Introduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Twenty four male Sprague Dawley rats were allocated into eight groups of three rats (n = 3): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined at 8 and 48 hours post insemination and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and p-value<0.05 was considered significant. Results: Administration of AM leave extract at 100 mg/kg/day to normal rats and CP-exposed rats has significantly increased (p<0.05) the fertilization rate, early cleavage rate and embryo quality when compared to CP only treated group. However, other groups showed no significant differences. Conclusion: Overall, the present results indicate the potential of AM leave extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals.

Objective: To describe a quick and simple diagnostic approach to monocular diplopia. Background: Diplopia is a common visual complain in casualty departments, general practice clinics, neurologic clinics as well as ophthalmic clinics. Monocular diplopia, however, is uncommon. Many well established clinical examination methods are available to address diplopia. Some require special equipments which are not easily available or unfamiliar outside of ophthalmic clinic. We describe a simple two-minute diagnostic approach to monocular diplopia. Conclusion: Basic knowledge and understanding of simple clinical examination techniques enhances diagnostic skill and allow proper localization of underlying disorders.

We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
*Accidents ; *Child Abuse ; Drowning/*etiology ; Nurseries/legislation & jurisprudence ; Singapore

Musca domestica Linnaeus or house fly is one of the well-known cosmopolitan pests. Poultry farms, horse stables and ranches are some of the main habitats for house flies to extend their interference and disturbance. Since 1999, large number of fly population around horse stables and barns in Terengganu Equestrian Resort (TER) was detected and still persists till today. Imported horse food are speculated to be the main cause for the increasing number of these flies. The current study was conducted to determine the effect of imported horse food (i.e. chaff, pallet and alfalfa) and the food conditions (wet and dry) on house fly population densities. Commercial sticky papers were used for trapping house fly distribution around the horse stables and barns in TER from October 2013 to January 2014. A total of 36,751 flies were caught during the eight week study period. The highest number of flies (2,843 individuals) was caught when using ‘wet alfalfa + chaff’ whereas the lowest catch was when using ‘dry alfalfa’ (1,652 individuals). Generally, the wet food treatments captured higher flies compared to dry food treatments. The total number of captured flies was found to be influenced by relative humidity. Higher mean number of flies was captured during lower weekly humidity. Our findings conclude that the wet condition of imported horse food in TER increases the house flies population densities. Thus, urgent action should be taken as soon as possible and may need special management considerations in order to reduce the impact of house flies on the horse industry in Malaysia.

Objective: To investigate the toxicity of indigenous Bacillus thuringiensis (B. thuringiensis) isolates from Malang City for controlling Aedes aegypti (Ae. aegypti) larvae. Methods: Soil samples were taken from Purwantoro and Sawojajar sub-districts. Bacterial isolation was performed using B. thuringiensis selective media. Phenotypic characteristics of the isolates were obtained with the simple matching method. The growth and prevalence of spores were determined by the Total Plate Count method, and toxicity tests were also performed on the third instar larval stage of Ae. aegypti. The percentage of larval mortality was analysed using probit regression. The LC50 was analysed by ANOVA, and the Tukey HSD interval was 95%. Results:Among the 33 selected bacterial isolates, six were obtained (PWR4-31, PWR4-32, SWJ4-2b, SWJ4-4b, SWJ-4k and SWJ5-1) that had a similar phenotype to reference B. thuringiensis. Based on the dendrogram, all of the bacterial isolates were 71%similar. Three isolates that had a higher prevalence of reference B. thuringiensis were PWR4-32, SWJ4-4b and SW5-1, of which the spore prevalence was 52.44%, 23.59%, 34.46%, respectively. These three indigenous isolates from Malang City successfully killed Ae. aegypti larvae. The PWR4-32 isolates were the most effective at killing the larvae. Conclusions:Six indigenous B. thuringiensis isolates among the 33 bacterial isolates found in the Sawojajar and Purwantoro sub-districts were toxic to the third instar larvae of Ae. aegypti. The PWR4-32 isolates were identical to the reference B. thuringiensis and had 88%phenotype similarity. The PWR4-32 isolates had the highest spore prevalence (52.44%), and the early stationary phase occurred at 36 h. The PWR4-32 isolates were the most effective at killing Ae. aegypti larvae (LC50-72 h=2.3í108 cells/mL).

The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.

Central corneal thickness plays a major role in the management of many types of glaucoma. Therefore, our aim is to determine the relationship between the severity of glaucoma measured by optical coherence tomography (OCT) and central corneal thickness (CCT) among normal tension and high tension glaucoma patients. This is an observational cross sectional study on 190 patients carried out in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Three groups of patients were identified; 60 normal tension glaucoma (NTG), 61 primary open angle glaucoma (POAG) and 69 control. Patients were identified based on the glaucomatous visual field changes and previous record of intraocular pressure before treatment. Visual acuity and intraocular pressure measurements were recorded. Specular microscope was used to measure the CCT and the severity of glaucoma was evaluated objectively based on the retinal nerve fibre layer (RNFL) thickness using optical coherence tomography. Results showed NTG patients had significantly thinner cornea, 503.07±32.27μm compared to the control group, 517.45±31.74 μm (p=0.012). However, there was no significant difference between the CCT of POAG and NTG groups (p=0.386).Retinal nerve fibre layer (RNFL) thickness was significantly different between the glaucoma and the control groups (p<0.05 in all quadrant). However, correlation between CCT and severity of RNFL thinning was only found for the POAG group but not for the NTG group. (mean RNFL and superior quadrant RNFL; r=0.251,0.401) . This study demonstrated the correlation between CCT and severity of glaucoma in POAG patients but not for the NTG group. Therefore, CCT is related to the severity of POAG-related visual loss.

Clonal disorders of LGL may either be CD3+ CD56- or CD3- CD56+ phenotype and these have been designated as T-cell leukaemia (T-LGL) or natural killer cell (NK)-LGL leukaemia respectively. Clonality is usually demonstrated by clonal rearrangement of T-cell receptor gene rearrangement or identified by flowcytometry analysis. Most patients with T-LGL will have an indolent course. In this report we described an aggressiveness of disease in a patient with clonal CD3+ LGL leukaemia whose cells also co-expressed CD56 diagnosed by flowcytometry. The patient responded well to interrupt ALL standard risk protocol however succumbed to her disease while waiting for upfront stem cell transplant. This case highlights on both the classical laboratory findings of rare entity of disease as well as a review of the literature pertaining particularly on its management.

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.