The future hospital is a resilient, physical learning facility featuring digital enhancement and leveraging an ecosystem of platforms for the Internet of Things (IoT) and analytics, achieving patient-centric care delivery via multidisciplinary healthcare provider teams coordinated to meet patients’ medical, psychological, social and economic needs. It exists in a just ecosystem that assimilates the care spectrum from healthy living, the prevention of disease to acute care and the rehabilitation of patients recuperating from illnesses. It will take some time for these future hospitals to be built or for current hospitals to evolve and/or transform, but efforts to spread wisdom among the stakeholders, healthcare providers and patients must start now. The development of the digital components can also begin today, as can competency building for the healthcare providers who will be staffing these future hospitals, ensuring that they are equipped with competent staff employing patient-centric care processes that cater to patients’ current and future needs.

Leptin is an adipokine that has strong correlation with the body mass index (BMI). Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. Leptin may lose its correlation with the body mass index (BMI) during diabetes due to hormonal rearrangement. Diet control is the first line management in GDM. Leptin reported to increase in pregnancy and further increases in diabetic patients during GDM screening. There is paucity in the reports concerning Leptin levels in GDM patients on diet control. The present study was aimed to evaluate the changes in maternal leptin in pregnancy complicated by GDM on diet control compared to the normal pregnancy in the 3rd trimesters by comparing the means and to find the correlation of Leptin with the body mass index in both groups. Methods: The study included 2 groups: normal pregnancy (n = 40) and pregnancy with GDM under diet control (n = 60) both groups are at 38-40 weeks of gestation. Leptin concentration in serum was measured in both groups and statistically tested using student t test. The BMI were measured and correlated with the Leptin level in test groups. Results: the results indicated that Leptin will nearly triple in the third trimester (38±30 ng/ml) of pregnancy compared to the standard normal non-pregnant. Leptin level was significantly lower in diabetic women on diet control (28±16 ng/ ml) when compared with the non-diabetics (38±30 ng/ml). The hormone has no correlation with the age of the patients but have a positive correlation with the body mass index before and during pregnancy in both groups. Conclusion: Leptin is increasing in pregnancy as part of the physiological changes. Dieting can decrease Leptin level in diabetics’ pregnant women. Diet can restore the hormonal dysregulation of Leptin. Assessment of Leptin level might be used as an indicator for good diet control during pregnancy.

Eurycoma longifolia (E. longifolia) which is better known locally as Tongkat Ali is an indigenous plant in Malaysia. It belongs to the family of Simaroubaceae and is popular as a traditional medicine for its aphrodisiac properties. Throughout the years, several studies have been conducted to prove its effect on aphrodisiac action, antimalarial, antibacterial and anxiolytic properties but its effect to the cardiovascular system had not been fully explored. This study was aimed to demonstrate the changes that take place in the isolated heart following the injection of the extract. Methods: Three parameters that were measured included the coronary perfusion pressure (CPP), the left ventricular developed pressure (LVDP) and the heart rate (HR). Eighteen isolated rat hearts were used and were divided equally into three groups. The first group was to observe the effect of Isoprenaline, a β agonist while the second group was to see the effect of sodium nitroprusside (SNP), a nitric oxide (NO) donor. The dose which gave the maximum effect for these two positive controls was used to compare with the effect of E. longifolia water extract in the third group of rats. Isolated heart was mounted using the Langendorff apparatus and perfused with modified Krebs-Henseleit buffer. Doses of controls and the extract were instilled through an injection port, and the effect of each dose was monitored. Results: E. longifolia extract was found to reduce the CPP in normotensive rat at two of the highest doses. A dose of 1.0 mg of the extract reduced the CPP significantly from 34.52 ± 4.99 mmHg of the baseline value to 31.99 ± 4.93 mmHg while the dose of 10.0 mg of the extract reduced the CPP significantly to 32.67 ± 3.89 mmHg. However, there were no significant changes of effect of the extract on the LVDP and HR as compared to control. Conclusion: These early findings suggest that E. longifolia extract may have vasodilatory property, which supports its traditional usage with minimum cardiovascular side effects.

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25 women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9 years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%) women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight (32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus. Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various maternal morbidities, in this case series , which could have been prevented if they were diagnosed and terminated at early trimester. A new direction is needed in our local practice.

The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p<0.05 for right and left lateral incisors and right first premolars in male; p<0.001 for all other teeth). In both gender, the highest R/C ratio was mandibular second premolars and the lowest R/C ratio were maxillary central incisors. The rootcrown ratio could be used as a baseline data and reference to help in orthodontic diagnosis, treatment planning and prognosis as well as evaluation developmental root deficiency.

Oral cancer is one of the common cancer cases identified in the developing countries. Genetic mutation and overexpression of certain genes and proteins have been associated in the development of this cancer. Notch signalling pathway is normally involved in controlling the development process of vertebrates and invertebrates; however, deregulation of this pathway was found to be responsible in the formation of certain cancers including oral cancers. Activation of this pathway requires binding of the ligands to its receptors. Four NOTCH receptors (NOTCH 1, 2, 3 and 4) have been identified in mammals. Disruptions within these molecules might interfere with the normal functions of Notch signalling pathway. Hence, this study was conducted to detect mutations of NOTCH1 and NOTCH2 receptor genes which might be occurring in the oral cancer cases obtained from the local population. DNA extracted from fresh-frozen tissue biopsy of the tongue and buccal mucosa from 10 confirmed cases of oral cancer were subjected for polymerase chain reaction (PCR) amplification using the specific sets of primers. The PCR products were sent for sequencing before final results were analysed. Due to time and cost limitation, only two out of four NOTCH receptor genes; NOTCH1 and NOTCH2, were used in this analysis. The results revealed absence of nucleotide changes for both NOTCH receptor genes amplified from these oral cancer samples. More samples and further analysis looking into other regions in these genes are required to conclude the involvement of NOTCH receptor genes mutation in causing oral cancer.

The endothelium plays a crucial role in maintaining vascular homeostasis by producing several vasodilating factors, including nitric oxide (NO), prostacyclin (PGI2), and endothelium-dependent hyperpolarisation (EDH); however, the balance between endothelial relaxing and contracting factors is disrupted in disease states such as diabetes mellitus and hypertension. Most reported studies of endothelial dysfunction in diabetes focused on the actions of NO; however, there is accumulating evidence demonstrating that in addition to NO, PGI2 and EDH are likely to contribute to the vasodilatation of blood vessels. EDH plays an important role as a regulator of vascular tone and reactivity in resistance and conduit arteries of animal models and humans. PGI2 only plays a minimal role in endothelium-dependent vasodilatation but may serve as an important compensatory mechanism in conditions in which NO and EDH activities are decreased. Further studies are needed to determine the exact roles of EDH and PGI2 in the development of endothelial dysfunction and clinical vasculopathy in humans with type 1 and type 2 diabetes.

·AIM: To present a case of Coats' disease in adult and to illustrate the retinal findings.·METHODS: A case report.·RESULTS: A 63 years old Malay man, a known case of diabetes mellitus, presented with one year history of painless and progressive reduced vision in the right eye. Right eye visual acuity was counting finger 2 feet while left eye best corrected visual acuity was 6/12. Right fundus showed presence of extensive subretinal exudates at the temporal part of the posterior pole involving the macular area and nasal to the optic disc. It was associated with multiple areas of abnormal blood vessels temporal to the macula with attenuated vessels. Fundus fluorescein angiography(FFA) showed presence of telangiectatic vessels at the area of subretinal exudates and leakage of fluorescein from the telangiectatic vessels. The left eye was normal. Based on clinical and FFA findings, he was diagnosed to have adult Coats' disease. The right eye was treated with argon laser photocoagulation. Six months post laser, his visual acuity remained at 6/120 and there was minimal regression of the disease seen in the retina. ·CONCLUSION: The clinical and angiographic findings are important in diagnosing retinal telangiectasia. Treatment by laser photocoagulation in area of leakages may be beneficial in preventing visual loss.

Photochemical reactions of poly(3-butoxythiophene-2,5-diyl) with chloroform under irradiation with light were studied. The reactions were separately carried out under air, oxygen, and nitrogen. The obtained results showed that this reaction belongs to the pseudo-first-order reaction with a rate constant k(obs) of 1.4 x 10(-5) s(-1) at room temperature. The presence or absence of air, oxygen, and nitrogen did not have obvious effects on the reaction rate under irradiation with light.
Air ; Chloroform ; analysis ; chemistry ; radiation effects ; Kinetics ; Light ; Nitrogen ; chemistry ; Oxygen ; chemistry ; Photochemistry ; methods ; Thiophenes ; analysis ; chemistry ; radiation effects

Aims: To evaluate the microbial count and palatability acceptance of spoiled fish after treatment with traditionally used natural solution. Methodology and results: To compare microbial count of spoiled fish before and after treatment with natural solution practiced by local people in Malaysia, 10 g of spoiled fish was respectively rinsed with 100 mL of 0.1% of natural solution such as Averrhoa bilimbi extract, rice rinsed water, rice vinegar, Citrus aurantifolia extract, salt, flour, and Tamarindus indica extract. Flesh of fish rinsed with rice vinegar was found to be able to reduce microbial count (CFU/mL = 0.37 X 107) more than 4.5 times when compared to spoiled fish (CFU/mL=1.67x 107). Spoiled fish that was treated with rice vinegar was prepared into a cutlet and fried. The cutlet was subjected to palatability acceptance study by a group of residents in Palm Court Condominium, Brickfields, Kuala Lumpur. The palatability study from the Cronbach alpha shown that the taste have the reliability of 0.802, the aroma has the reliability of 0.888, colour with the reliability of 0.772, texture or mouth feel have reliability of 0.840 and physical structure of the cutlet is 0.829. Conclusion, significance and impact of study: Treatment of spoiled fish using rice vinegar as practice by local people traditionally shown a significant reduction in microbial count and the vinegar-treated fish could be developed into a product that is safe and acceptable by the consumer.