Acute necrotizing encephalopathy of childhood: a severe case with fatal outcome

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem tegmentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options

Natural and Consequence of Tourism Industry’s Susceptibility to Natural Disaster : A Conceptual Framework using Input-Output Model

Tourism business plays an important role in developing a region’s economy. Most of the operators are small businesses and are highly vulnerable to disaster. On top of bearing the direct loss such as personal asset damages, impacted and adjacent communities are concerned of the possibility of losing their jobs and future incomes due to business interruption between the primary and secondary industries. The government’s receipts of tax revenue would be disrupted as well. Despite recognition of indirect losses, the disaster literature’s focus had been on estimating the direct damages to local residents. Literature that studied impacts on the business community tended to focus on those that originated from the disruption in the economic system – such as economic recession rather than environmental disaster. Compared to direct losses, indirect losses are more difficult to estimate because of the complex task in obtaining relevant data to measure the multiplier impact, especially in smaller regions. This study extended the literature by highlighting a way to measure the indirect effects of natural disasters on the tourism and secondary industries and its local and adjoining communities. This study hopefully could contribute to a better understanding – by tourism industry analysts as well as public officials – of the trail of economic effects and its implications of carrying or not to carry-out restoration work

Animal models for the study of primary and secondary hypertension in humans.

This is the final version of the article. It first appeared from Spandidos Publications via http://dx.doi.org/10.3892/br.2016.784Hypertension is a significant cause of morbidity and mortality worldwide. It is defined as systolic and diastolic blood pressures (SBP/DBP) >140 and 90 mmHg, respectively. Individuals with an SBP between 120 and 139, or DBP between 80 and 89 mmHg, are said to exhibit pre-hypertension. Hypertension can have primary or secondary causes. Primary or essential hypertension is a multifactorial disease caused by interacting environmental and polygenic factors. Secondary causes are renovascular hypertension, renal disease, endocrine disorders and other medical conditions. The aim of the present review article was to examine the different animal models that have been generated for studying the molecular and physiological mechanisms underlying hypertension. Their advantages, disadvantages and limitations will be discussed.Biotechnology and Biological Sciences Research Council (Doctoral Training Award), Economic and Social Research Counci

Clinical features of girls with turner syndrome in a single centre in Malaysia

Objectives. Diagnosis of Turner syndrome in Malaysia is often late. This may be due to a lack of awareness of the wide clinical variability in this condition. In our study, we aim to examine the clinical features of all our Turner patients during the study period and at presentation. Methodology. This was a cross-sectional study. Thirty-four (34) Turner patients were examined for Turner-specific clinical features. The karyotype, clinical features at presentation, age at diagnosis and physiologic features were retrieved from their medical records. Results. Patients with 45,X presented at a median age of 1 month old with predominantly lymphoedema and webbed neck. Patients with chromosome mosaicism or structural X abnormalities presented at a median age of 11 years old with a broader clinical spectrum, short stature being the most common presenting clinical feature. Cubitus valgus deformity, nail dysplasia and short 4th/5th metacarpals or metatarsals were common clinical features occurring in 85.3%-94.1% of all Turner patients. Almost all patients aged ≥2 years were short irrespective of karyotype. Conclusion. Although short stature is a universal finding in Turner patients, it is usually unrecognised till late. Unlike the 45,X karyotype, non-classic Turner syndrome has clinical features which may be subtle and difficult to discern. Our findings underscore the importance of proper serial anthropometric measurements in children. Awareness for the wide spectrum of presenting features and careful examination for Turner specific clinical features is crucial in all short girls to prevent a delay in diagnosis

Hydrodynamic Modeling of a Tropical Tidal River Using the Dynamic Estuary Model (DYNHYD5): A Case Study in Sibu Laut River, Sarawak, Malaysia

Application of the Dynamic Estuary Model (DYNHYD5) in a tropical tidal river is limited. The successfully calibrated and validated hydrodynamic model is valuable in subsequent water quality simulation for environmental management. Hence, a hydrodynamic modeling approach using the DYNHYD5 was conducted in a tropical tidal river in Malaysia. Samplings were conducted in the Sibu Laut River to collect the hydrology data for model simulation. The model was calibrated and validated by comparing the simulated flow and mean depth with the field data at different simulation periods of time. The results showed that the model DYNHYD5 was successfully calibrated with channel flows and mean depths and then reproduced with good agreement in validation. The observed and simulated data were linearly correlated (R2 > 0.8) with values of slope γ ranging from 0.891 to 1.204 in both calibration and validation. The Nash–Sutcliffe coefficient of efficiency (NSE) of more than 0.7 in both calibration and validation also indicated satisfactory comparison between the observed and simulated data. The result indicated that the application of the DYNHYD5 is feasible in a tropical tidal river in Malaysia

Outcome for self-expandable metal stents in patients with malignant gastroduodenal obstruction: A single center experience

SummaryBackgroundMalignant gastric outlet obstruction causes significant malnutrition and morbidity. The implantation of a metallic stent is an alternative palliative treatment to allow the intake of food in these patients.Patients and MethodsThirty-eight consecutive patients with malignant gastric outlet obstruction who had received an uncovered metallic stent placement in our department from April 2010 to April 2012 were enrolled for analysis. The mean follow-up time was 6.3 months. Food intake, measured by the Gastric Outlet Obstruction Scoring System, complications, duration of stent patency, and survival were evaluated.ResultsThe technical and clinical success rates of the procedure were 100% and 94.7%, respectively. The Gastric Outlet Obstruction Scoring System scores were significantly improved at 1 day, 7 days, and 30 days after the implantation compared with those prior to the procedure (p < 0.001). Aspiration pneumonia developed in two patients (5.2%) after the procedure. One of these patients developed respiratory failure and died 3 days later. Stent dysfunction developed in 11 of 38 patients (28.9%) during the follow-up period; one patient (2.6%) experienced migration of the stent 38 days later due to resolution of the stricture; 10 patients (26.3%) had stent restenosis. The median time of stent patency was 120 days. The presence of peritoneal carcinomatosis when the procedure was carried out was a significantly poor predictive factor of stent patency [hazard ratio (HR) 7.9, p = 0.039]. The median survival of the patients was 156 days. Poor performance status ≥3; HR 2.647, p = 0.012) and nongastric cancer origin (HR 3.466, p = 0.008) were associated with a significantly short survival time.ConclusionMetallic stent placement is an effective and relatively safe treatment for patients with malignant gastric outlet obstruction

Assessment of water quality of Batang Rajang at Pelagus Area, Sarawak, Malaysia

This study was carried out to examine the water quality of Batang Rajang at Pelagus area, Sarawak, Malaysia. Water quality was determined at 12 stations along Batang Rajang and its tributaries in terms of in-situ and ex-situ water quality parameters. The results showed that most stations at main river were categorized as slightly polluted while most tributaries were clean according to the Water Quality Index. The river is suffering from organic pollution where almost all stations along the river contained high chemical oxygen demand (≈ 43.1 mg/L) and total ammonia nitrogen (≈ 0.520 mg/L) and were classified as Class III and IV at most of the stations. High suspended solids (218.3 mg/L) and low dissolved oxygen (4.6 mg/L) were observed at the main river. The low dissolved oxygen content from the Bakun dam upstream of the study area has an impact on the river particularly during dry season where DO dropped below the minimum required for sensitive aquatic organisms. As seven tributaries are within Class II indicating healthy freshwater ecosystems, they should be conserved as habitats for sensitive aquatic organisms. Conversely, proper management need to be initiated in particular, Sungai Merit tributary and the main river where DO were below the minimum required for sensitive aquatic organisms

High intrinsic biosorption efficiency of cattle manure on Cr(VI): a potential low-cost fibre-rich biosorbent

Fibre-rich manure derived from grass-fed cattle showed significantly higher intrinsic sorption efficiency on Cr(VI) solution as compared to corncob, sawdust and cogon grass. This observation could be attributed to the ligneous nature and rough surface morphology of the cattle manure. Four-factor, three-level, face-centred composite design (FCCD) suggested the process was greatly affected by initial pH of the solution, contact time and sorbent dosage (p50% adsorption efficiency. It is predicted that both physisorption and chemisorption are involved in the sorption process