Stress modulates pain perception, resulting in either stress-induced analgesia or stress-induced hyperalgesia, as reported in both animal and human studies. The responses to stress include neural, endocrine, and behavioural changes, and built-in coping strategies are in place to address stressors. Peculiar to humans are additional factors that modulate pain that are experienced in times of stress, notably psychological factors that potentially influence the directionality of pain perception.

The fi rst part of this study was about measurement of dosimetric parameters for small photon beams to be used as input data for treatment planning computer system (TPS) and to verify the dose calculated by TPS in Stereotactic Radiosurgery (SRS) procedure. The beam data required were percentage depth dose (PDD), off-axis ratio (OAR) and scattering factor. Small beams of 5 mm to 45 mm diameter from a circular cone collimator in SRS were used for beam data measurements. Measurements were made using pinpoint ionisation chamber (0.016cc). In the second part of this study, we reported the important of carrying out quality assurance (QA) procedures before SRS treatment which were found to infl uence the accuracy of dose delivery. These QA procedures consisted of measurements on the accuracy in target localization and treatment room laser alignment. The calculated TPS dose for treatment was verifi ed using pinpoint ionisation chamber and thermoluminescent detector (TLD) 100H. The deviation mean between measured and calculated dose was -3.28%. The measured dose obtained from pinpoint ionisation chamber is in good agreement with the calculated dose from TPS with deviation mean of 2.17%. In conclusion, pinpoint ionisation chamber gives a better accuracy in dose calculation compared to TLD 100H. The results are acceptable as recommended by International Commission on Radiation Units and Measurements (ICRU) Report No. 50 (1994) that dose delivered to the target volume must be within ± 5% error.
Radiosurgery

Introduction: Diabetes is common among the elderly and can significantly affect their lives including the issues related with social support and diabetic self-care activities. Objectives: The objective of this study was to examine the social support and self-care activities among the elderly patients with diabetes. Methods: A survey involving 200 patients was conducted from March 2013 to May 2013 in three hospitals in Kelantan. Data were obtained through self-administered questionnaires and clinical characteristics were acquired from the patients’ records. Results: The scores for social support (mean = 19.26; SD = 2.63) and self-care activities (mean = 14.83; SD = 4.92) were moderate. Higher social support was associated with high levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS) level, the duration of diabetes and a decrease in body mass index (BMI) (p<0.05). It was observed that the patients with low educational, Hb1Ac and FBS level, with other chronic diseases and who have had diabetes for some time had low self-care activities (p<0.05). There was a significant negative relationship between an increase in social support and decrease in self-care activity (p<0.05). Conclusion: Healthcare providers, family and friends have to strengthen their relationship with the elderly patients with diabetes to provide more social support and promote the compliance with diabetic self-care activities to improve clinical outcomes.

Background: Superselective embolisation has been recognised as integral in the management of lower gastrointestinal haemorrhage. It has also reduced the need for emergency surgery. The objective of this case series was to describe the lower gastrointestinal haemorrhage cases seen in our centre, its diagnosis and the role of superselective embolisation in patient management. Methods: All patients who underwent superselective embolisation from January 2008 until April 2009 in our centre were analysed. Data were collected from the hospital electronic medical records. Results: Four patients (three males) with a mean age of 81 years were analysed. Multidetector computerised tomography and digital subtraction angiography were positive in all patients. Superselective embolisation with platinum microcoils was performed in all patients (n = 4). Technical success was achieved in all patients (100%). Conclusion: Superselective embolisation in the treatment of lower gastrointestinal haemorrhage is safe and effective with a very high technical success rate.

Endovascular treatment of wide-necked aneurysms poses a challenge for the endovascular therapist. The Y-stent–assisted technique has been used for stent-assisted coil embolisation for wide-necked bifurcation aneurysms. This technique has been described for basilar tip aneurysms and middle cerebral artery bifurcation aneurysms using Neuroform and Enterprise stents. We report 2 cases of wide-necked bifurcation aneurysms that were treated with Y-stent–assisted coil embolisation using a new, fully retrievable and detachable intracranial stent (Solitaire ABTM). We describe the advantages of a fully retrievable and detachable stent and its feasibility of forming a Y configuration.

Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.

Aims: This study was designed to determine the virulence genes and antibiotic resistance profiles of Staphylococcus aureus isolated from dogs, cats, chickens and horses. Methodology and results: A total of 15 S. aureus isolates were used in this study. Antibiogram and screening of virulence genes was carried out using disc diffusion method and polymerase chain reaction. The results obtained showed that a total of 9 S. aureus isolates were resistant towards oxacillin (60%), 9 isolates were resistant towards neomycin (60%) and 8 isolates were resistant towards tilmicosin (53%). Resistance to amoxicillin, tetracycline and vancomycin was also observed in 6 (40%) of the isolates. Additionally, 5 (33%) of the isolates showed resistance towards streptomycin and linzolide while 4 (27%) of the isolates were resistant towards rifampin, erythromycin and mupirocin. Lastly, 3 (20%) of the isolates were resistant towards doxycycline. Intermediate resistance to amoxicillin and doxycycline was also observed. Virulence gene profiling showed that 4 (26.7%) of the isolates were positive for hlβ and SspA, 9 of the isolates (60%) showed positive for geh and 12 of the isolates (80%) showed positive for Set-1. Similarly, 2 (13.3%) of the isolates showed positive for etA and Seu while only 1 isolate (6.7%) showed positive for PVL and hlα. None of the isolates were positive for tst-1 and etB. Conclusion, significance and impact of study: This study revealed reduced susceptibility and multiple drug resistance (MDR) in four isolates, and susceptibility to all antibiotics in two isolates in addition to low carriage rate of virulence gene in all isolates. Thus, indicating resistance development in majority of the isolates and the need to regulate indiscriminate use of antibiotics in animals.
Staphylococcus aureus

The present study compared and evaluated the shear bond strength (SBS) of two types of glass ionomer cement (GIC), Riva Self Cure HVTM (SDI Ltd., Victoria, Australia) and GC Fuji IX GP EXTRATM (GC America Inc., Alsip, USA) with and without the use of Riva Bond LCTM (SDI Ltd., Victoria, Australia), a lighted cured resin-modified glass ionomer cement (RMGIC) universal adhesive. Sixty extracted sound premolars with prepared exposure of the dentine on the occlusal surface were randomly assigned into four groups according to the tested restorative materials. Shear bond strength (SBS) tests were performed by using the Shimadzu Universal Testing Machine at a crosshead speed of 0.5 mm/minute, and the values obtained were statistically analysed using one-way ANOVA and Tukey tests. The inter-group comparison showed statistically significant differences in the SBS values between all the test groups (p < 0.001). A stereomicroscope was used to assess the modes of failure. Adhesive failures were predominant in adhesive groups (>80%) compared to higher cohesive failures found in the non-adhesive groups (>86%). A Spearman's rho correlation test performed to determine the association between SBS values and mode of failures had indicated positive correlations between the adhesive failure and SBS values in the adhesive groups (rs=0.86, p<0.001; rs=0.85, p<0.001) and the cohesive failure and SBS values in the non-adhesive groups (rs=0.87, p<0.001). These findings support the improvement in adhesion of GICs to tooth structure with the use of RMGIC adhesive.
Glass Ionomer Cements

Most health advisories related to outdoor physical activity during haze are general in nature. The advisories normally advise everyone to reduce or limit prolonged exertion or heavy exertion without mentioning the acceptable duration for performing outdoor physical activity causing difficulty for public to decide to stop or cancel a particular outdoor or sport event. The aim of this paper is to determine the acceptable duration for performing outdoor physical activity pattern based on API level. Health risk assessment approach that comprises of hazard identification, exposure assessment, dose-response, and risk characterization steps were used to determine the potential inhaled dose and risk associated with performing the physical activity during haze. We have considered many factors that include time spent for physical activity patterns for Malaysian adult, age, physical intensity-specific inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. A hypothetical exposure scenario of PM10 was created using the breakpoints of PM10 concentration for the calculation of respective API levels. The association between physical activity pattern, API level and risk quotient were presented in the form of risk radar diagram. In general, based on the average estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 175 and > 200 respectively. Whereas, based on the high estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 135 and > 150 respectively. Below the said API, the duration for performing prolonged exertion and heavy exertion should be adjusted according to the API level as stated in the recommended maximum duration for performing physical activity. Reducing the physical activity is an effective strategy to lower the dose of inhaled pollutants and reduce the health risk during poor air quality. Based on the assessment, the recommended maximum duration for performing the physical activity based on API level was established as a guide for the authority or public to plan their activity during poor air quality.​

Objectives: Alpha thalassaemia is wide spread in Malaysia and is a public health problem. This study aimed to describe the carrier frequencies of α‒thalassaemia and its distribution among major ethnic groups in three states of Malaysia. Methods: Educational forums were organised and study was explained to students from three schools. Students were invited to take part in the screening with parent consent. A total of 8420 adolescent students aged 16 years volunteered to participate in the study. Peripheral blood samples were analysed for complete blood counts, haemoglobin quantification and typing, and serum ferritin levels. Genomic DNA was used for screening alpha thalassaemia alleles by PCR based molecular methods. Results: We identified seven α‒globin gene defects in 341 (4.08%) students: amongst them α+‒ and α0‒thalassaemias were detected in 232 (2.77%) and 107 (1.28%) students respectively. Genotype ‒α3.7/αα was the most prevalent among sub-populations of Malay, indigenous communities of Sahab and Indian, while ‒‒SEA/αα deletion is more prevalent in Malaysian Chinese. It is estimated that 63 pregnancies annually are at risk of Hb Bart’s hydrops fetalis. Conclusions: We have demonstrated the prevalence and mutation patterns of α‒thalassaemia in the 16 year olds in three states of Malaysia. High α0‒thalassaemia deletions amongst the study subjects place these carriers at an increased risk of conceiving fetuses with HbH disease and Hb Bart’s hydrops fetalis should they choose another heterozygous partner. It is therefore highly recommended to institute community screening programmes and provide prospective carriers with genetic counselling to help them make informed choices.