Introduction: Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. Objective: To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. Methods: We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14– 57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. Conclusion: The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

Objective: Contrast-enhanced ultrasound has become increasingly utilised as an alternative imaging modality for the diagnosis of vesicoureteric reflux (VUR) in paediatric patients. The study objective is to evaluate the efficacy of contrast enhanced Voiding Urosonography (ce-VUS) compared with fluoroscopic micturating cystourethrography (MCU) in the detection of VUR. Methods: This prospective study was carried out between July 2011 and January 2013 on paediatric patients who underwent MCU. All consented patients would undergo ceVUS prior to MCU. We documented the epidemiology details, the number of Kidney-Ureter (K-U) unit studied, baseline renal and bladder sonogram, as well as presence of VUR on ce-VUR. The technique for ce-VUS was standardized using normal saline to fill the bladder prior to administration of SonoVue® (2.5 ml) to assess the kidney-ureter (K-U) unit. Dedicated contrast detection software was used to discern the presence of microbubbles in the pelvicaliceal system (PCS). The findings were then compared with MCU. Results: 27 paediatric patients were involved in the study [17 males (63%) and 10 females (37%)] involving 55 K-U units (one patient had a complete duplex system). MCU detected VUR in 10 K-U units while ce-VUS detected VUR in 8 out of the 10 K-U units. There were 2 false negative cases (both Grade 1) with ce-VUS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ce-VUS were 80%, 98%, 95%, 89% and 96%, respectively. Conclusion: ce-VUS is a sensitive and specific radiation-free alternative for the detection of VUR in the paediatric population.
Urinary Tract Infections

A study on the isolation and identification of bacterial flora from hot spring was carried out using water from Bentong hot spring in Pahang. In general most of the bacteria identified from the hot springs were from Bacillus sp. This was due to its ability to adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria other than Bacillus that were able to survive in hot springs. Three hot spring pools were identified (A,B and C) with temperatures ranging from 36°C to 52°C and pH values between 7.88-8.65. This study has succesfully isolated two species of Gram positive cocci and three species of Gram negative bacilli. The two Gram positives were Streptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were unidentified and were denoted as X, XI and XII.

A 36-year-old lady presented with four episodes of right sided pneumothorax during pregnancy requiring multiple chest drain insertion. It was complicated with persistent air leak despite low pressure high volume suction applied to the chest drainage. She delivered safely through spontaneous vaginal delivery with chest drainage. Further imaging by high resolution computed tomography (HRCT) scan of thorax done revealed bilateral scattered pulmonary cysts and sub pleural bullae and was later followed up with respiratory unit. She had no further episodes of pneumothorax postpartum. This case highlights the vital importance of prompt recognition and management of pneumothorax in pregnancy as the patient involved is at higher risk for acute respiratory failure leading to maternal and/or foetal mortality. It is essential for early involvement of obstetric team and to expedite the delivery for a better perinatal and maternal outcome.
Pneumothorax ; Pregnancy

This study was conducted to determine the prevalence of bacterial vaginosis among women of age 20 to 59 years at Sarawak General Hospital by examining the conventional Pap smear. The prevalence of this infection was studied among the five main ethnic groups comprising the Iban, Chinese, Malay, Bidayuh and Orang Ulu. Microscopic screening of 300 conventional Pap smears which had been processed and stained with the Papanicolaou staining method was conducted. Based on the information provided in the Pap smear screening form, the clinical manifestations were observed which may provide some indications on the type of infection. The details of the clinical manifestations were very important because in an infection or inflammation, Pap smears would usually demonstrate changes on the cyto-morphology of the epithelial cells. The age factor among the different ethnics also played important role in the assessment of the infection frequency. Bacterial vaginosis was detected in 79.7% (239/300) of cases. The infection occurred in all ethnic groups and the infections were more frequently seen among the 20 to 39 years age group. Majority of the cases (93.9%) presented with clinical signs and symptoms. The results of this study revealed the importance of undergoing a Pap smear screening for bacterial vaginosis detection besides screening for the early detection of cervical cancer

This study was conducted to determine the prevalence of candidiasis among women of 20 to 59 years of age at Sarawak General Hospital by examining the conventional Pap smear. The prevalence of this infection was studied among the five main ethnic groups comprising of Iban, Chinese, Malay, Bidayuh and Orang Ulu. Microscopic screening of 300 conventional Pap smears which had been processed and stained with the Papanicolaou staining method was conducted. Based on the information provided in the Pap smear screening form, the clinical manifestations were observed which may provide some indications on the type of infection. The details of the clinical manifestations were very important because in an infection or inflammation, Pap smears would usually demonstrate the cyto-morphological changes of the epithelial cells. The age factor among the different ethnics also plays important role in the assessment of the infection frequency. Candida sp. was detected in 12.7% of the specimens. The infection occurred in all ethnic groups as well as in all age groups. All cases presented with clinical signs and symptoms. The results of this study revealed the importance of undergoing Pap smear screening for candidiasis detection besides screening for the early detection of cervical cancer

Loss of teeth can affect masticatory efficiency in older adults. This may result in avoidance or modifications in foodchoices and lead to lower intake of important nutrients among older individuals. The aim of this study was to determinethe association between tooth loss and body mass index, BMI, among older adults in Kuala Pilah, Negeri Sembilan. Across-sectional study was carried out on 428 older adults aged 50 years and above from selected villages in district ofKuala Pilah. Respondents were interviewed to collect information on their demographic characteristics. Number of toothloss was determined through oral assessment, followed by anthropometric assessment to calculate the BMI of respondents.Findings showed that majority of the respondents were overweight and obese, 40.4% and 19.9% respectively, while onlya small proportion was underweight, 3.9%. The proportion of edentulism (total tooth loss) was 18.3% and majority ofthe older adults had lost more than 12 teeth (77.1%) and less than 4 pairs of occluding posterior teeth (86.0%). Totaland partial tooth loss was found to be not significantly associated with BMI. In relation to the arrangement of teeth,older adults with reduced number of posterior occluding pairs of teeth were more likely to experience unsatisfactoryBMI (OR = 3.61, 95% CI: 1.48, 8.76). This may suggest that functional arrangement of the tooth in the oral cavity is moreimportant than the number of tooth loss alone. Thus, maintaining an optimum number of teeth for chewing is essentialfor maintenance of ideal BMI.

A study on the isolation and identification of bacterial flora from hot spring was carried out from Bentong hot springwater, Pahang. In general, many of the bacteria identified from the hot spring were from Bacillus sp. due to its abilityto adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria otherthan Bacillus sp. that were able to survive this hot spring. Three hot spring pools were identified as A, B and C. Thetemperatures were ranging from 36°C to 52°C and their pH values were between 7.88-8.65. The result shows thattwo species of Gram positive cocci and three species of Gram negatives were isolated. The two Gram positives wereStreptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were identified as Pseudomonas sp.,Klebsiella sp. and Proteus sp. In conclusion, non-sporulating species of bacteria other than Bacillus sp. have adaptedto survive in hot spring

Epigallocatechin-3-gallate (EGCG) is a naturally derived compound from green tea with high antioxidant activity and various anti-cancer properties. EGCG has been widely investigated worldwide. However, effects of EGCG on cell cycle of K562 have not been clearly stated elsewhere. This study was conducted with the aim to investigate the antiproliferative effect of EGCG on K562 human leukemic cells and its underlying mechanism of action on the cells. MTT assay was conducted to determine cytotoxicity effect of EGCG on the K562 cells. Meanwhile, cell cycle analysis and DNA damage on the cells were determined by Flow cytometry and Comet assay respectively. K562 cells were treated with EGCG at concentrations ranging from 0 to 100µg/ml for 48 hours. The results showed that EGCG effectively decreased the percentage of cell viability in a dose dependent manner. The IC10, IC25 and IC50 of EGCG on K562 cell lines were 5 ± 2.44 µg/mL, 10 ± 5.93 µg/mL and 50 ± 1.93 µg/mL, respectively. In cell cycle assay, EGCG has shown no significant effect (p>0.05) on the cell cycle of K562 cell line as compared to negative control, whereas Imatinib mesylate as the positive control showed cell cycle arrest at S phase in this cell line. Hence, EGCG can be verified as a non-cell cycle specific compound. In addition, EGCG was found to cause a significant increase (p<0.05) in tail moment value and percentage of DNA tail in K562 cell line, suggesting DNA damage as an early signal of EGCG induced cell cytotoxicity. In conclusion, by decreasing the cell viability and inducing DNA damage, EGCG showed promising potential as an alternative treatment for leukemia through non-cell cycle specific pathway and further investigation on other mechanisms of action of EGCG on the cells is recommended.

Introduction: Patient health can be influenced by indoor air quality (IAQ) level, where the risks of IAQ pollution are proportionate with the occupant number in the clinic. This research aims to determine the level of IAQ in Medical Clinic 1 and 2 of University Hospital in Klang Valley, Malaysia. Methods: The indoor exposure to physical (temperature, relative humidity and air movement), chemical (formaldehyde, CO2 , CO, TVOC and PM10) and biological (bacterial and fungal count) parameters following Industry Code of Practice (ICOP) IAQ (2010) were assessed in the morning and afternoon using relevant equipment. Data was analysed with One-Sample T Test and Independent T Test using SPSS Version 25. Results: No statistically significant mean difference (p>0.05) of IAQ parameters between both Medical Clinics (morning & afternoon) except for Rh and CO by Independent T Test analysis. In contrast, the One-Sample T Test showed there was statistically significant mean difference (p<0.01) of all parameters as compared to the ICOP (2010) standard in both Medical Clinics (morning and afternoon). There was a positive correlation of CO2 , CO and formaldehyde with bacterial counts (TBC) for both Medical Clinics. Meanwhile, CH2 O concentration was slightly higher in the morning due to the usage of cleaning products which may have released CH2 O gas killing the bacteria, thus lower the rate of bacterial growth in the afternoon. Fungal counts showed no significant impact. Conclusion: All measured parameters were complied with the ICOP (2010) standard except air movement and CO2 in both Medical Clinics.