The aim of this study was to determine the genotoxicity of a locally produced nanocomposite by Universiti Sains Malaysia, Malaysia using Comet assay. Stem cells from human exfoliated deciduous teeth (SHED) were treated with the nanocomposite at five different concentrations (0.006, 0.0125, 0.025, 0.05, and 0.1 mg/ml) along with concurrent negative (medium alone) and positive control (zinc sulfate heptahydrate) and incubated at 37°C for 24 hours in an incubator at 5% CO2. The tail moment was used to assess the extent of DNA damage. The tail moment for the group of SHED treated with nanocomposite (for all the five different concentrations) was not statistically significant as compared to the negative control, suggesting that the locally produced dental nanocomposite did not induce any DNA damage. Hence, it can be concluded that the locally produced nanocomposite is non-genotoxic on stem cells from human exfoliated deciduous teeth.

To investigate some morphological and molecular characteristics of fungal parasites isolated from wild tropical bed bug, Cimex hemipterus. Methods: A series of culture methods were used to obtain fungal isolates from field-collected bed bugs. Characteristics of the isolates such as colony appearance, mycelial texture and pigmentation were studied to explore their morphology. Isolates were also subjected to a PCR-based genotyping test. Results: There were noticeable differences in morphological characteristics among the four isolates. Conidial areas of one isolate were dark green, whereas those of the remaining colonies were olive-green, black or dark brown. Conidia of the dark green isolate were globose, while those of olive-green, black and dark brown isolates were globose to subglobose, globose to spherical and globose to subglobose/finely roughened, respectively. These morphological specificities and the molecular analyses showed that the fungal internal transcribed spacer ribosomal region and β-tubulin gene sequences of the isolates shared clade with Trichoderma and Aspergillus sequences. Conclusions: Overall, the new discovery of common pathogens in agricultural field developed in live bed bugs storage tank may initiate the use of biological agents in later years.

Worldwide maternal mortality rate had reduced tremendously including Malaysia. At the 2000 Millenium Summit, eight Millenium Development Goals (MDGs) were established with target for the year 2015. Three years remained until the dateline to achieve MDG5, which comprised of two targets and one being reducing the maternal mortality ratio by 75%. This review compared the trend of maternal mortality and its causes in our centre to the national data. The national data had shown a reduction from 44 to 27.6 in 100 000 live births in1991 and 2008 respectively. The subsequent rate had stabilized for the past seven years. In contrast the UKM Medical Centre (UKMMC) data in the past 15 years had not been stable. The target of MDG5 seemed to be achievable by our country but may require longer time as we have yet to find ways to overcome medical care inadequacy in remote areas.

Introduction: Attention Deficit Hyperactivity Disorder(ADHD) and Tourrete Syndrome(TS) commonly co-occur, imposing a special challenge in the management. Case report: This is a case of a nine year old boy with ADHD and TS, who had been on methylphenidate, risperidone, fluvoxamine and atomoxetine, alone and in combination. Tics worsened with methylphenidate but improved after its withdrawal, and the addition of risperidone and fluvoxamine. Later, atomoxetine was added which worsened the tics, even when it was removed. Significant improvement in the tics were only obvious when fluvoxamine was taken off. Discussion: The possible roles of dopamine and serotonin neurotransmission, and metabolism of cytochrome P450 D26 in the pathophysiology were discussed. Conclusion: The use of multiple medications need cautious consideration and monitoring in a child patient to avoid unwanted complications and risks.
Attention Deficit Disorder with Hyperactivity

Symptomatic bronchial artery aneurysm warrants urgent intervention. It has a known association with pulmonary infection caused by Staphylococcus aureus. We hereby report an elderly lady with a ruptured left superior bronchial artery mycotic aneurysm. She was in the early stages of treatment for a left lung abscess. She had multiple episodes of haemoptysis following which she underwent a left lower lobectomy. Presentation of lung abscess with a concurrent ruptured mycotic aneurysm warrants early surgical intervention and can be curative as seen in this case.
Staphylococcus aureus

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication. KEY WORDS: Microtia; canal atresia; cochleovestibular nerve aplasia; inner ear anomaly
Congenital Microtia

Introduction: Microbial keratitis is one of the most challenging complications of contact lens (CL) wear. Proper CL practice plays an important role to reduce the risk for contact lens related microbial keratitis (CLRMK). Methods: This multi-centre case-control study was conducted from January 2008 until June 2009 to determine the risk factors associated with CLRMK. Cases were defined as respondents who were treated for CLRMK, whilst controls were respondents who were contact lens wearers without microbial keratitis. Ninety four cases were compared to 94 controls to determine the risk factors for CLRMK. Results: The predictors for CLRMK were: Not washing hands with soap before handling CL (aOR 2.979, CI 1.020, 8.701 p=0.046), not performing rubbing technique whilst cleaning the CL (aOR 3.006, CI 1.198, 7.538 p=0.019) and, not cleaning the lens case with multipurpose solution daily (aOR 3.242 CI 1.463, 7.186 p=0.004). Sleeping overnight with the CL in the eye (aOR 2.864, CI 0.978, 8.386 p=0.049) and overall non-compliance with lens care procedures (aOR 2.590, CI 1.003, 6.689 p=0.049) contributed significantly to CLRMK. Conclusion: Health education and promotion in contact lens care are important and should be conducted by eye care practitioners to reduce the occurrence of CLRMK.
Contact Lenses

Introduction: A hospital based case control study was conducted in government hospitals on contact lens patients diagnosed with microbial keratitis. Methods: The objective of this study is to determine the visual outcomes of contact lens related microbial keratitis. The visual outcomes which comprised of visual acuity, keratometry readings, corneal topography findings and contrast sensitivity examinations was determined after three months from the first presentation at the hospitals. Results: The mean LogMAR visual acuity during presentation was 0.96 ± 0.73 or a Snellen equivalent 6/60 (n=76) and mean LogMAR visual acuity after three months was 0.10 ± 0.48 or a Snellen equivalent 6/7.5 (n=76) with a significant difference (t=11.22, df=78, p=0.001). Best fit curve for the cases had a regression coefficient, r=0.350 ± 0.063 (95% CI = 0.224, 0.447, df=78, p=0.001. The visual acuity in cases and controls was 0.10 ± 0.48 and -0.10 ± 0.14 respectively (t= -3.61, df=154 p=0.001) after three months which showed improvement. There was a reduction in the corneal uniformity index and corneal asphericity in the cases. The Corneal Uniformity Index (CU index) in cases was 63.03 ± 26.38 (n=76) and in controls, 80.13 ± 11.30 (n=77), (t= -5.22, df=151, p=0.001). There was also a reduction in the contrast sensitivity function at all spatial frequencies in the cases which was significantly different. Conclusion: Microbial keratitis reduced the vision, corneal uniformity index, asphericity and contrast sensitivity after three months in eyes of patients diagnosed with the condition.
Keratitis ; Eye

Background: Medical training is often regarded as a stressful period. Studies have previously found that 21.6%–50% of medical students experience significant psychological distress. The present study compared the prevalence and levels of psychological distress between 2 cohorts of first-year medical students that underwent different admission selection processes. Methods: A comparative cross-sectional study was conducted by comparing 2 cohorts of first-year medical students; 1 group (cohort 1) was selected based purely on academic merit (2008/2009 cohort) and the other group (cohort 2) was selected based on academic merit, psychometric assessment, and interview performance (2009/2010 cohort). Their distress levels were measured by the General Health Questionnaire, and scores higher than 3 were considered indicative of significant psychological distress. Results: The prevalence (P = 0.003) and levels (P = 0.001) of psychological distress were significantly different between the 2 cohorts. Cohort 1 had 1.2–3.3 times higher risk of developing psychological distress compared to cohort 2 (P = 0.007). Conclusion: Cohort 2 had better psychological health than cohort 1 and was less likely to develop psychological distress. This study provided evidence of a potential benefit of multimodal student selection based on academic merit, psychometric assessment, and interview performance. This selection process might identify medical students who will maintain better psychological health.

Nosocomial blood stream infection (or nosocomial bacteremia) is a common problem in hospitals worldwide, including Malaysia. A three-year prospective cohort study (October 2003-March 2007) of the incidences, risk factors, and patterns of the microorganisms causing bacteremia was conducted using a validated surveillance form in three intensive care units (ICUs) in Malaysia. Center for Disease Control criteria were used to diagnose bacteremia. Patients were monitored from admission until the end point of study, which was the first detection of bacteremia in the blood in each patient. The frequency of occurrence of bacteremia with clinical symptoms was 10.7% (n = 23). Bacteremia was observed to occur within a mean length of stay of 10 days in ICU. The rate of device-related infection was 10.4% per device utilization days with a device utilization rate of 95.9%/1000 patient days. The total number of patient days was 2309 and the period of device utilization was 2211 days. The common bacteria detected were extended-spectrum beta-lactamases (ESBLs) Klebsiella pneumoniae (n = 6); Pseudomonas aeruginosa (n = 6); Acinetobacter species (n = 5); Methicillin-resistant Staphylococcus aureus (MRSA)(n = 3); and (non- ESBL) Klebsiella pneumoniae (n = 2). Multivariable analysis using Cox Proportional Hazard Model showed that the predictors for developing bacteremia were cancer, MRSA carriage, duration of central venous catheter (CVC) infusion, frequency change of CVC, and the administration of hydrocortisone drugs. These results indicate that a combination of nursing and medical interventions as well as patients' severity of illness could lead to bacteremia in ICU. Strategic implementation of quality assurance measures in ICUs could help to control this problem.