The emergence of fungal species as opportunistic pathogens has warranted further studies on their pathogenicity, epidemiology, and transmissibility. Fungal genotyping has been employed to study the genetic relatedness within the organism, in order to obtain answers to epidemiological questions (such as in outbreak confirmation) as well as to provide basis for the improvement for patients care. Various fungal genotyping methods have been previously published, which can be chosen depending on the intended use and the capability of individual laboratory.

The Laryngeal Mask Airway ProSeal™ (LMA-ProSeal™; Laryngeal Mask Company Limited) is a reusable supraglottic airway device developed to enhance supraglottic airway protection and extend the benefits of the classic LMA (Laryngeal Mask Airway) to greater number of patients. Added features include an additional drain tube to channel fluid away from the airway and a tighter seal against the glottic opening with no increase in mucosal pressure. Clinicians have extended the use of the LMA-ProSeal™ inside and outside the operating theatre including use for difficult airway management and airway rescue. However, even these new devices have their limitations. We report an unforeseen acute airway obstruction caused by LMA-ProSeal™ malfunction during ophthalmic surgery. The cuff of the device was deformed with herniation to one side upon insufflation of the balloon.
Laryngeal Masks ; Equipment Failure ; Complications ; Percutaneous Coronary Intervention ; Stents ; Thrombosis

Cervical Vestibular Evoked Myogenic Potential (cVEMP) is a routine vestibular test which checks the integrity of vestibulocollic reflex (VCR) pathway. Clinically, 500-Hz tone burst is widely used stimulus to evoke a cVEMP. Although several studies have suggested different plateau times (PT) for eliciting cVEMPs, but not many have reported the optimal PT for evoking cVEMP using 500 Hz tone burst stimuli. Therefore, the present study aimed to investigate the effect of PT on cVEMPs elicited by 500 Hz tone burst at 95 dBnHL using four different PT (0, 2, 4 and 10 ms). Thirty healthy adults with normal hearing and vestibular systems participated in this study. Results revealed that the P1 latency was significantly longer for PT 10 ms compared to other PTs. N1 latency was significantly prolonged for long PT of 10 ms compared to PT 2 ms. P2 latency showed no significant differences among PTs. The P1-N1 inter-amplitude values however revealed no significant difference across all PTs. It was found that the P1-N1 inter-amplitude was severely affected after 4 ms of PT. This study concluded that the PT of either 0 or 2 ms yielded the most robust cVEMP.
Vestibular Evoked Myogenic Potentials

Metastatic eyelid tumours are rare and account for less than 2% of all eyelid neoplasms. We report a case of metastatic breast carcinoma to the eyelid in a 60-year-old Chinese lady presenting with a 2-year history of enlarging, painless nodular lower eyelid swelling. The 1 cm diameter lesion was provisionally diagnosed as a sebaceous cyst. However the excision biopsy revealed a mucinous carcinoma expressing oestrogen receptor protein. She had a past history of mastectomy one year previously and histology showed an infiltrating ductal carcinoma (oestrogen receptor status negative) without evidence of axillary lymph node metastasis. She had completed adjuvant radio- and chemotherapy. Further treatment of the current lesion involved a wide excision which did not show any residual malignancy. She had no other evidence of metastasis and was treated with letrozol. We highlight this case to create awareness among clinicians and opthalmologists on the possibility of metastatic disease as a cause of eyelid swelling, especially in patients with a history of cancer. It may also be the first sign of metastatic disease of an internal malignancy. A review of the literature is also presented.
Eyelids ; Metastatic to ; Neoplasm Metastasis ; Carcinoma ; brief historical notes, excludes case histories

ract Various standardised assessment tools have been used to evaluate children with disabilities. However, assessment tools that provide information on the movement and function of children with specific learning disabilities (SLD) are still limited. This article provides a narrative review of the characteristics of five movement and/or function assessment tools. The strengths and limitations of the tools will be highlighted. Empirical studies on the assessment tools used are reviewed based on three criteria: (i) standardised tools; (ii) assessment of movement and/or function; (iii) applicability to children with SLD ranging from 4–17 years of age and widely used in practice. The following instruments have been included as they have been found to fulfil the criteria: (i) the Bruininks-Oseretsky test of motor proficiency-2 (BOT-2); (ii) the movement assessment battery for children-2 (MABC-2); (iii) the pediatric balance scale (PBS); (iv) the Vineland adaptive behaviour scale-II (VABS-II) and (v) the pediatric evaluation of disability inventory-computerised adaptive test (PEDI-CAT). The article presents the characteristics, strengths and limitations of five standardised assessment tools that are currently in use, which measure the movement and/or function of children with SLD. This article concludes with a discussion of recommendations for the best approaches to evaluating the movement and functional abilities of children with SLD.

INTRODUCTIONDiabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors.

METHODSThis cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors.

RESULTSThere were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00).

CONCLUSIONInsulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.

Adult ; Aged ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; epidemiology ; Female ; Follow-Up Studies ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Malaysia ; epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

Background: Traumatic brain injury (TBI) has been associated with an acute stress response mediated by the sympathoadrenomedullary axis, which can be assessed by measuring blood glucose level. Methods: This prospective observational study was conducted for a year in 2007 among 294 patients who had been treated for TBI in Hospital Kuala Lumpur. Patients fulfilling the set criteria were recruited into the study and data, including blood glucose level and Glasgow Outcome Score at 3-month follow-up, were collected. Results: 294 patients were included in the study: 50 females (17.0%) and 244 males (83.0%). The majority of cases were young adult patients (mean age of 34.2 years, SD 13.0). The mean blood glucose level during admission and post-surgery were 6.26 mmol/L (SD 1.30, n = 294) and 6.66 mmol/L (SD 1.44, n = 261), respectively. Specifically, the mean admission glucose level associated with mild TBI was 5.04 mmol/L (SD 0.71); moderate TBI, 5.78 mmol/L (SD 1.02); and severe TBI, 7.04 mmol/L (SD 1.18). The mean admission glucose level associated with a poor outcome in patients with isolated TBI was 6.98 mmol/L (SD 1.21). Patients with admission glucose of 5.56 mmol/L (SD 1.21) were more likely to have a favourable outcome. Conclusion: Mild, moderate, and severe TBI were associated with an increase in blood glucose levels during admission, and the mean increase in glucose levels is based on the severity of the isolated TBI. Surgical intervention did not cause further significant changes in blood glucose levels. Patients with isolated TBI and minimal increases in blood glucose levels were more likely to have a favourable outcome.

Background: Different computational methods have been used for the prediction of X-ray spectra and beam quality in diagnostic radiology. The purpose of this study was to compare X-ray beam qualities based on half-value layers (HVLs) determined through measurements and computational model estimations. Methods: The HVL estimations calculated by IPEM78 (Spectrum Processor of the Institute of Physics and Engineering in Medicine’s Report 78) and SpekCalc software were compared with those determined through measurements. In this study, the HVLs of both Philips (Phil) (Philips Healthcare, Best, NL) and General Electric Company (GE) (GE Global Research, Niskayuna, US) diagnostic range X-ray machines (50 kVp to 125 kVp) were evaluated. Results: In the HVL estimations, SpekCalc and IPEM78 showed maximum differences of 10% and 9%, respectively, compared with direct measurements. Both models provided means and SDs of HVLs that were within 5% of the HVL measurements of GE and Phil machines. Conclusion: Both computational models provide an alternative method for estimating the HVL of diagnostic range X-ray. These models are user-friendly in predicting HVLs, which are used to characterise the quality of the X-ray beam, and these models provide predictions almost instantly compared with experimental measurements.

This study targeted two candidate genes from the best known regulator of blood pressure; the rennin angiotensin system; the ACE gene I/D polymorphism and the angiotensinogen M235T polymorphism. The study aimed to determine the genotypes trend between two different populations; the primary hypertensive patients, and the normal populations. 126 subjects were involved in this study (86 primary hypertensive patients and 40 normal individuals). All demographic factors were considered and analyzed.Insertion/deletion polymorphisms of the ACE gene were determined by an assay based on the polymerase chain reaction (PCR). Polymorphism analysis using PCR-RFLP procedure was used to identify the missense mutation M235T of the AGT gene. All significant data was collected using standardized case report form. The association of the different genotypes and the subjects' condition was analyzed using the chi squared and odds ration analyses. In the pooled analysis of both groups, it was shown that the polymorphisms in these genes were significantly associated with the incidence of primary hypertension, p<0.05. Results also showed that the D allele of the ACE gene may be associated with increased risk of primary hypertension (p<0.05,O.R:3.0[C.I: 1.25-5.35]). The angiotensinogen M235T polymorphism also showed a significant result; the T allele is associated with increased risk of primary hypertension (p<0.05,O.R:2.56[C.I: 1.55-5.28]). This knowledge of the candidate genes of rennin angiotensin system has rendered it possible to show that gene polymorphism in symphony leads to the individual risk of primary hypertension

Low levels of serum 25(OH)D in women are reported in temperate countries, and increasingly so in tropical countries but few such studies have been reported in Indonesia. This study was aimed at assessing the serum vitamin D status and its associated factors in a sample of Indonesian women Methods: A cross-sectional study was conducted on 156 apparently healthy women during the dry season in North Sumatera. The measurements carried out included exposure to sun's rays, intake of vitamin D food sources, reported physical activity, body fatness (by bioelectrical impedance analysis), and serum 25(OH)D levels (by chemiluminescent immunoassay). Serum 25(OH)D levels were categorised into: deficient(<20 ng/mL), insufficient (20-32 ng/mL), sufficient (32-100 ng/ mL), and normal for tropical countries (54-90 ng/mL). Statistical analysis included Pearson correlation, independent t-test, and one way ANOVA tests. Results: The mean age of the subjects was 35.6±7.7 years, with about 70% working indoors. About half of the women were obese. The majority had low vitamin D intake. More than half had sun ray exposure of less than 1 hour, and moreover, nearly two-thirds of them wore the 'hijab' that covers most parts of their body. The majority of women reported low physical activity level. The mean serum 25(OH)D level of the subjects was 17.71 ng/mL (95% CI: 16.22, 19.34 ng/mL). Of the total, 95% (148) were in the vitamin D deficient-insufficient category, with the remaining 5% in the sufficient category. An association was found between occupation, dietary intake of vitamin D, sun ray exposure, and physical activity levels with serum vitamin D concentrations. Conclusion: The results showed that vitamin D deficiency can occur in women living in a tropical country if they have sun-avoiding lifestyles, work indoors, and have low dietary intake of vitamin D.
Vitamin D ; Women ; Indonesia