Managing post stroke hyperglycaemia

Post stroke hyperglycaemia (PSH) is prevalent in acute ischaemic stroke (AIS) patients and it has been associated with a dismal outcome of death and disability. Insulin has been proven to attenuate glucose effectively in stroke patients, thus many trials over the years had studied the efficacy of intensive treatment aiming at normalization of blood sugar level in order to improve the bleak outcomes of PSH. However, tight glycaemic control failed to be translated into clinical benefits and the outcomes are no different from the conventional approach, despite the costly healthcare expenditure invested. On the contrary, it brings more significant harm than the intended benefit, as 1 in every 9 treated patients had symptomatic hypoglycaemia. Thus, the benefits of tight glucose control, if any, are overshadowed by this potential risk of hypoglycaemia causing permanent neurological injury. Therefore, international practice guidelines recommend for less aggressive treatment to maintain blood glucose level within an appropriate range in AIS patients. However, there are limited details for stroke-specific glycaemic management and this made management of PSH particularly difficult. This review is to discuss and provide suggestions concerning glycaemic control in acute ischaemic stroke; the direction of its future prospective clinical trials and the treatment strategy required based on recent literature

Students" e-profiling / Nor Jaslina Nik Wil ...[et al.]

Having a complete and adequate data profiling system about students is very vital as it can be used to obtain statistics or informative summaries on any matters concerning students. Currently, in UiTM Cawangan Kelantan (UiTMCK), the students’ data could be found in the data system which is only available at the Hal Ehwal Akademik Department but with limited access. There are two types of data keeping in UiTMCK namely paper printed version and soft copy. The data of paper printed version are ept in the students file gathered during registration and are quite comprehensive whereas the soft copy data is concerned students’ academic results only. Thus, to have a one stopcenter and fast-tracking of students’ data profiling, a system to collect information is created known as Students’ eProfiling (SeP). This system is meant for collecting data in order to get information about students’ background concerning non-academic matters. The system is unique in the sense that it can be accessed either by using QR code or a link for the students to fill up required particulars. The system is beneficial as it could help academic staff to identify the students in terms of income, health or any physical limitation that needs further attention. The information gathered through this system could be used in the process of zakat selection, food bank selection, time table preparation et

Obturator hernia: A rare condition with common surgical symptoms

Hernia is a common surgical problem. However, worldwide incidence of obturator hernia is <1% of all hernia cases, occurring more commonly in thin, elderly and multiparous female. An 82 years old lady presented with bowel obstruction sign and symptoms for 4 days duration. Imaging study, computed tomography with enhanced contrast (CECT) of abdomen and pelvis showed small bowel obstruction secondary to left obturator hernia. Emergency abdominal exploration with left transverse transperitoneal approach was performed. Intraoperatively, anti mesenteric part of ileal wall was incarcerated through the left obturator foramen causing small bowel obstruction and it was resected with end to end anastomosis. She recovered well and was discharged on postoperative day 7. The signs and symptoms of obturator hernia are non-specific. Most cases are presented with symptoms of intestinal obstruction, resulting in diagnostic difficulty for this rare condition. Delay in diagnosis and surgical intervention contribute to poorer outcomes

Mini review: MANAGING POST STROKE HYPERGLYCAEMIA: MODERATE GLYCAEMIC CONTROL IS BETTER? AN UPDATE

ABSTRACT Post stroke hyperglycaemia (PSH) is prevalent in acute ischaemic stroke (AIS) patients and it has been associated with a dismal outcome of death and disability. Insulin has been proven to attenuate glucose effectively in stroke patients, thus many trials over the years had studied the efficacy of intensive treatment aiming at normalization of blood sugar level in order to improve the bleak outcomes of PSH. However, tight glycaemic control failed to be translated into clinical benefits and the outcomes are no different from the conventional approach, despite the costly healthcare expenditure invested. On the contrary, it brings more significant harm than the intended benefit, as 1 in every 9 treated patients had symptomatic hypoglycaemia. Thus, the benefits of tight glucose control, if any, are overshadowed by this potential risk of hypoglycaemia causing permanent neurological injury. Therefore, international practice guidelines recommend for less aggressive treatment to maintain blood glucose level within an appropriate range in AIS patients. However, there are limited details for stroke-specific glycaemic management and this made management of PSH particularly difficult. This review is to discuss and provide suggestions concerning glycaemic control in acute ischaemic stroke; the direction of its future prospective clinical trials and the treatment strategy required based on recent literature

Radiation-induced formation of acrylated palm oil nanoparticle using pluronic F-127 microemulsion system

This study demonstrated the utilization of radiation-induced initiator methods for the formation of nanoparticles of Acrylated Palm Oil (APO) using aqueous Pluronic F-127 (PF-127) microemulsion system. This microemulsion system was subjected to gamma irradiation to form the crosslinked APO nanoparticles. Dynamic light scattering (DLS), Fourier Transform Infrared (FTIR) spectroscopy and Transmission Electron Microscopy (TEM) were used to characterize the size and the chemical structure of the nanoparticles. As a result, the size of the APO nanoparticle was decreased when the irradiation dose increased. The decrease in size might be due to the effects of intermolecular crosslinking and intramolecular crosslinking reactions of the APO nanoparticles during irradiation process. The size of the nanoparticle is in the range of 98 to 200 nanometer (nm) after irradiation using gamma irradiator. This radiation-induced method provides a free initiator induced and easy to control process as compared to the classical or chemical initiator process. The study has shown that radiation-induced initiator methods, namely, polymerization and crosslinking in the microemulsion, were promising for the synthesis of nanoparticles

Holistic thoughtful classroom for promoting higher order thinking skills in the 21st Century Learning

The Fourth Industrial Revolution (IR4.0) brings technology into our everyday lives, making education accessible anytime, anywhere. To align with the fourth industrial revolution is challenging for any education system especially when content and structure of school curriculum do not change as fast as changes in technological advancement. Therefore, the only logical step to do is to prepare students as independent learners by providing them with essential skills of 21st-century learning, one of which is higher order thinking skill (HOTS). However, the implementation of HOTS in teaching and learning (TnL) seems to be problematic at schooling level. This is associated with the lack of knowledge and experiences among teachers to infuse effectively thinking skills in their classrooms. The success of developing HOTS in students depended highly on teachers’ knowledge and skills in HOTS. The first step in training teachers to have knowledge and competence in HOTS is to present clear theoretical framework of what constitute excellent thinking behaviour. This paper elucidates three dimensions of teaching thinking namely habits of mind posited by Costa (2001), human passion by Costa and Garmston (2001) and language of thinking by Costa and Marzano (1991). The review revealed entwined and overlapping elements which were synthesized to come up with a more holistic framework of thinking behaviour. It consists of six components which are creative thinking, flexible thinking, interdependence thinking, metacognition, precision in thinking and self-efficacy. This framework is suggested to be the foundation for developing an educational model of Holistic Thoughtful Classroom as a guide for teachers to implement effectively HOTS in their classrooms. This paper suggests some implications on effective thoughtful teachers, conducive classroom learning as well as uniqueness, learning styles and readiness to think among students at all levels of schooling in general

A randomized open-label trial on the use of budesonide/formoterol (Symbicort®) as an alternative reliever medication for mild to moderate asthmatic attacks

BACKGROUND Conventionally, a nebulized short-acting β-2 agonist like salbutamol is often used as the reliever in acute exacerbations of asthma. However, recent worldwide respiratory outbreaks discourage routine use of nebulization. Previous studies have shown that combined budesonide/formoterol (Symbicort®, AstraZeneca) is effective as both a maintenance and reliever anti-asthmatic medication. METHODS We performed a randomized, open-label study from March until August 2011 to compare the bronchodilatory effects of Symbicort® vs. nebulized salbutamol in acute exacerbation of mild to moderate asthmatic attack in an emergency department. Initial objective parameters measured include the oxygen saturation, peak expiratory flow rate (PEFR) and respiratory rate. During clinical reassessment, subjective parameters [i.e., Visual Analog Scale (VAS) and 5-point Likert scale of breathlessness] and the second reading of the objective parameters were measured. For the 5-point Likert scale, the patients were asked to describe their symptom relief as 1, much worse; 2, a little worse; 3, no change; 4, a little better; 5, much better. RESULTS Out of the total of 32 patients enrolled, 17 patients (53%) were randomized to receive nebulized salbutamol and 15 (47%) to receive Symbicort®. For both treatment arms, by using paired t- and Wilcoxon signed rank tests, it was shown that there were statistically significant improvements in oxygen saturation, PEFR and respiratory rate within the individual treatment groups (pre- vs. post-treatment). Comparing the effects of Symbicort® vs. nebulized salbutamol, the average improvement of oxygen saturation was 1% in both treatment arms (p = 0.464), PEFR 78.67 l/min vs. 89.41 l/min, respectively (p = 0.507), and respiratory rate 2/min vs. 2/min (p = 0.890). For subjective evaluation, all patients reported improvement in the VAS (average 2.45 cm vs. 2.20 cm), respectively (p = 0.765). All patients in both treatment arms reported either "a little better" or "much better" on the 5-point Likert scale, with none reporting "no change" or getting worse. CONCLUSION This study suggests that there is no statistical difference between using Symbicort® vs. nebulized salbutamol as the reliever for the first 15 min post-intervention

Students’ Inclination towards English Language as Medium of Instruction in the Teaching of Science and Mathematics

AbstractMalay language, the national language of Malaysia has been the medium of instruction for Science and Mathematics for the past four and a half decades in Malaysia. The government however changed the medium of instruction of these subjects to English in January 2003. The “Teaching and Learning of Science and Mathematics in English” (PPSMI) policy was implemented in all primary and secondary schools. It aims to improve the English language proficiency among students as well as the learning and achievement level in science and mathematics. This paper presents findings of the study on students’ inclination towards English language as medium of instruction in teaching and learning of Science and Mathematics in Higher Learning Institutions in Malaysia. The respondents were 291 undergraduate students from the Faculty of Science and Technology (FST) and Faculty of Education (FPEND) of Universiti Kebangsaan Malaysia (UKM). A questionnaire pertaining to students’ inclination was used as research instrument. Using descriptive statistics, ANOVA and t-test, the study found that undergraduate students of FST and FPEND had an inclination towards English as medium of instruction in the teaching and learning of Science and Mathematics. Using the Post-Hoc test, it is found that Indian students and students from other races than Malay and Chinese have greater inclination towards English as medium of instruction in teaching and learning of Science and Mathematics in UKM for both faculties. However, FST students who studied in Mandarin and Tamil at pre-university level (STPM) had higher inclination compared to those who used Malay language or even English

Urinary levels of organophosphate flame retardants metabolites in a young population from Southern Taiwan and potential health effects

BackgroundOrganophosphate flame retardants (OPFRs) are widely distributed in the environment and their metabolites are observed in urine, but little is known regarding OPFRs in a broad-spectrum young population from newborns to those aged 18 years.ObjectivesInvestigate urinary levels of OPFRs and OPFR metabolites in Taiwanese infants, young children, schoolchildren, and adolescents within the general population.MethodsDifferent age groups of subjects (n=136) were recruited from southern Taiwan to detect 10 OPFR metabolites in urine samples. Associations between urinary OPFRs and their corresponding metabolites and potential health status were also examined.ResultsThe mean level of urinary Σ10 OPFR in this broad-spectrum young population is 2.25 μg/L (standard deviation (SD) of 1.91 μg/L). Σ10 OPFR metabolites in urine are 3.25 ± 2.84, 3.06 ± 2.21, 1.75 ± 1.10, and 2.32 ± 2.29 μg/L in the age groups comprising of newborns, 1-5 year-olds, 6-10 year-olds, and 11-18 year-olds, respectively, and borderline significant differences were found in the different age groups (p=0.125). The OPFR metabolites of TCEP, BCEP, DPHP, TBEP, DBEP, and BDCPP predominate in urine and comprise more than 90% of the total. TBEP was highly correlated with DBEP in this population (r=0.845, p&lt;0.001). The estimated daily intake (EDI) of Σ5OPFRs (TDCPP, TCEP, TBEP, TNBP, and TPHP) was 2,230, 461, 130, and 184 ng/kg bw/day for newborns, 1-5 yr children, 6-10 yr children, and 11-17 yr adolescents, respectively. The EDI of Σ5OPFRs for newborns was 4.83-17.2 times higher than the other age groups. Urinary OPFR metabolites are significantly correlated with birth length and chest circumference in newborns.ConclusionTo our knowledge, this is the first investigation of urinary OPFR metabolite levels in a broad-spectrum young population. There tended to be higher exposure rates in both newborns and pre-schoolers, though little is known about their exposure levels or factors leading to exposure in the young population. Further studies should clarify the exposure levels and factor relationships

Analisis trend hujan di Bandaraya Ipoh Perak 1970-2007.

Penelitian terhadap trend hujan jangkamasa panjang adalah penting dan relevan dalam kajian hidrologi khususnya sebagai alat untuk mengesan dan mengenalpasti perubahan yang berlaku dalam sistem hidrologi. Untuk itu, data hujan bulanan dan tahunan dari tahun 1970 hingga 2007 yang diperolehi daripada Jabatan Meteorologi Malaysia dianalisis dengan menggunakan ujian statistik dan Ujian Mann-Kendall bagi mengesan perubahan (meningkat, menurun atau stabil) atau trend yang berlaku. Dapatan kajian menunjukkan trend hujan tahunan meningkat dari tahun 1970-2007 dengan purata tahunan 2497 mm. Rekod juga menunjukkan bahawa trend hujan yang meningkat semasa Monsun Timur Laut dan Monsun Barat Daya dalam tempoh yang sama. Hujan maksimum adalah pada bulan April dan Oktober iaitu semasa berlakunya pertukaran monsun. Rekod juga menunjukkan kawasan Ipoh menerima hujan paling banyak semasa Monsun Timur Laut walaupun stesen hujan terletak di sebelah pantai barat Semenanjung Malaysia dengan purata 1016 mm. Hujan bulanan dari tahun 1970-2007 menunjukkan kepelbagaian variasi. Berdasarkan Ujian Mann-Kendall (S), bulan Mei (-21), September (-25), Oktober (-35) dan Disember (-16) menunjukkan trend yang menurun dan bulan-bulan lain menunjukkan trend yang meningkat. Keadaan ini jelas menunjukkan variasi hujan yang kompleks di kawasan tropika. Faktor perubahan iklim global masa kini serta hidrometeorologi tempatan dijangka mempengaruhi trend hujan serta perubahan guna tanah khususnya aktiviti perbandaran yang wujud di bahagian tengah lembangan Kinta iaitu di Bandaraya Ipoh