Rare cause of Horner's syndrome: pseudoaneurysm of right subclavian artery in an intravenous drug user

Pseudoaneurysms of the subclavian artery are extremely rare lesions despite the overall increase in the frequency of septic pseudoaneurysms caused by illicit parenteral drug abuse. A case of subclavian artery pseudoaneurysm presenting with Horner's syndrome in an intravenous drug user is discussed.     

Micronutrients and its correlation with mental performance among schoolchildren in Bario, Sarawak: a preliminary study

Children who are born in a community with insufficient micronutrients, particularly iodine in remote rural areas are associated with low intellectual functions and mental retardation. The aim of this cross-sectional study is to determine the mental performance of the schoolchildren in Bario, a highland settlement of the Kelabit people in the district of Baram, Sarawak and to determine its correlation with the availability of iodine in the environment, as well as other micronutrients such as selenium, copper and manganese. A total of 25 schoolchildren in Bario age ranging from 7 to 12 years old participated in the study. Mental performance of the schoolchildren were tested using TONI-2 (Test of Nonverbal Intelligence--second edition), a cognitive ability measures with a response format which eliminates language and reduces motoric and cultural factors. The iodine levels from several wells, soils and salt found in Bario were determined using HPLC (software version 3.05.01) whilst serum levels of selenium, copper and manganese were measured using Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS). The results showed that the median and mode scores of intelligence quotient for Bario were 82 and 75, respectively, whilst median and mode scores of intelligence percentile were 11.0 and 5.0, respectively. The maximum score achieved were at the average level with the quotient score between 90-110. It was found that salt produced from one of the wells in Bario contained high quantity of iodine. Based on standards established by the Trace Elements Laboratory, Roben Institute, University of Surrey, United Kingdom, schoolchildren in Bario are having sufficient blood levels of copper and a high selenium and manganese levels. Despite the remoteness of the study area, the schoolchildren in Bario, Sarawak showed higher mental performance compared to other isolated areas. This is probably correlated with the high micronutrients availability, particularly iodine, found naturally in Bario.     

An uncommon cause of duodenal obstruction

This is a case report of an elderly male, who presented with duodenal obstruction caused by abdominal aortic aneurysm. An axillo-bifemoral shunting with an infra renal straight inlay graft together with a feeding jejunostomy was performed. This is rare presentation with only a few cases reported.     

beta-Lactam resistance phenotype determination in Escherichia coli isolates from University Malaya Medical Centre

beta-Lactamases have been identified as the major cause of antimicrobial resistance to beta-lactam antibiotics in Escherichia coli. The activities of ampicillin-sulbactam and amoxicillin-clavulanate as well as a range of beta-lactam antibiotics were studied with 87 clinical E. coli isolates from patients of the University Malaya Medical Center using the disc diffusion technique. Susceptible, intermediate and resistant categories were established based on the diameter of zones of inhibition set by the National Committee for Clinical Laboratory Standards (NCCLS). The isolates were then classified into 6 phenotypes according to the criteria stated in the methodology: S (susceptible to all beta-lactams); TL (resistant to aminopenicillins; amoxicillin-clavulanate susceptible and susceptible or intermediate to ampicillin-sulbactam); TI (resistant to aminopenicillins and ampicillin-sulbactam; susceptible to amoxicilin-clavulanate); TH-IRT (resistant to aminopenicillins; intermediate or resistant to amoxicillin-clavulanate; resistant to ampicillin-sulbactam); ESBL (resistant to aminopenicillins and oxyimino cephalosporins; positive results with the double-disc diffusion test); and CP (resistant to aminopenicillins, beta-lactam-beta-lactamase inhibitor combinations, oxyimino cephalosporins and cephamycins). Results showed that the TL phenotype was the commonest (40.2% of the isolates) followed by S (31%), TH-IRT (16.1%), ESBL and CP (3.4% each) and TI (2.3%). One isolate showed both ESBL and CP phenotypes while two isolates were classified as inconclusive. Representatives from each phenotype were further analysed for the presence of beta-lactamases which revealed a predominance of TEM and SHV enzyme producers. PCR-SSCP analysis of the SHV gene from all the ESBL and CP isolates revealed the predominance of SHV 5-type enzyme which was concurrent with our previous studies.     

A Modified Shirodkar Surgical Closure of the Incompetent Cervix During Pregnancy

A modified technique of Shirodkar cervical cerclage is described; 28 patients had 33 pregnancies with such a suture inserted after 12 weeks' gestation. An overall fetal survival of 93.9% showed a significant improvement (p less than 0.001) over that obtained in the previous pregnancies without cervical stitch. The operation is safe for both mother and fetus.     

Abdominal aortic aneurysm in a renal transplant patient

Repair of an abdominal aortic aneurysm in a renal transplant recipient poses many different problems due to warm ischaemia to the grafted kidney. This is a case of 50-year-old gentleman who had a pervious renal transplant with abdominal aortic aneurysm. To reduce the effects of warm ischaemia on the transplanted kidney, an axillo unifemoral bypass was done prior to aneurysm repair. This ensured continued perfusion to the transplanted kidney. The post operative period was complicated by Methicillin Resistant Staphyloccus Aureus infection of the graft.     

Comparison of Preoperative Nutritional Indexes for Outcomes after Primary Esophageal Surgery for Esophageal Squamous Cell Carcinoma

Background: This study aimed to compare the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) for predicting postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing esophagectomy. Methods: We retrospectively reviewed the data of 1265 consecutive patients who underwent elective esophageal surgery. The patients were classified into no risk, low-risk, moderate-risk, and high-risk groups based on nutritional scores. Results: The moderate-risk (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.24–1.92, p < 0.001 in CONUT; HR: 1.61, 95% CI: 1.22–2.12, p = 0.001 in GNRI; HR: 1.65, 95% CI: 1.20–2.26, p = 0.002 in PNI) and high-risk groups (HR: 1.91, 95% CI: 1.47–2.48, p < 0.001 in CONUT; HR: 2.54, 95% CI: 1.64–3.93, p < 0.001 in GNRI; HR: 2.32, 95% CI: 1.77–3.06, p < 0.001 in PNI) exhibited significantly worse 5-year overall survival (OS) compared with the no-risk group. As the nutritional status worsened, the trend in the OS rates decreased (p for trend in all indexes < 0.05). Conclusions: Malnutrition, evaluated by any of three nutritional indexes, was an independent prognostic factor for postoperative survival.     

The Behavior of Polyurethane Foam-Filled Glass-Fiber-Reinforced Polymer Crossarm Subjected to Lightning Transient Voltage

The demand for composite materials in high-voltage electrical insulation is escalating over the last decades. In the power system, the composite glass-fiber-reinforced polymer has been used as an alternative to wood and steel crossarm structures due to its superior properties. As a composite, the material is susceptible to multi-aging factors, one of which is the electrical stress caused by continuous and temporary overvoltage. In order to achieve a better insulation performance and higher life expectancy, the distribution of the stresses should firstly be studied and understood. This paper focuses on the simulation work to better understand the stress distribution of the polyurethane foam-filled glass-fiber-reinforced polymer crossarm due to the lightning transient injection. A finite-element-based simulation was carried out to investigate the behavior of the electric field and voltage distribution across the sample using an Ansys Maxwell 3D. Electrical stresses at both outer and inner surfaces of the crossarm during the peak of lightning were analyzed. Analyses on the electric field and potential distribution were performed at different parts of the crossarm and correlated to the physical characteristics and common discharge location observed during the experiment. The results of the electric field on the crossarm indicate that both the outer and internal parts of the crossarm were prone to high field stress.     

Ethnic differences in lifetime cumulative incidence of syncope: the Malaysian elders longitudinal research (MELoR) study

Clinical Autonomic Research - To determine the lifetime cumulative incidence of syncope, potential ethnic differences and factors associated with syncope using the Malaysian elders longitudinal...     

Effects of Ionic Liquid, 1-Ethyl-3-methylimidazolium Chloride ([EMIM]Cl), on the Material and Electrical Characteristics of Asphaltene Thin Films

Asphaltene is a component of crude oil that has remained relatively unexplored for organic electronic applications. In this study, we report on its extraction technique from crude oil tank bottom sludge (COTBS) and its thin-film characteristics when 1-ethyl-3-methylimidazolium chloride ([EMIM]Cl) ionic liquid (IL) was introduced as dopants. The extraction technique yielded asphaltene with more than 80% carbon content. The IL resulted in asphaltene thin films with a typical root-mean-square surface roughness of 4 nm, suitable for organic electronic applications. The thin films each showed an optical band gap of 3.8 eV and a sheet resistance as low as 10⁵ Ω/□. When the film was used as a conductive layer in organic field-effect transistors (OFET), it exhibited hole and electron conduction with hole (µ_h) and electron (µ_e) mobilities in the order of 10⁻⁸ and 10⁻⁶ cm²/Vs, respectively. These characteristics are just preliminary in nature. With the right IL, asphaltene thin films may become a good alternative for a transport layer in organic electronic applications.