Introduction: Our objectives are to identify the incidence of hypophosphatemia and the associated risk factors. We also want to establish intravenous replacement therapy that is effective for ICU patients. Methods: A prospective observational study assessing adults admitted to ICU in between March and May 2009. All patients without baseline phosphate level and renal failure were excluded. They were evaluated for the occurrence of common risk factors. Association with independent variables that includes age, gender and BMI were verified. Evaluation of IV replacement therapy was done in the treated patients. Results: From 50 patients that were reviewed, nine were excluded. There were 66% male and 34% female with mean age 46.88±17.89. The mean ICU stay was 8.00±6.41 days. The incidence of hypophosphatemia was 29% (n=12/41). Gender and creatinine clearance was found to be significantly different between normophosphatemia and hypophosphatemia patients. There was no significant association for each potential risk factor and the number of risk factors (≥3) with the incidence of hypophosphatemia. Multi-linear regression analysis showed that lactate, creatinine clearance and pH were significant predictors to the serum levels. A significant difference of mean serum phosphate was seen after repletion by total dose of 10, 20 and 40 mmols in the treatment subgroups. Conclusions: The incidence of hypophosphatemia in our ICU was high and comparable to previous studies. None of the commonly reported risk factors is associated with hypophosphatemia in this studied population. Among all significant correlated variables, only pH was found to be a significant predictor for serum phosphate. Baseline phosphate level may guide the initial replacement dose to prevent delay in normalization of serum levels.

Introduction: Urine output provides a rapid estimate for kidney function, and its use has been incorporated in the diagnosis of acute kidney injury. However, not many studies had validated its use compared to the plasma creatinine. It has been showed that the ideal urine output threshold for prediction of death or the need for dialysis was 0.3 ml/kg/h. We aim to assess this threshold in our local ICU population. Methods: This was a secondary analysis of an observational study done in critically ill patients. Hourly urine output data was collected, and a moving average of 6-hourly urine output was calculated over the first 48 hours of ICU admission. AKIuo was defined if urine output ≤ 0.5 ml/kg/h, and UO0.3 was defined as urine output ≤ 0.3 ml/kg/h. Results: 143 patients were recruited into the study, of these, 87 (61%) had AKIuo, and 52 (36%) had UO0.3. The AUC of AKIuo in predicting death was 0.62 (0.51 to 0.72), and UO0.3 was 0.66 (0.55 to 0.77). There was lower survival in patients with AKIuo and UO0.3 compared to those without (p=0.01, and 0.001, respectively). However, only UO0.3 but not AKIuo independently predicted death (HR 2.44 (1.15 to 5.18). Conclusions: A threshold of 6 hourly urine output of 0.3 ml/kg/h but not 0.5 ml/kg/h independently predictive of death. This support previous finding of a lower threshold of urine output criteria for optimal prediction.

The purpose of this study was to gather information on the oral hygiene behaviour among the visually impaired adolescents. Interview and observation methods were used to collect data. A total of 114 visually impaired adolescents were interviewed and 10 of the interviewees were selected for observation on the actual oral hygiene practices. The mean age of the sample was 16 years old. The sample comprised of 53.5% female, majority were Malays (86.8%) and most of them were from the lower income group. Fifty four percent of the sample had low vision and 45.6% were blind. All of the participants reported that they brushed their teeth daily and most of them brushed twice a day or more. Flossing (6.1%) was not common practice among this group. It was observed that they encountered some difficulties, especially when putting the toothpaste on the toothbrush and also the way that they brushed their teeth could cause detrimental effect to the oral cavity. Thus, they need to be taught on proper oral hygiene care so that they can practice safe oral hygiene care and maintain their own oral health.

Introduction: There is a lack of information on the trans fatty acid (TFA) content in Malaysian foods. The objective of this study is to determine the TFA content of bakery products, snacks, dairy products, fast foods, cooking oils and semisolid fats, and breakfast cereals and Malaysian fast foods. This study also estimated the quantity of each isomer in the foods assayed. Methods: The trans fatty acid content of each food sample was assessed in duplicate by separating the fatty acid methyl esters (FAME) in a gas chromatography system equipped with HP- 88 column (USA: split ratio 10: 1) for cis/trans separation. Five major TFA isomers, palmitoelaidic acid (16: 1t9), petroselaidic acid (18:1t6), elaidic acid (18:1t9), vaccenic acid (18: 1t11) and linoelaidic acid (18:2t9, 12), were measured using gas chromatography (GC) and the data were expressed in unit values of g/100 g lipid or g/100 g food. Results: The total TFA contents in the studied foods were <0.001 g-8.77 g/100 g lipid or <0.001 g-5.79 g/100 g foods. This value falls within the standard and international recommendation level for TFA. The measured range of specific TFA isomers were as follows: palmitoelaidic acid (<0.001 g-0.26 g/100 g lipid), petroselaidic acid (<0.001 g – 3.09 g/100 g lipid), elaidic acid (<0.001 g-0.87 g/100 g lipid), vaccenic acid (<0.001 g-0.41 g/100 g lipid) and linoelaidic acid (<0.001 g-6.60 g/100 g lipid). Conclusion: These data indicate that most of the tested foods have low TFA contents (<1 g/100 g lipid).

This study was aimed at assessing the antioxidant capacity and phenolic (free, bound, and total) contents in selected commercial beverages. Three different types of beverages commonly available in Malaysian supermarkets namely, cocoa, coffee and tea were selected. Phenolic contents were determined using a Folin-Ciocalteu assay. Antioxidant capacity (ferric reducing power and scavenging activity) was determined using FRAP and TEAC assays. Based on analysis of variance, coffee showed the highest amount of free phenolic compounds and antioxidant capacity compared to cocoa and tea (p < 0.05). The major phenolic compound detected in coffee was chlorogenic acid. Cocoa showed higher phenolic content than tea. However, cocoa and tea have similar catechin content and possessed comparable antioxidant capacity. The free phenolic content in the three beverages was found to be highly correlated with antioxidant capacity. In addition, moderate correlation was observed between total phenolic content and antioxidant capacity. On the other hand, there was no significant contribution of bound phenolic compounds towards antioxidant capacity. The contribution of antioxidant capacity in these beverages could be due to phenolic compounds in the free form. The study indicated that the beverages studied possessed varying degrees of antioxidant capacity and phenolic contents.
Antioxidants ; Tea ; commercial ; Coffee ; Assessment: Cognition

This study aimed to investigate the effect of saffron extract and crocin on blood biomarkers associated with obesity using the rat model. Methods: Obesity was induced by feeding a high-fat diet to 42 male Sprague-Dawley rats for 12 weeks, after which they were equally distributed into seven groups. Three groups served as controls namely, normal diet (ND), high-fat diet (HFD), and high-fat diet plus orlistat (HFD + ORL), while the remaining four treatment groups consisted of HFD added low or high dose (40 and 80 mg/kg/day) of either saffron extract or crocin in the food. At the end of 8 weeks, blood samples were collected by cardiac puncture for biochemical analysis. Results: Obese rats treated with a high dose of saffron extract and crocin showed significantly lower plasma glucose levels (5.26 and 5.67 mmol/L respectively) than the HFD rats (6.92 mmol/L). Saffron extract and crocin at a high dose showed significantly lower levels of plasma insulin (3.97 and 3.88 ng/mL respctively) compared to HFD control (5.41 ng/mL). Adiponectin levels significantly increased in obese rats fed saffron extract and crocin at high doses (7.44 and 7.92 µg/mL respectively) compared to HFD control (5.34 µg/mL). Ghrelin level significantly increased from 419.10 to 284.10 pg/mL,while leptin level significantly decreased from 8.08 to 5.68 ng/mL for the high dose crocin groups compared to HFD control. No significant differences in plasma serotonin levels were found among the groups. Conclusion: Saffron extract and crocin show potential in reducing blood biomarkers associated with obesity as well as anti-inflammatory and regulatory potential of adipocytokines in an animal model.

The present study was carried out to determine the concentrations of selected metal elements (lead, copper, manganese, zinc and iron) in 51 samples of commercial drinking water and tap water available in Malaysia. The results indicated that low metal elements were found in the studied water samples. Lead, manganese, zinc and iron were not detected in some of the studied samples, except copper. The concentrations of the metal elements in the studied samples were well below the maximum permitted concentrations as recommended. Therefore these drinking water are safe for consumption and do not pose adverse effect to the health of consumers due to metal toxicity.

Defatted dabai peel contains a high amount of anthocyanin. Anthocyanins are known to prevent several types of disease, including cardiovascular-related complications. This study aimed to describe the effects of different doses of defatted dabai peel extract by histopathological analyses on lesions in the liver, kidney, heart and aorta. Histopathology methods were applied to determine the protective effects of defatted dabai peel extracts against hypercholesterolemia-induced oxidative damages to animal organs. Haematoxylin and eosin staining was applied for histopathology examination for liver, kidney, heart and aorta. Data showed that a high dose of defatted dabai extract (3000 mg per day) applied to hypercholesterolemic rabbits for eight weeks had mild protective effect, especially reducing the severity of hepatic fibrosis and steatosis of the renal medulla. The high dose of extract supplementation also reduced inflammation of aorta and formation of atherosclerosis plaque in the cell wall of right ventricle of the heart. The high dose of defatted dabai peel extract could be a protective agent against oxidative stress.
Anthocyanins

Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort of AKI patients.

This study was designed to examine the nutritional composition, antioxidant activity and medium lethal concentration (LC50 value) of Tamarindus indica L. pulp and seed extracts in vitro. The extraction was set at 40°C, 60°C and 100°C for 12 hours, 6 hours and 15 minutes respectively to determine the optimum extraction parameter whereas the anti-oxidant activity of the extracts was measured using iron (III) reduction (FRAP) assay. Total phenolic content (TPC) of the extracts was estimated as gallic acid equivalent by Folin-Ciocalteau method. Toxicity potential of the extract was assessed in vitro by Artemia salina lethality test both in seed and pulp samples. The results showed that tamarind seed contained a higher percentage of carbohydrate, protein, fat and energy (15%, 82%, 95% and 33.13% respectively) than the pulp. On the other hand, the pulp demonstrated a high moisture (51.1%) and ash (34.84%) content than the seed. For the mineral analysis, tamarind seed contained higher Ca and C (1.0% and 50.73% respectively) than the pulp (0.27% and 40.40% respectively). No heavy metals were detected in both samples. Seed extracted at 60°C/6 hours and 100°C/15 minutes showed the highest TPC value and were significantly different (p<0.05) than the seed extracted at 40°C/12 hours. Anti-oxidant activity is positively correlated to the TPC value of the extracts (R=0.991). The pulp and seed extracted at 100°C/15 minutes showed the highest FRAP value among its groups (216.17 ± 14.06 μmol (Fe)/g and 659.74 ± 16.40 μmol (Fe)/ g respectively). This study indicates that tamarind pulp and seed extracts possess beneficial antioxidant properties and the optimum extraction parameter is 100°C for 15 minutes. In Artemia salina lethality test, tamarind pulp caused significant mortality of the crustacean larvae with LC50 in the range of 26-28 μL/mL. Tamarind seed were not toxic to Artemia salina since the LC50 of the extracts was higher than 1000 μL/mL.