Introduction: Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Materials and Methods: Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk.

In this paper, we report three cases of orbital rhabdomyosarcoma in different age groups with different histopathologic types. Case 1 is a 10-year old Malay boy who presented with painless proptosis of the left eye. Magnetic resonance imaging (MRI) showed soft tissue mass arising from the lateral rectus muscle. Tissue biopsy revealed rhabdomyosarcoma of embryonal type. Case 2 is a 32-year old Malay man who presented with a progressive left eye proptosis associated with pain and redness. Computed Tomography (CT) scan showed a retrobulbar mass extending medially in the left orbit. Meanwhile, biopsy showed rhabdomyosarcoma of pleomorphic type. Case 3 is a 67-year old Malay woman who presented with proptosis and fungating growth of left orbital region, epistaxis and nasal blockage. CT scan revealed an ill-defi ned mass fi lling up the left orbital cavity. Biopsy showed rhabdomyosarcoma of alveolar type. Rhabdomyosarcoma is the most common in childhood but it should be considered as a differential diagnosis of orbital tumours irrespective of age.

Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.

Pericardial cysts occur rarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cyst requires surgical removal. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.

Pericardial cysts occur rarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cyst requires surgical removal. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.

Aluminium phosphide (ALP) is highly toxic and poisoning can result in high mortality rates. A 26-year-old female who allegedly ingested a toxic dose of ALP presented with vomiting and diarrhoea. She developed cardiac arrest with refractory pulseless ventricular tachycardia. Despite aggressive resuscitation, she succumbed to death seven hours following ingestion. In cases like this, a better outcome can be achieved with early arrival, prompt diagnosis, aggressive resuscitation and intensive monitoring.

One of the crucial health policies in hospitals is about physician payment methods. Indonesia had implemented the National Health Assurance since 2014 to achieve Universal Health Coverage by 2019. Most of hospital revenue is packaging from the National Health Insurance Agent (called BPJS). However, Fee-for-service (FFS) payment method is still dominant in many hospitals. How can hospitals make policy to rearrange the payment method to attain hospital performance? The purpose of this research is to analyze the payment system that can improve employee satisfaction and performances. Mix method was used to collect data and make an interpretation. Data collected from 185 respondents and four key informants. The result showed that the policy in private and public hospitals in Indonesia of the physician payment is diverse. Most of the hospitals use the pure FFS for self-employee physicians (part timer employee). For full time employee, they applied FFS mixed with salary, or remuneration. To improve employee satisfaction and performance, the hospitals should make a policy to link the FFS to pay for performances. The hospital should make the tailoring program by involving the physician in a designing method of the hospital remuneration.

Chlorella vulgaris, a unicellular microalgae, produces many intracellular phytochemicals namely carotenoids, tocopherols, ubiquinone and protein. Skin ageing which is induced by oxidative stress involves decreased extracellular matrix synthesis and increased expression of enzymes that degrade the collagenous matrix. The objective of this study was to determine the effect of C. vulgaris on the expression of genes encoded for collagen (COL) and matrix metalloproteinases (MMPs) which are involved in skin ageing. Human diploid fibroblasts (HDFs) were obtained from circumcision foreskin of 8-12 year-old boys. HDFs were cultured into 3 groups: untreated control cells, cells with stress-induced premature senescence (SIPS; cells were induced with H2O2 at passage 6 for 2 weeks) and SIPS treated with C. vulgaris (prolonged C. vulgaris treatment started at passage 4 and combined treatment with H2O2 at passage 6 for 2 weeks). Senescence-associated ß-galactosidase (SA ß-gal) was determined using senescent cells histochemical staining kit (Sigma, USA). Expression of COLI, COLIII, COLIV, MMPI, MMPII and MMPIII genes was quantitatively analysed with real-time RT-PCR method (iScript™ One Step real-time PCR with SYBR® Green; Biorad). HDFs treated with H2O2 (SIPS) exhibited senescent morphological features of flattening and enlarged with increased expression of SA ß-gal (p<0.05). Gene expression analysis showed COLI was downregulated in SIPS and SIPS treated with C. vulgaris (p<0.05) while COLIII decreased in SIPS and increased in SIPS treated with C. vulgaris (p<0.05). Expression of MMPI was increased in SIPS and SIPS treated with C. vulgaris (p<0.05) indicating its synergistic effect with H2O2 treatment. In conclusion, in skin ageing, COLI and COLIII genes were downregulated while MMPI was upregulated. C. vulgaris modulated the expression of COL and MMP genes by downregulating COLI and upregulating COLIII and MMPI but it did not exert anti-ageing effect.

Background: Coaptive film (i.e., Steri-StripsTM) is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. Methods: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film). Results: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. Conclusion: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.

This study was carried out to compare the macronutrient contents in three types of local sweet kuih; kuih seri muka (SM), kuih bakar (B) dan kuih wajik (W) which recipes were developed using calculation according to the Malaysian Food Composition Table (MFCT) and proximate analysis technique. The contents of the macronutrients were identified using proximate analyses while determination of energy and total carbohydrate were based on calculation. Results from proximate analysis showed that W contained significantly higher (p < 0.05) total carbohydrate content (61.5 ± 1.6%) compared to B (39.3 ± 1.5%) and SM (38.7 ± 1.5%). SM contained significantly higher (p < 0.05) of water (46.7 ± 1.6%) compared to B (42.5 ± 6.6%) and W (30.2 ± 0.4%). The protein content in B was 6.1 ± 0.9% and significantly higher than that in W (3.0 ± 0.3%). There were no significant difference of fat content between B (12.8 ± 1.8%), SM (9.9 ± 0.2%) and W (8.2 ± 2.6%). Total calorie for W was the highest (332 kcal/100g), followed by B (299 kcal/100g) and SM (262 kcal/100g). In general, macronutrients content determined based on proximate analyses were lower compared to the calculation method based on MFCT. This was because calculation of macronutrient based on MFCT was based on raw material while the proximate analysis was based on the prepared cooked kuih