then given to rats in the CCl4 and P+CCl4 groups to induce lipid peroxidation. After 24 hours, all the rats were sacrificed and the plasma and tissue MDA were measured. Our results showed carbon tetrachloride had caused significant elevations of the plasma and hepatic MDA of the CCl4 group compared to the NC group. Phytosterol pretreatment (P+CCl4 INTRODUCTION Phytosterols or plant sterols are a group of steroid alcohols, phytochemicals naturally occuring in plants. They have a chemical structure which is similar to cholesterol (Weihrauch & Gardner 1978) and exist in several forms in plants (Law 2000; Katan et al. 2003; Abumweis et al. 2007) including β-sitosterol, campesterol, stigmasterol and cycloartenol (Ostlund 2002). Phytosterols are natural compo-nents found in the human diet. It made up 0.1 to 0.5% w/w of vegetable oils or margerine (Kochlar 1983) and are also found in corn, wheat and rice. Phytosterol intake varies according to the type of diet taken. Europeans consume about 200-300 mg/day of phytosterol (Morton et al. 1995) while the vegetarian Japanese have a higher intake of phytosterol (Nair et al. 1984). group) were able to prevent the MDA elevations. Phytosterols treatments in normal rats (P group) were found to reduce the hepatic MDA level. The conclusion of this study was that phytosterols are effective suppressor of plasma and hepatic lipid peroxidation. They have potential as supplements to further reduce lipid peroxidation in healthy individuals.

Effects of vitamin E on receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in rats treated with nicotine.

Vitamin E is found to reverse the effects of nicotine on bone and this study aimed to determine its mechanism. Male Sprague Dawley rats were divided into four groups and treated for 3 months: Group 1 was the control group (RC). Groups 2 (N), 3 (N+TT) and 4 (N+ATF) received nicotine 7 mg/kg throughout the treatment period. In addition, groups 3 and 4 received tocotrienol 60 mg/kg and alpha-tocopherol 60 mg/kg respectively during months 2 and 3. Parameters measured were serum osteoprotegerin (OPG), serum receptor activator of nuclear factor kappa B ligand (RANKL), femoral and lumbar bone calcium content and body weight. Nicotine did not affect OPG or RANKL levels but reduced bone calcium content suggesting the calcium loss is not due to increase osteoclastogenesis. OPG was increased in N+ATF while RANKL was slightly increased in N+TT. Both vitamin E supplements restored bone calcium loss induced by nicotine. Nicotine impaired weight gain in all treatment groups starting week 4 however, N+TT group was comparable to RC from week 6 onwards. Bone protective effects of ATF, but not TT, may be partly due to inhibition of osteoclastogenesis.

Effects of Palm Tocotrienols on Oxidative Stress and Bone Strength in Ovariectomised Rats

Oxidative stress has been associated with postmenopausal osteoporosis which pre-disposes to risk of fracture. Palm tocotrienol is a potent antioxidant and has the poten-tial to be used for treatment of post-menopausal osteoporosis. The aim of the study is to determine if palm tocotrienol supplementation could alleviate oxidative stress in ovariectomised rat model and improve its bone strength. The rats were divided into four groups: (i) sham-operated group (SHAM) (ii) ovariectomised-control group (OVX) (iii) ovariectomised and given 60mg/kg α-tocopherol by oral gavage (OVX + ATF) (iv) ovariectomised and given 60mg/kg palm tocotrienols by oral gavage (OVX + PTT). After eight weeks of treatment, blood samples were taken to measure oxidative status (MDA, SOD and GPX) while the femurs were biomechanically tested for strength and resistance to fracture. Ovariectomy was shown to induce oxidative stress as shown by the raised MDA levels and reduced GPX activity. Palm tocotrienols seemed to offer protection against the ovariectomy-induced oxidative stress as shown by the suppression of MDA levels and raised GPX and SOD activities in the OVX+PTT group. In comparison, α-tocopherol was only able to raise the SOD but not as high as palm tocotrienols. The biomechanical tests have shown that ovariectomy has not af-fected the bone strength significantly after eight weeks. Palm tocotrienols supplemen-tation for eight weeks was effective in preventing oxidative stress in a post-meno-pausal rat.

Anesthesia outcomes in a randomized double-blind trial of sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy.

The purpose of the study was to compare hemodynamics and postanesthetic tolerability of sevoflurane versus thiopental in electroconvulsive therapy (ECT). The design was a randomized double-blind trial in the ECT suite of a tertiary referral medical center. Thirty-one patients were randomized to either sevoflurane or thiopental induction of anesthesia for up to 6 of each subject's ECT treatments. Measurements included hemodynamics (heart rate and blood pressure), arrhythmias, posttreatment orientation, time to first breath, and posttreatment side effects. Sevoflurane compared favorably with thiopental in terms of hemodynamics and time to first breath, although there was a slightly nonsignificant trend toward faster recovery with sevoflurane. Sevoflurane was associated with significantly better postictal orientation 20 minutes after the treatment. We conclude that inhalational anesthesia with sevoflurane presents a well-tolerated alternative for ECT anesthesia.

Effects of vitamin E supplementation on bone metabolism in nicotine-treated rats.

INTRODUCTION: Nicotine has been shown to exert negative effects on bone. This study determined whether vitamin E supplementation is able to repair the nicotine-induced adverse effects in bone. METHODS: 24 male rats were divided into three groups. The fi rst group was the baseline control and killed untreated at the beginning of the study. Groups 2 and 3 received nicotine at 7 mg per kg for three months but during the second and third months, group 2 was supplemented with alpha-tocopherol (N+ATF) while group 3 was given palm tocotrienol mixture (N+TT). Serum interleukin-1 (IL-1), serum interleukin-6 (IL-6), serum osteocalcin, urine deoxypyridinoline (DPD) and bone calcium content were measured. RESULTS: Palm tocotrienol mixture was able to prevent the increment of IL-1 and IL- 6 due to nicotine treatment. No changes were seen in the osteocalcin levels, but the N+ATF group had lower urine DPD levels after treatment. However, bone-remodelling index revealed no significant changes. No significant differences were seen in the femoral bone calcium content results, although the fourth lumbar bone calcium content was reduced in both groups with 66.5 percent reduction in the N+ATF group and 59.6 percent reduction in the N+TT group. CONCLUSION: Palm tocotrienol mixture was better than alpha-tocopherol in reversing the effects of nicotine on IL-1 and IL-6. Both forms of vitamin E were not able to restore the nicotine-induced bone calcium loss, but the N+ATF group suffered a greater loss. Tocotrienol seemed to be superior to alpha-tocopherol in combating against the adverse effect of nicotine.

Reheating of soy oil is detrimental to bone metabolism in oestrogen deficient rats.

INTRODUCTION: The short-term and long- term effects of heated soy oil on bone metabolism in ovariectomised Sprague-Dawley rats were studied. METHODS: Three-month-old female rats, were divided into five groups: normal control (NC); ovariectomised control (OVXC); ovariectomised and fed rat chow with added fresh soybean oil (SOF) or once-heated soy oil (SO1) or five-times-heated soy oil (SO5). Short-term parameters measured after one month were serum interleukin-6 (IL-6) and osteocalcin. Long-term parameters measured after six months were the structural bone histomorphometrical parameters. Vitamin E content in the soy oil subjected to the different heating treatments were also measured. RESULTS: Rats in the SO5 group had higher levels of IL-6 after one month compared to the other four groups. Osteocalcin levels in the SO1 and SO5 groups remained high after treatment, while those in the NC and SOF groups declined. After six months, bone mass declined in the SO5 group. Vitamin E assay in the oils showed that levels of alpha-tocopherol decreased after heating the oil once and five times, while levels of gamma- and delta-tocopherols only declined after heating five times. CONCLUSION: Repeated heating of soy oil destroyed the tocopherols causing raised serum IL-6 and osteocalcin levels, leading to increased bone resorption and osteoporosis in the long term.

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.

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.

Seizure length with sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy: a randomized double-blind trial.

In general, seizure length does not correlate with clinical outcome with electroconvulsive therapy (ECT), but whether markedly short seizures are still therapeutic is unknown. Furthermore, seizure length effects on clinical outcome in ECT may be different among the various anesthetic agents available. Several studies have investigated the use of inhalational anesthesia in ECT with sevoflurane. In general, seizure length when reported has been in the range of typical values encountered in practice. We recently completed a randomized double blind trial with sevoflurane induction compared with thiopental. Seizure duration with sevoflurane anesthesia was 8 seconds shorter than with thiopental for electroencephalogram and 6.4 seconds shorter for motor, the latter just barely missing statistical significance. Absolute values for seizure duration with both sevoflurane and thiopental are well within typical ranges for those seen with the more commonly used methohexital as anesthetic.

Adequacy of pain relief in closed manipulative reduction of fracture and dislocation.

Adequate pain relief is a requisite for a successful closed manipulative reduction (CMR) of fractures and dislocations. This prospective study was undertaken to assess the mode and adequacy of pain relief given to patients undergoing such procedures at Seremban Hospital from the 1st April to the 31st May 2001. All patients with fractures and dislocations scheduled to undergo CMR were included in this study. The type of sedative agents and analgesia administered were recorded. Demographic data and the type of fracture or dislocation of the selected patients were documented. A visual analogue scale (VAS) for pain perception was given to both to the patients and the medical personnel who performed the procedure. All data were collected manually before entered into computerized database for analysis. Of 72 patients included in this study, 47% were Malay, 26% Indian, 21% Chinese and 6% others. There was male predominance and the patients' age ranged between 9 to 79 years (average 27.4 years). Upper limb injuries (79%) were mainly fractures of the radius and ulna (29%) and isolated fracture radius (21%). For the lower limb injuries (21%), combined tibia and fibula fractures constituted 10% of the total cases followed by isolated tibia fractures (10%) and hip dislocation (1%). The most common pain relieving agents given during the CMR were intravenous pethidine alone (43%) followed by combination of intravenous pethidine and valium (36%), intramuscular pethidine (17%) and intramuscular tramal (4%). The Visual Analogue Score (VAS) for pain perception revealed that 61% of the patients had moderate pain while 21% had severe pain during the course of the procedures. Suboptimal pain relief administered during CMR should prompt positive actions to ensure that the patient is not subjected to undue pain just for the sake of an acceptable fracture reduction.

Vitamin E deficiency reduced lumbar bone calcium content in female rats.

Vitamin E deficiency has been found to impair bone calcification. This study was done to determine the effects of vitamin E deficiency and supplementation on parathyroid hormone, i.e. the hormone involved in bone regulation. Female Sprague-Dawley rats were divided into 4 groups: 1) normal rat chow (RC), 2) vitamin E deficiency (VED), vitamin E deficient rats supplemented with 3) 60 mg/kg alpha-tocotrienol (ATT) and 4) 60 mg/kg (alpha-tocopherol (ATF). Treatment was carried out for 3 months. Vitamin E deficiency caused hypocalcaemia during the first month of the treatment period, increased the parathyroid hormone level in the second month and decreased the bone calcium content in the 4th lumbar bone at the end of the treatment. Vitamin E supplementation (ATT and ATF) failed to improve these conditions. The bone formation marker, osteocalcin, and the bone resorption marker, deoxypyridinoline did not change throughout the study period. In conclusion vitamin E deficiency impaired bone calcium homeostasis with subsequent secondary hyperparathyroidism and vertebral bone loss. Replacing the vitamin E with pure ATF or pure ATT alone failed to correct the changes seen.