Neurotoxicity: A rare side effect of programmed cell death 1 (PD-1) inhibitors

Immunotherapy is a biological therapy that helps the body\u27s immune system to fight against cancer cells. The Food and Drug Administration (FDA) approved the first immune checkpoint inhibitor in 2011. Since 2011, many immune checkpoint inhibitors have been approved. Programmed cell death 1 (PD-1) inhibitors are now commonly used in multiple malignancies due to their remarkable response. Thus, immune-related adverse events are now coming into the limelight due to the increasing use of PD-1 inhibitors. Here, we present a case of a 54-year-old female with non-small cell lung cancers (NSCLC) treated with pembrolizumab and later presented with severe neurotoxicity

The potential of Empty Fruit Bunch (EFB) biochar produced from Modification of Gas Burner (MGB) as a soil amendment at different temperature level as compared to Top Lid Updraft (TLUD) and muffle furnace heating / Syed Ahmad Ibrahim Al-Kired S. Hasan

Top-Lid Updraft (TLUD) stove and muffle furnace heating is one of the methods to produce biochar trough slow pyrolysis process. However, there is a limitation involve the TLUD stove and muffle furnace heating which are poorly designed may result in high gas emission and more costing in term of operation and maintenance respectively. The new method of slow pyrolysis to produce biochar which is “Modification of Gas Burner (MGB)” has innovated to overcome the problem. The purposes of this study were to investigate the physco-chemical properties of Empty Fruit Bunch (EFB) biochar produce from MGB at three different temperatures and to compare their properties with TLUD stove and muffle furnace heating. Sample of EFB used in this study was collected from Serting Hillir Oil Palm Mill, Negeri Sembilan, Malaysia. Biochar from dried EFB was produce from MGB at three different range of temperature and different type of slow pyrolysis process (MGB, TLUD stove and muffle furnace). The experiment outcome show the increasing temperature of biochar produced from MGB will increase the total ash, pH and EC value of the biochar. For the three different type of pyrolysis process, the results showed that biochar produce form MGB, TLUD stove and muffle furnace heating has high in pH ranging from 9.1 to 10.4. Between these three method , TLUD stove has a lower ash content, pH and EC value, phosphorus and potassium compared to MGB400 and muffle furnace heating. It is was found that EFB biochar that produced from MGB400 which is compatible with muffle furnace in term of physical and chemical properties has a potential as a new soil amendment with low cost of production

Knowledge and attitudes toward epilepsy among Malaysian Chinese

Background: Epileptics are often socially discriminated due to the negative public attitudes, misconceptions and false beliefs. Thus, the main objective of this study was to assess the knowledge and attitudes toward epilepsy among Malaysian Chinese. Methods: A cross-sectional study by using a 23-item validated, self-administered questionnaire was carried out in urban areas, selected through stratified sampling. A Chinese population was randomly selected in the stratified areas of Penang, Ipoh, Klang valley, and Kuala Lumpur and was asked to complete the questionnaire. Results: Among 382 (74.6%) respondents, 16.2% believed that epilepsy is a type of mental illness. Majority (90.8%) accepted that epileptics can become useful members of the society however, only 16% agreed to marry them. About 57% of respondents recognised epilepsy as nervous system problem. Significant relationships between education level and statements such as, epileptics are as intelligent as everyone else (p=0.009), epilepsy can be successfully treated with drugs (p=0.037) and epileptics can be successful in their chosen career (p=0.009), were found. Conclusions: The general Chinese population in the selected areas of peninsular Malaysia had relatively good knowledge and positive attitudes toward certain aspects of epilepsy at the time of the investigation. However, minority of the study participants demonstrated prejudice and discriminatory behaviour towards people with epilepsy

Early surgical results with intent to treat by radical retropubic prostatectomy for clinically localized prostate cancer

Aims: To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinicallylocalized adenocarcinoma prostate.Methods: Patient\u27s characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.Results: Patient\u27s mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive symptoms, followed by hematuria (9%) and back pain (4%). Clinical stages were T1b in 4%, T1c in 9%, T2a in 17%, T2b in 22% and T2c in 48% of the patients. Mean pre-operative serum prostate specific antigen (PSA) was 25 +/- 29 ng/ml (1.1 to 99.3). Bilateral pelvic lymphnode disection(PLND) and RRP was performed in 20 cases (nerve-sparing RRP 5 cases). In 3 cases with gross lymph node metastasis at frozen section, only bilateral orchidectomy was done. The mean operative time was 270 +/- 65 minutes and mean blood loss was 1097 +/- 654 mls. Packed cell transfusions were nil in 26%, 1-2 units in 44%, 3-4 units in 26% and 5 units in 4% of the patients who underwent RRP. The mean length of hospital stay was 10.2 +/- 1 days. Out of 20 patients who underwent RRP, 65% of tumors were confined to the specimen, 20% had seminal vesicle invasion and 15% had nodal metastasis. There was no peri-operative mortality while 2 patients developed epididymo-orchitis and 1 had myocardial ischemia (without infarction). Overall 87% of the patients were fully continent and 13% had mild to moderate stress urinary incontinence. The mean time of return of continence was 11.5 +/- 11.6 weeks. Two of the 3 patients (66%) with follow up information and having undergone nerve-sparing RRP are potent. At a mean follow up of 19.4 +/- 13 months (range 3-45 months), 20 of 23 total patients (87%) and 17 of 20 RRP patients (85%) remained free of disease recurrence with PSA \u3c or = 0.4 ng/ml. Conclusion: Our early results confirm the excellent potential for cancer control and low morbidity of radical prostatectomy for men with localizedprostate cancer. These results are in conformity with the vast Western experience. Long-term results will be provided

Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities Caused by Plantar Fasciitis

Background: Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material and Methods: Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results: Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P Conclusions: This trial showed that MPC is useful in treating inferior heel symptoms caused by PF

Patient-reported adverse drug reactions and drug-drug interactions: a cross-sectional study on Malaysian HIV/AIDS patients

Objective: This study aimed to explore the adverse drug reactions (ADRs) reported by patients and to identify drug-drug interactions (DDIs) among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Subjects and Methods: This cross-sectional study was conducted at the Medication Therapy Adherence Clinic, Hospital Sungai Buloh, an HIV/AIDS referral centre. The patients were randomly selected and were encouraged to describe ADRs caused specifically by any of the prescribed antiretroviral drugs (ARDs). Sociodemographic characteristics were recorded from the patients’ medical records. In addition data on antiretroviral treatment (ART), DDIs and other conventional medication were also documented. Results: A total of 325 randomly selected HIV/AIDS patients with a mean age of 22.94 years participated in the study. The most frequently prescribed ARDs were lamivudine (64.6%), zidovudine (40.6%) and efavirenz (42.5%). Commonly reported ADRs were fatigue (54.8%), allergic reactions (41.5%), weight loss (41.5%), dry mouth (35.1%) and memory loss (35.1%). Female (87.8%), non-complementary and alternative medicine (CAM) users (87.3%) and participants below 50 years old (81.1%) were identified as having a higher prevalence of ADRs compared to males (79.6%), CAM users (78.7%) and participants aged 50 years or more (77.5%). Patient age was found to be significantly associated (p = 0.048) with the ADRs. In addition, a total of 44 cases of DDIs belonging to category D were also found in this study. Conclusions: This study enabled us to identify the most common ADRs and DDIs associated with the use of ART. Safe and effective treatment depends on the healthcare providers’ knowledge of the same

Perceived sources of stress among Malaysian dental students

Objectives: The study objectives were to identify the stress levels and to explore the impact of students’ year of study and gender on the perceived sources of stress among Malaysian dental students. Methods: This was a cross-sectional study involving dental students from year one to year five from private and public universities in Malaysia. The study was formally approved by the Research and Ethics Committee, International Medical University Malaysia. Dental Environment Stress (DES) questionnaire was used for data collection and the gathered data were analyzed using SPSS® version 18. The Kruskal-Wallis and the Mann-Whitney U tests were used to compare stress items across various academic years and universities. Results: A total of five hundred and twenty nine (529) students participated in this study. Fear of failing the course at the end of year exams (mean stress level=5.57); concerns regarding completion of clinical work (mean=5.30); and examination results and grades (mean=5.27) were found as top stressors among dental students. Female students had higher stress scores than males with respect to personal issues, academic performance, educational environment and learning of clinical skills. Students from public universities had higher stress scores than their counterparts from private universities. Conclusion: The Malaysian dental students reported higher levels of stress. Present study identified stressors affecting dental students’ academic life, and highlights the importance of stress management programs and other measures to minimize the impact of stress on both academic and personal lives of the students

Optical Properties and Behavior of Whispering Gallery Mode Resonators in Complex Microsphere Configurations: Insights for Sensing and Information Processing Applications

Whispering gallery mode (WGM) resonators are garnering significant attention due to their unique characteristics and remarkable properties. When integrated with optical sensing and processing technology, WGM resonators offer numerous advantages, including compact size, high sensitivity, rapid response, and tunability. This paper comprehensively investigates the optical properties and behavior of WGMs in complex microsphere resonator configurations. The findings underscore the potential of WGMs in sensing applications and their role in advancing future optical information processing. The study explores the impact of configuration, size, excitation, polarization, and coupling effects on the WGMs properties. The paper provides crucial insights and valuable guidance for designing and optimizing microsphere resonator systems, enabling their realization for practical applications.Comment: 11 pages, 13 figure

Peer-assisted learning (PAL): An innovation aimed at engaged learning for undergraduate medical students

Objective: To evaluate the effectiveness of Peer Assisted Learning in teaching at undergraduate level and to assess its effects on Peer Leaders and Peer Learners.Methods: The cross-sectional study was conducted at the Aga Khan University, Karachi, from May to October 2017, and comprised Peer Learners who were trained by faculty members in workshops and pre-run of experiments. Students were divided into two groups; Group A had Peer Learners taught by Peer Leaders, and Group B had those taught by trained lab technologists. Knowledge of the groups was assessed by a quiz using Kahoot. Post-session feedback questionnaires were also filled by the participants. Data was analysed using SPSS 23.Results: There were 10 Peer Leaders with a mean age of 19.5±0.85 years, and 62 Peer Learners with a mean age of 19.08±0.81 years. Among the learners, there were 35(56.5%) males and 27(43.5%) females. Post-session assessment showed a significant difference in the test performance by the two groups (p\u3c0.05). Feedback indicated that the learners found Peer Leaders more accessible than lab staff, leading to enhanced understanding of the subject.Conclusions: Peer-Assisted Learning was found to promote learning by creating an informal student-friendly learning environment

Blood Transfusions in Revision Surgery for Prosthetic Hip and Knee Infection

Background: Surgery for prosthetic joint infection (PJI) can often have significant blood loss necessitating allogeneic blood transfusion (ABT). ABT is associated with higher rates of morbidity and death in revision TJA, particularly in the treatment of PJI. It is important to understand how the rates of ABT differ among the various surgical treatments of PJI. We compared ABT rates by procedure type among patients treated for PJI a multimodal blood conservation protocol. Methods: We retrospectively reviewed 143 operative cases of revision arthroplasty for hip and knee PJI involving 102 patients at a single institution between 2016 and 2018. Procedures were categorized as 1. irrigation and debridement (I&D) with modular component exchange (“modular component exchange”), 2. explantation with I&D and placement of antibiotic spacer (“explantation”), 3. I&D with antibiotic spacer exchange (“spacer exchange”), or 4. antibiotic spacer removal and prosthetic reimplantation (“reimplantation”). ABT rates and number of units transfused were assessed for the four procedures. Factors associated with ABT were assessed with a multilevel mixed-effects regression model. Results: Seventy-seven cases (54%) received ABT. The highest rates of ABT occurred during explantations (74%) and spacer exchanges (72%), followed by reimplantations (36%) and modular component exchanges (33%). After adjusting for perioperative variables, lower preoperative hemoglobin level was associated with higher odds of ABT (odds ratio [OR], 1.9 [per 1-g/dL decrease]; 95% confidence interval [CI]: 1.5–2.5). Explantation (OR, 14; 95% CI: 4.0–50), reimplantation (OR, 4.3; 95% CI: 1.1–16), and spacer exchanges (OR, 5.6; 95% CI: 1.1–28) were associated with greater odds of ABT. Antibiotic spacer exchanges (OR, 26; 95% CI: 2.1-315) and explantations (OR, 11; 95% CI: 2.1-61) were associated with greater odds of multiple unit transfusions. Discussion: Despite a restrictive transfusion protocol, ABT rates remain high in the surgical treatment of PJI. Antibiotic spacer exchange and explantation procedures had high rates of multiple unit transfusions, and additional units of blood should be made available. Preoperative anemia should be treated when possible, and further refinement of blood management protocols in prosthetic joint infection is necessary