Background: and Purpose New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only. Methods: We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Results: Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low-certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD -0.7%, 95% CI -3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI -0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only. Conclusion Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.

As the number of COVID-19-related infections and deaths increased exponentially in the during 2020, few countries were equipped to manage and curb this novel coronavirus. Initially there was no proven cure or vaccine to this novel virus (SARS-Cov-2), leaving the authorities with no choice but to impose quarantines at the short-term expense of their economies. As we gain more knowledge on this novel virus, the tried-and-tested method of selective testing of the symptomatic patients, used successfully in almost all infectious respiratory diseases, has been replaced with traceand-test method, as most of the infected patients remained asymptomatic. In early 2021, the availability of vaccines provided a shed of light out from this pandemic. Nevertheless, we faced an enormous task in juggling between vaccination of the population, managing patients with COVID-19 infection as well as non-COVID-19 patients. Here, we share our experience and response in managing this healthcare crisis across a two-year period during the pandemic and we hope other centres can learn from what we went through and help them derive a protocol to navigate through a future pandemic.

Introduction: Cerebral palsy is a group of early childhood chronic mobility disorders. Parenting a child with cerebral palsy is often challenging, especially for mothers. This research aimed to identify the determinants of the psychological states of mothers of children with cerebral palsy in Bangladesh. Methods: A cross-sectional study was conducted from December 2019 to February 2020. A total of 344 mothers of children with cerebral palsy was recruited using a simple random sampling technique and guided questionnaires. The data were analysed using the Chi-square test and logistic regression models. Results: The overall response rate was 98.29%. The median (IQR) age of respondents and the children with cerebral palsy were 30 (13) and 6 (6), respectively. The proportions of mothers with good knowledge on cerebral palsy and having higher negative family impact were 57.8% and 41.9%, respectively. Fifty-nine per cent of mothers of children with cerebral palsy had higher levels of maternal psychological stress. The predictors of maternal psychological stress were the mother’s age, marital status, types of family, family income, age of children, gender, and higher levels of the negative maternal appraisal. Conclusions: Mothers of children with cerebral palsy in Bangladesh had a higher level of maternal psychological stress. The factors identified in this study could help to develop policies and strategies to minimise maternal psychological stress associated with parenting children with cerebral palsy in Bangladeshi households.

Mosquitoes are undesirable arthropods transmitting many diseases not only in Saudi Arabia but also worldwide. Identifying mosquito species relied for long time on both larval and adult characters whilst little or no attention was given to eggs. Electron microscopic studies of mosquito eggs are important as it is not only characterizing the external morphology of the eggs never seen by stereoscopic microscopes but also facilitates mosquito species identification. Accordingly, morphology and morphometric of Culex pipiens eggs collected from Al-Ahsa oasis, eastern Saudi Arabia were examined by scanning electron microscopy (SEM) for the first time in Saudi Arabia in the present work. Mosquito egg rafts were collected from breeding sites in Al-Ahsa by using of special long aquatic net. A portion of the rafts was reared for identification whilst the other portion was preserved in glutaraldehyde and prepared for SEM examination. Eggs appeared to be conical in shape with two ends, the anterior one that is represented with the micropyle is more tapered than the posterior end. The morphometrics gave many characteristics for the eggs such as length, width, proportion of length /width and so on. Eggs morphology and morphometrics were then compared to that of other Culex eggs. Our findings using SEM of the eggshell confirmed that the present mosquito species is Cx. pipiens. Scanning electron micrographs of any mosquito species eggs are valuable in correlating its fine structure that cannot be easily seen by light microscope and can assist in species separation. Thus, identifying medically important mosquito species is crucial in both mosquito and disease control.

OBJECTIVES: Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. METHODS: Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. RESULTS: There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. CONCLUSION: EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.
Ameloblastoma ; Cheek ; Endoscopy ; Fibroma, Ossifying ; Follow-Up Studies ; Humans ; Hypesthesia ; Lacrimal Apparatus Diseases ; Lip ; Maxillary Sinus Neoplasms ; Maxillary Sinus ; Medical Records ; Papilloma, Inverted ; Postoperative Complications ; Recurrence

PURPOSE: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. METHODS: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. RESULTS: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. CONCLUSION SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.

This study aimedto evaluate the coronal microleakage of different thickness of different restorative materials (glass ionomer cement (GIC, GC Gold Label 2), composite restoration (SDR, Dentsply Sirona) and (Filtek Z350 XT, 3M ESPE)) used as final restoration in endodontically treated teeth. 72 sound maxillary incisors were used. Following instrumentation, all canals were obturated with gutta-percha (Dentsply Maillefer) and Roth sealer (Roth International Ltd). After 2mm of gutta-percha removal below cemento-enamel junction, the crown was cut until length of 6mm from the gutta-percha to the incisal edge was achieved. The teeth were divided into four experimental groups (n=18) and access restorations were placed in different thickness combinations. Group 1 (G1): 2mm SDR + 4mm Filtek; Group 2 (G2): 4mm SDR + 2mm Filtek; Group 3 (G3): 2mm GIC + 2mm SDR + 2mm Filtek; Group 4 G4): 6mm SDR. All samples were thermocycled (500 thermal cycles between 5o and 55oC and dwell time of 30s), coated with nail varnish leaving 1mm margin around the filling material, immersed in 2% Rhodamine B solution and sectioned longitudinally. The dye penetration was observed under a stereomicroscope (Olympus SZX7) with 1.25x magnification. The data were analysed using Kolmogorov-Smirnov test, ANOVA test and post-hoc Tukey’s HSD test.There was significant difference of microleakage among all groups. G1 showed least microleakage but with no significant difference between G1 and G3 (p=0.513) and G1 and G4 (p=0.477). G2 showed significant microleakage compared to G1, G3 and G4 (p<0.05). In conclusion, sandwich technique between SDR and Filtek reduces microleakage in which the combination of 2mm SDR with 4mm Filtek in G1 had the least microleakage but with additional 2mm of GIC in G3 further reduces the microleakage.

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.

Consumption of iced beverages is common in Malaysia although specific research focusing on its safety parameters such as presence of faecal coliforms and heavy metal elements remains scarce. A study conducted in Kelantan indicated that faecal coliforms were detected in the majority of the ice cube samples analyzed, largely attributable to improper handling. Hence, it was found pertinent to conduct similar study in other parts of the country such as Johor Bahru if the similar pattern prevailed. Therefore, this present crosssectional study which randomly sampled ice cubes from 30 permanent food outlets in Taman Universiti, Johor Bahru for detecting contamination by faecal coliforms and selected heavy metal elements (lead, copper, manganese and zinc) acquires significance. Faecal coliforms were detected in 11 (36.67%) of the samples, ranging between 1 CFU/100 mL to > 50 CFU/100 mL; two of the samples were grossly contaminated (>50 CFU/100 mL). Interestingly, while positive detection of lead was observed in 29 of the 30 ice cube samples (mean: 0.511±0.105 ppm; range: 0.489-0.674 ppm), copper, manganese and zinc were not detected. In addition, analysis on commercially bottled mineral water as well as in tap water samples did not detect such contaminations. Therefore, it appears that (1) contamination of faecal coliforms in ice cubes in food outlets in Malaysia may not be sporadic in pattern but rather prevalent and (2) the source of water used for manufacturing the ice cubes that contained significant amount of lead would suggest that (3) it was neither originated from the treated tap water supply nor bottled mineral water or (4) perhaps contaminated during manufacturing process. Further studies exploring the source of water used for manufacturing these ice cubes as well as the handling process among food operators deserve consideration.

To investigate the questions that Muslim patients, embryologists, paramedics, clinical counsellor and doctors may have pertaining to the compliance of Assisted Reproductive Technique (ART) to Shari’aa. Methods: As a preliminary study, an open-ended survey was administered to participants. Participants for the survey comprised of 21 patients, 2 embryologists, 2 doctors, 4 paramedics and 1 counsellor. Results: Data analysis showed that most of the participants posed questions that fall into six classifications which are: Munakahat (Family Law), social Hukm, Fiqh Ibadah, Fiqh Qadha (Islamic Hukm), General Fiqh and Usul Fiqh. Conclusion: It is clear that even though the participants were rather familiar with some of the existing Fatwas pertaining to ART and IVF in Malaysia, there are still remaining doubts which need to be clarified. This indicates that there are challenges faced in seeking and providing ART treatment to Muslim patients. This needs to be addressed perhaps in the form of Shari’aa-compliant guidelines to provide a clear explanation of each process and procedure in fertility treatment.