Impact of temperature and residence time on sewage sludge pyrolysis for combined carbon sequestration and energy production

Environmental challenges related to sewage sludge call for urgent sustainable management of this resource. Sludge pyrolysis might be considered as a sustainable technology and is anticipated to support measures for mitigating climate change through carbon sequestration. The end products of the process have various applications, including the agricultural utilization of biochar, as well as the energy exploitation of bio-oil and syngas. In this research, sewage sludge was pyrolyzed at 500 °C, 600 °C, 750 °C, and 850 °C. At each temperature, pyrolysis was explored at 1hr, 2hrs, and 3hrs residence times. The ratio (H/Corg)at was tapped to imply organic carbon stability and carbon sequestration potential. Optimum operating conditions were achieved at 750 °C and 2hrs residence time. Produced biochar had (H/Corg)at ratio of 0.54, while nutrients' contents based on dry weight were 3.99%, 3.2%, and 0.6% for total nitrogen (TN), total phosphorus (TP), and total potassium (TK), respectively. Electrical conductivity of biochar was lesser than the feed sludge. Heavy metals in biochar aligned with the recommended values of the International Biochar Initiative. Heat content of condensable and non-condensable volatiles was sufficient to maintain the temperature of the furnace provided that PYREG process is considered. However, additional energy source is demanded for sludge drying.

Metabolites alterations associated with obesity: A scoping review

INTRODUCTION

Obesity can be considered a major public health concern throughout the world. Various studies have been conducted to combat the rising number of cases of this health problem. Therefore, identifying the roots of the disease is critical in developing the desperately needed treatment approaches. However, in order to fully understand the origin of this disease, figuring out the metabolites present, and the alterations that occurred in a particular metabolism are crucial, and the information regarding the metabolites involved is limited. The aim of this study is to analyse the literature relevant to the metabolites involved in obesity conditions through a scoping review.

MATERIALS AND METHODS

This review utilises three databases (SCOPUS, Science Direct, and PubMed). The search phrases used are (Metabolomic* OR Metabolite*) for metabolomic study, (3T3-L1 OR Adipocyte OR "Adipose Tissue") for experimental design, and (Obesity) for obesity condition. Each of the search keywords was separated by an "AND" term in the databases. Other terms related to obesity, such as insulin resistance, heart disease, type 2 diabetes, muscular disorders, respiratory problems, and psychological problems were omitted because they did not contribute to the total number of studies discovered.

RESULTS

A total of 27 research publications were included in this scoping review. Most of the study focuses on metabolomics in obesity. Metabolites detected were found in various metabolic pathways including amino acids, carbohydrates, lipids as well as other metabolisms. Most of these metabolites discovered in obese conditions showed an alteration when compared to the level of the metabolite in normal conditions.

CONCLUSION

Unfortunately, these studies had some limitations in which the metabolites detected varied between the articles and the information concerning the relationship between the technique or instrument utilised and the metabolites detected in the samples were not well described. Therefore, using the findings obtained in this study, it can help to determine the direction of the study in the future.

Phytochemical quantification and HPLC analysis of Parkia speciosa pod extract

INTRODUCTION

Parkia speciosa Hassk., commonly known as bitter bean or twisted cluster bean, is a tropical leguminous plant species native to Southeast Asia. The plant's edible pods have been traditionally used in various cuisines, particularly in Malaysian, Thai, and Indonesian cooking. Apart from being used as a food ingredient, the pods of P. speciosa also have a range of potential applications in other fields, including medicine, agriculture, and industry. The pods are said to have several phytochemicals that hold great therapeutic values such as reducing inflammation, improving digestion, and lowering blood sugar levels. However, there is limited information on the specific phytochemical contents of the pods in the literature. Thus, the aim of this study is to quantify the total phenolic and flavonoid compounds and to determine the concentrations of four selected phytochemical compounds in the P. speciosa pod extract (PSPE).

MATERIALS AND METHODS

Quantification of the total phenolic (TPC) and flavonoid contents (TFC) in PSPE were done via colourimetric methods; and the determination of the concentrations of four specific phytochemicals (gallic acid, caffeic acid, rutin, and quercetin) were done via High- Performance Liquid Chromatography (HPLC).

RESULTS

Colourimetric determination of PSPE showed TPC and TFC values of 84.53±9.40 mg GAE/g and 11.96±4.51 mg QE/g, respectively. Additional analysis of the phytochemicals using HPLC revealed that there were 6.45±3.36 g/kg, 5.91±1.07 g/kg, 0.39±0.84 g/kg, and 0.19±0.47 g/kg of caffeic acid, gallic acid, rutin, and quercetin, respectively.

CONCLUSION

The findings show that PSPE contains substantial amounts of caffeic acid, gallic acid, rutin, and quercetin, which may indicate its potential as antibacterial, anti-inflammatory, anti-lipid, and antiviral medicines.

Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial

BACKGROUND

The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported.

OBJECTIVE

To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.

DESIGN

Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).

SETTING

46 U.S. and Canadian hospitals.

PARTICIPANTS

Patients aged 50 years or older undergoing hip fracture surgery.

INTERVENTION

Spinal or general anesthesia.

MEASUREMENTS

Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.

RESULTS

A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups.

LIMITATION

Missing outcome data and multiple outcomes assessed.

CONCLUSION

Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.

PRIMARY FUNDING SOURCE

Patient-Centered Outcomes Research Institute.

Malnutrition among patients admitted to the subacute geriatric ward during the COVID-19 pandemic era: A cross-sectional study in a tertiary hospital in Malaysia

BACKGROUND

Acute illness and hospitalisation detriment the nutritional status of older patients. This study aimed to describe the prevalence of malnutrition, characteristics and in-hospital outcomes associated with malnutrition, and nutritional management among patients who were admitted to the Subacute Geriatric Ward.

METHODS

This is a retrospective study of older patients (age ≥ 60) who were admitted to the Subacute Geriatric Ward of Kuala Lumpur Hospital from 1 March 2021 to 31 May 2021. Malnutrition was identified using the Mini Nutritional Assessment-Short Form (MNA-SF). The in-hospital outcomes evaluated were hospital-associated complications, namely delirium, functional decline, incontinence, inpatient falls, inpatient pressure injuries, hospital-acquired infection, institutionalisation, and inpatient mortality.

RESULTS

Seventy-three patients were included (mean age 74.7, female 58.9%), of which 28 (38.4%) and 27 (37.0%) were malnourished and at risk of malnutrition, respectively. Poorer nutritional status was associated with increased age, comorbidity burden, frailty, immobility, impaired basic activities of daily living, history of falls, cognitive impairment, incontinence, and arthritis. About 71.2% and 60.3% of patients were offered dietitian review and oral nutritional supplements, respectively. The in-hospital outcome rates were higher among malnourished patients, but the differences were not statistically significant. However, multiple hospital-associated complications were more common with poorer nutritional status (p = 0.018).

CONCLUSION

Hospital malnutrition is prevalent among older patients, and unidentified malnutrition is not justified due to its association with multiple adverse outcomes.

Implication of current ASE/EACVI left ventricular diastolic function classification in predicting 2-year MACE in asymptomatic patients with diabetes and hypertension

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia

Background

Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes. Substantial number of patients were classified as indeterminate diastolic function based on the current ASE/EACVI guidelines. The implication of current diastolic function classification in predicting MACE among diabetic patients is not well established.

Purpose

To assess prognostic impact of current guidelines-based diastolic function classification, and determine predictors of 2-year MACE based on individual LVDD parameters.

Methods

A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients had no prior cardiovascular events, had preserved left ventricular (LV) ejection fraction on echocardiography and sinus rhythm on ECG at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LV diastolic function. The 2016 ASE/EACVI guidelines were applied to classify diastolic function. All patients were followed up until 2 years to assess MACE.

Results

There were 65 (58.6%) female patients. Mean age was 59.86 ± 7.45 years; mean duration of type 2 diabetes was 10.5 ± 5.41 years. 80 (72.1%) patients were classified as having normal diastolic function (nDF); 24 (21.6%) patients were classified as indeterminate diastolic function (iDF); 7 patients (6.3%) were classified as LVDD. Patients with LVDD had significantly higher LV mass index (LVMI) (mean 121.72 ± 23.28g/m2 vs 116.62 ± 24.66g/m2 in iDF vs 102.50 ± 22.89g/m2 in nDF, p = 0.003); higher left atrial volume index (LAVI) (mean 41.24 ± 10.28ml/m2 vs 30.55 ± 10.07ml/m2 in iDF vs 25.75 ± 6.30ml/m2 in nDF, p < 0.001); lower lateral e’ velocity (mean 6.35 ± 2.05cm/s vs 7.37 ± 1.73cm/s in iDF vs 8.59 ± 2.13cm/s in nDF, p = 0.003); higher septal E/e’ ratio (mean 14.89 ± 3.29 vs 12.16 ± 3.99 in iDF vs 9.99 ± 2.35 in nDF, p = 0.001); higher average septal-lateral E/e’ ratio (mean 14.22 ± 3.77 vs 11.34 ± 3.74 in iDF vs 9.04 ± 2.10 in nDF, p < 0.001).

Among these 111 patients, 10 patients (9%) reported MACE at 2 years. The risk of 2-year MACE is elevated in both indeterminate diastolic function[hazards ratio (HR) 3.80, p = 0.023] and LVDD (HR 37.78, p = 0.002). BMI (HR 1.25, p = 0.004), and systolic blood pressure (HR 1.07, p < 0.001) were found to be associated with 2-year MACE.

Conclusions

LVDD and indeterminate diastolic function were correlated with increased MACE at 2 years. BMI and systolic blood pressure were predictors of increased risk of MACE at 2 years. Further investigation with larger sample size is warranted.

Implication of Current ASE/EACVI Left Ventricular Diastolic Function Classification in Predicting 2-Year MACE in Asymptomatic Patients with Diabetes and Hypertension

Background

Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes. Substantial number of patients were classified as indeterminate DF based on the current ASE/EACVI guidelines. The implication of current DF classification in predicting MACE among diabetic patients is not well established.

Purpose

To assess prognostic impact of current guidelines-based DF classification, and determine predictors of 2-year MACE based on individual LVDD parameters.

Methods

A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients had no prior cardiovascular events, had preserved left ventricular (LV) ejection fraction on echocardiography and sinus rhythm on ECG at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. The 2016 ASE/EACVI guidelines were applied to classify DF. All patients were followed up until 2 years to assess MACE.

Results

There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of DM was 10.5 (5.41). 80 (72.1%) patients were classified as having normal DF (nDF); 24 (21.6%) patients were classified as indeterminate DF (iDF); 7 patients (6.3%) were classified as LVDD. Patients with LVDD had significantly higher LV mass index (LVMI) (mean 121.72±23.28g/m2 vs 116.62±24.66g/m2 in iDF vs 102.50±22.89g/m2 in nDF); higher left atrial volume index (LAVI) (mean 41.24±10.28ml/m2 vs 30.55±10.07ml/m2 in iDF vs 25.75±6.30ml/m2 in nDF); lower lateral e' velocity (mean 6.35±2.05cm/s vs 7.37±1.73cm/s in iDF vs 8.59±2.13cm/s in nDF); higher septal E/e' ratio (mean 14.89±3.29 vs 12.16±3.99 in iDF vs 9.99±2.35 in nDF); higher average septal-lateral E/e' ratio (mean 14.22±3.77 vs 11.34±3.74 in iDF vs 9.04±2.10 in nDF).

Among these 111 patients, 10 patients (9%) reported MACE at 2 years. The risk of 2-year MACE is elevated in both iDF [odds ratio (OR) 3.80, 95% CI 0.87–16.54, p=0.075] and LVDD [OR 7.60, 95% CI 1.11–52.02, p=0.039]. LVMI (OR 1.027, 95% CI 1.004– 1.051, p=0.023), LAVI (OR 1.092, 95% CI 1.017–1.172), and average septal-lateral E/e' ratio (OR 1.276, 95% CI 1.047–1.557, p=0.016) significantly correlated with 2-year MACE.

Conclusions

LVDD is correlated with increased MACE at 2 years. LVMI, LAVI and average septal-lateral E/e' ratio were predictors of increased risk of MACE at 2 years. Further investigation with larger sample size is warranted.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia

Primary sinonasal Ewing sarcoma: A case report

BACKGROUND

Ewing sarcoma (ES) is an aggressive tumour which is typically skeletal in origin. ES involving the head and neck region is uncommon and can be easily confused with other small round blue cell tumours. We herein present a rare case of ES involving the sinonasal area.

CASE PRESENTATION

A 5-year-old Somalian boy with no known medical illness presented with progressive nasal blockage associated with clear nasal discharge and intermittent spontaneous epistaxis for three months. CT paranasal sinus and neck region revealed poorly enhancing expansile mass in the right maxillary sinus with areas of necrosis within. Initial radiological differential diagnoses were lymphoma and rhabdomyosarcoma. The mass was biopsied and histologically showed diffuse sheets of small round blue cells that was positive to CD99, NSE and vimentin. The muscle and lymphoid markers were negative. Fluorescence in-situ hybridisation (FISH) study revealed the presence of EWSR1 gene rearrangement thus diagnosis of ES was rendered.

CONCLUSIONS

ES of sinonasal tract is a rare entity and its pathological features significantly overlap with others small round blue cells tumour. Demonstration of EWSR1 gene translocation is recommended for the diagnosis of ES particularly at uncommon sites.

Honey-borne infant botulism in tahnik practice: an explanation of the risk and its solutions

Tahnik is a primarily Islamic practice wherein a newborn’s palate is daubed with dates or honey. However, feeding honey to an infant has been associated with numerous infant botulism cases. This situation has raised the question of how a religious practice could lead to such a severe health risk? The objectives of the study were to investigate: a reliable method of performing tahnik; the original proposition of using honey in tahnik; and the efficacy of using ingredients other than dates in tahnik. Semi-structured interviews and armchair research methods were utilised to gain data from three Islamic scholars. Other resources were also consulted, including the United States Department of Agriculture (USDA) Food Composition Database and various Islamic Literary Manuscripts. The findings indicated that the use of honey in tahnik did not originate within Islamic jurisprudence. Therefore, it should not be associated with the Prophet's Sunnah. When dates are not available for tahnik practice, then raisins, figs, pomegranates, grapes, or other sweet fruits can be used as a replacement rather than honey.

Recently-Arrived Afghan Refugee Parents' Perspectives About Parenting, Education and Pediatric Medical and Mental Health Care Services

Refugee children are at risk for mental/behavioral health problems but may not receive timely diagnosis or care. Parental experiences and perspectives about resources in the US may help guide interventions to improve mental/behavioral health care. In a community-academic partnership, we performed a qualitative study of recently-arrived Afghan refugee parents, using in-depth, semi-structured interviews to characterize experiences with parenting, education, and health care services. A four-person coding team identified, described, and refined themes. We interviewed 19 parents from ten families, with a median residence in the US of 24 months. Four themes emerged; parents described: (1) shifting focus as safety needs changed, (2) acculturation stress, (3) adjustment to an emerging US support system, and (4) appreciation of an engaged health care system. Health and educational providers' appreciation for the process of acculturation among newly-arrived refugee Afghan families may facilitate screening, diagnostic, and intervention strategies to improve care.

Impact of 2016 ASE/EACVI recommendations on evaluation of left ventricular diastolic function and clinical outcomes in patients with diabetes and hypertension without prior adverse cardiac events

Background

Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes, compared to those without diabetes. The complexity of previous 2009 ASE/EACVI algorithms makes diastolic function (DF) assessment challenging. Hence, prognostic value of LVDD estimates in clinical setting is not well-established.

Objective

To evaluate the impact of 2016 recommendations in estimates of LVDD and predicting cardiovascular outcomes in patients with diabetes and hypertension.

Materials and methods

A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients were clinically NYHA Class I, had no prior adverse cardiac events, and had preserved left ventricular (LV) ejection fraction on echocardiography at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. Both 2009 and 2016 algorithms were applied in DF assessment. All patients follow-up at 1 year to assess clinical outcomes.

Results

There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of diabetes was 10.5 (5.41). 55 (50.5%) patients had LV hypertrophy on echocardiography.

Prevalence of LVDD (14.4% vs 55.0%) and elevated LV filling pressure (9.0% vs 26.1%) were lower with 2016 compared with 2009 recommendations. Prevalence of indeterminate DF was 18.0% and 12.6% according to 2016 and 2009 recommendations respectively. Concordance between 2016 and 2009 recommendations was fair (k=0.29, p<0.001), with a reclassification rate of 45.9%.

None out of 45 patients who were diagnosed with indeterminate and normal DF according to 2016 and LVDD with 2009 algorithms developed MACE at 1 year. Out of 12 patients diagnosed with LVDD based on both 2016 and 2009 recommendations, 4 patients developed MACE at 1 year. 2016 recommendations showed better accuracy (sensitivity=80.0%; specificity=88.68%) than 2009 recommendations (sensitivity=80.0%; specificity= 45.28%) in predicting MACE at 1 year.

Conclusions

The application of 2016 recommendations results in lower prevalence of LVDD. The 2016 criteria detect more advanced cases and predict 1 year cardiovascular outcomes better. Further studies are warranted to investigate the prognostic impact of this criteria.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH), Ministry of Health Malaysia

The Effect of Recombinant Human Bone Morphogenetic Protein-7 on the Osteoblast-like Cells Cultured on Implant

AIM: The aim of the study was to study the effect of recombinant human bone morphogenetic protein-7 (rhBMP-7) on the osteoblast-like cells cultured on implant. MATERIALS AND METHODS: The osteoblast-like osteo-1 cell line was used in this experiment and derived from the parietal bone tissue of newborn albino rats. The cells were incubated in a humid atmosphere of 95% air and 5% carbon dioxide at 37°C. The medium was changed every 2 days. Four groups were conducted as follows osteoclast-like cell (machined), implanted osteoclast-like cell on titanium (Ti) (modified), osteoclast-like cell supplemented with BMP-7 (Machined + BMP-7), and implanted osteoclast-like cell on Ti and supplemented with BMP-7 (Modified + BMP-7). RESULTS: Cell proliferation was influenced by rhBMP-7, as demonstrated by a significant increase in collagen content after 7 and 21 days of culture (p = 0.005) and a significant increase in alkaline phosphatase (ALP) activity after 7 days (p < 0.001). The addition of rhBMP-7 influenced ALP activity, and a significant increase was observed after 21 days (p < 0.001). CONCLUSION: Within the limitations of the study, we concluded that the presence of rhBMP-7 did not influence cell adhesion to chemically modified Ti surfaces but provided an additional stimulus during the differentiation of rat osteo-1 cells cultured on this type of surface.

Validity and reliability of the Patient Assessment on Chronic Illness Care (PACIC) questionnaire among patients with type 2 diabetes mellitus in Malaysia: English version

INTRODUCTION

The Patient Assessment on Chronic Illness Care (PACIC) was developed to assess patients' perspectives on the alignment of primary care to the chronic care model. The Malay PACIC has been validated; however, Malaysia is a multicultural society, and English is spoken by many Malaysians and expatriates. We sought to validate the English version of the PACIC among patients with diabetes mellitus in Malaysia, as Malaysians may interpret a questionnaire that was originally developed for Americans in a different way.

METHOD

This study was conducted between November and December 2016 at two primary care clinics that offered integrated diabetes care at the time. These sites were selected to assess the discriminative validity of the PACIC. Site 1 is a Malaysian Ministry of Health-run primary care clinic while site 2 is a university-run hospital-based primary care clinic. Only site 1 annually monitors patient performance and encourages them to achieve their HbA1c targets using a standard checklist. Patients with diabetes mellitus who understood English were recruited. Participants were asked to fill out the PACIC at baseline and two weeks later.

RESULTS

A total of 200 out of the 212 invited agreed to participate (response rate=94.3%). Confirmatory factor analysis confirmed the 5-factor structure of the PACIC. The overall PACIC score and the score in two of the five domains were significantly higher at site 1 than at site 2. The overall Cronbach's alpha was 0.924. At test-retest, intra-class correlation coefficient values ranged from 0.641 to 0.882.

CONCLUSION

The English version of the PACIC was found to be a valid and reliable instrument to assess the quality of care among patients with diabetes mellitus in Malaysia.

The effect of Acacia senegal as potential prebiotic on obese gut microbiota

Gut microbiota is able to affect body weight by fermenting dried fibers and generating short chain fatty acids (SCFA). Acacia senegal is an edible dried which might have potential prebiotic activity. The aim of this study was to investigate the effect of Acacia senegal as potential prebiotic on the composition and activity of human colonic microbiota of obese healthy subjects. In order to identify a potential prebiotic effect of Acacia senegal on obese individuals, anaerobic, pH-controlled batch cultures system was applied. The growth of different microbes and the concentration of lactic acid and short chain fatty acids were studied at 0, 6, 12, 24 and 36 hrs using fluorescent in situ hybridization (FISH) and HPLC respectively. The results showed that Acacia senegal was able to simulate the microbiota population since it significantly increased (P>0.05) the population of Bifidobacterium and decreased the population of Clostridium. Moreover, the supplement of Acacia senegal to the models significantly modulate short-chain fatty acid concentration. These findings clearly identified Acacia senegal as an additional contributing factor to the gut microbiota of obese subject and suggest that Acacia senegal could be an interesting supplement for obese human which might help to control obesity.

Effects of ketogenic diet intervention on selected obese IIUM students during Ramadhan

Obesity and overweight are one of the main problems faced by Malaysian society due to sedentary lifestyle and high-carbohydrate consumption. A “low glycemic diet” is suggested as a suitable alternative in preventing obesity, because of its low carbohydrate intake which can be referred to as Atkins or Ketogenic diet (KD). A case study was carried out to assess the effect of KD during Ramadan on obese individuals. KD meal intervention was developed upon consultation with a dietician and tailored for Sahur (a pre-dawn meal) and Iftar (evening meal for breaking fast). A total of six participants were involved in this study which consists of 2 groups. A control group of 3 selected obese male IIUM students received no specific diet, and a study group of 3 selected obese male IIUM students underwent KD meal intervention. The KD meal intervention was carried out one week before Ramadan to allow the participants’ body to familiarize with high fat and low carbohydrate diet. Results showed that most of the selected obese participants who applied KD meal intervention exhibited satisfactory results in weight and Body Mass Index (BMI) reduction, steady levels of blood glucose, normal blood pressure levels and the presence of ketone bodies at a p-value < 0.01. However, the participants in the control group showed no significant changes at p<0.01 in weight, BMI, blood glucose levels, blood pressure and not a trace of ketone bodies. The findings of this study indicated that KD showed a positive effect on obesity control when conducted during Ramadan fasting.

Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study

AIM

To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling.

MATERIAL AND METHOD

Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL.

RESULTS

Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered.

CONCLUSION

The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term.

LEVEL OF EVIDENCE

3.

Effect of Ramadan fasting on renal function in patients with type 2 diabetes

AIM

To evaluate the effect of Ramadan fasting on kidney functions in patients with type 2 DM.

METHODS

We recruited 90 subjects with type 2 DM intending to fast Ramadan; classified into 30 with albuminuria and renal impairment (group I), 30 with albuminuria and normal kidney functions (group II) and 30 without albuminuria and normal kidney functions (group III). Two weeks before and after Ramadan, fasting plasma glucose, 2 h plasma glucose, hemoglobin A1c, fructosamine, serum creatinine, BUN, eGFR and albumin/ creatinine ratio were measured.

RESULTS

On comparing data before and after Ramadan, significant reduction in HbA1c was found in all groups. As regards kidney function parameters, no significant difference was found in group I but a significant decline in these parameters was found in groups II and III; serum creatinine, eGFR, urinary albumin/ creatinine ratio (p <0.001). Only Group I showed significant hypoglycemic events and need for dose reduction.

CONCLUSION

Ramadan fasting improved glycemic control in patients with type 2 DM with no decline in kidney functions in renally impaired group, only a decline in albuminuric and healthy groups within the normal range. Patients should be adviced regarding adequate hydration and dietary modification during Pre-Ramadan health care education.

Abstract P2-01-18: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Abdullah A, Tao A, Wendt MK. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-01-18.

Malaysian Northern Region Cancer Support Effort: Education and Empowerment - Building Hope, Strengthening Lives

Background: The agenda of the United Nations Sustainable Development Goals (SDGs) calls for unanimous actions to end poverty, battle against inequalities, protect the earth and to promote inclusive well-being. Today, the impact of cancer on societies threatens the ambitions of the SDGs. In developing nations, public awareness campaigns often focus on controlling the spread of communicable diseases, overlooking the rise of cancer afflictions. As a nation of multiethnic populations with different cultural and educational backgrounds, the views pertaining cancer treatment in Malaysia are often hampered by cultural beliefs. Cancer is often linked to bad luck or black magic, particularly among rural communities. The lack of knowledge in diagnostics and cancer therapeutics, in addition to many firm believers in alternative medicine may contribute to late detection and treatment only at the advanced stages of cancer. Aim: This project aims to tap into the pool of skills and expertise of the staff at the Universiti Sains Malaysia (USM) to help educate and raise public awareness on cancer causes, diagnosis and treatment among cancer survivors and the general public. Methods: My role as a scientist is to ensure that my research addresses the key problems faced in cancer therapies and that this information trickles down to the less informed traditional societies who have very different perceptions toward modern medicine. Workshops on cancer awareness highlighting cancer causes and treatment options, cancer diagnosis and holistic approaches while living with cancer were organized in partnership with MAKNA National Cancer Council Malaysia between the years 2015-2017. Support groups led by MAKNA, were also organized in a bid to educate cancer survivors who may lack important knowledge which could impinge on daily informed decisions concerning cancer diagnosis and treatment. Results: Through working hand in hand with MAKNA, a nonprofit organization with a duty 'to pool and use every effort, expertise and welfare from every faction of society to fight cancer', this project has successfully drawn knowledge and expertise from USM staff to come together as one to raise awareness and support cancer survivors. Members have also traveled to remote regions of Malaysia for home visits and cancer group meetings to support the cancer survivors and to raise awareness. Cancer survivors have been able to obtain personal advice from the university's cancer pathologist on their diagnosis, and have their queries answered pertaining to western medicine vs alternative medicine from academic research point of view. Conclusion: Working together with MAKNA has enabled cancer researchers and university staff to relate to real-life adversities so that we can continue to translate our research and knowledge to benefit the society.

Precise position control of an electro-hydraulic servo system via robust linear approximation

This paper presents a study on electro-hydraulic servo system for the purpose of position control using a compatible linear model. The system has high level of nonlinearity and linearization introduces extra error in system model. In order to reduce this error several methods of linearization uncertainty are discussed. In spite of applying Taylor's series for all methods, several procedures are used for considering uncertainty on linearization constants. In the first procedure, a simple bound is considered for each linearization constant. In the second procedure, a polytope is extracted for the uncertainty by a graphical method. Finally, a procedure with less conservativeness and less restriction is proposed. This procedure is used to extract the linear model of the electro-hydraulic servo system for the task of position control. The resulting model is used to synthesize an output-feedback H_∞ controller for the EHSS using a Linear Matrix Inequality (LMI)-based approach. The effectiveness of the proposed method is demonstrated by simulation and experimental results. The results showed that the procedure is less conservative and has the fastest operation without any overshoot.

Investigation of Ti-6Al-4V alloy acoustic softening

High power ultrasonic vibration is widely used for improving manufacturing processes such as machining and metal forming. High frequency mechanical vibration affects material properties and friction forces in contacting surfaces. Flow stress reduction under superimposed ultrasonic vibration is called as acoustic softening. The amount of this parameter should be determined for ultrasonic assisted metal forming processes. For determination of this parameter for workhorse Ti-6Al-4V alloy, experimental setup was designed and fabricated. Then tensile test under longitudinal ultrasonic vibration was performed for different ultrasonic powers. Results show that ultrasonic vibration has considerable effect on plastic behavior of the alloy and decreases flow stress. Also, increasing ultrasonic power leads to higher acoustic softening. Yield stress reduction up to 9.52%, ultimate stress reduction up to 4.55% and elongation up to 13% were obtained at 340W ultrasonic power. After applying ultrasonic vibrations and its termination, hardness of specimens were measured in which increase up to 9% was observed.

Decreased live births among women of Middle Eastern/North African ethnicity compared to Caucasian women

PURPOSE

The objective of this study is to determine if IVF outcome disparities exist among MENA women in the USA in comparison to a control group of Caucasian women.

METHODS

A retrospective cohort study comparing MENA (N = 190) and Caucasian (N = 200) women undergoing their first IVF cycle between 5/2006 and 5/2014 was carried out at an academically affiliated fertility practice. All MENA cycles during that time period undergoing IVF/ICSI using autologous embryos and blastocyst transfers were compared to a control group of Caucasian women.

RESULTS

MENA women were significantly younger (32.9 vs 34.5, P < 0.005) and had a lower BMI (25.2 vs 27.1, P < 0.001). Male factor infertility was higher among partners of MENA women (62 vs 50%, P < 0.05). MENA women experienced decreased live birth rates per blastocyst transfer compared to Caucasian women after controlling for age and BMI (OR 0.55, 95% CI 0.35-0.85 P = 0.007). The odds of a miscarriage were also significantly higher among MENA women (OR 2.55, 95% CI 1.04-6.27 P = 0.036).

CONCLUSION

Middle Eastern/North African women have worse IVF outcomes with decreased live birth rates per blastocyst transfer and increased miscarriage rates compared to Caucasian women.

Protoplasmic astrocytoma with multifocal involvement: case report and radiological findings

Protoplasmic astrocytomas are a poorly characterized and extremely rare subtype of astrocytoma. We describe the CT, MR and ¹⁸F-fludeoxyglucose positron emission tomography (FDG-PET) findings of a multifocal protoplasmic astrocytoma in a 29-year-old male with neurological deficits. He was initially diagnosed with neurosarcoidosis based on imaging. MRI demonstrated intraparenchymal lesions involving the right temporal lobe and cerebellum. These appeared as extremely hyperintense signals on T₂ weighted imaging and as homogeneous enhancements with a small non-enhancing cystic component on contrast-enhanced MR. Diffuse post-contrast enhancement of the craniospinal meninges was also noted. Post-radiation therapy PET-CT demonstrated a highly FDG-avid tumour in the right temporal lobe and left cerebellum. To our knowledge, a multifocal form of protoplasmic astrocytoma in an adult patient has not been previously described.

Endometrial Ablation for Aplastic Anemia-Associated Menorrhagia

Aplastic anemia is characterized by bone marrow failure and pancytopenia. In women, this can lead to menorrhagia secondary to thrombocytopenia which may require treatment depending on its severity. We report a patient with aplastic anemia-associated menorrhagia requiring emergency inpatient endometrial ablation due to transfusion dependence. A 42-year-old G3P3003 female presented with severe anemia, thrombocytopenia, and metrorrhagia. Her subsequent bone marrow biopsy revealed aplastic anemia. Her menometrorrhagia progressively worsened and she remained transfusion dependent. In the hospital, the patient underwent an uneventful endometrial ablation to control her vaginal bleeding. Patient reports only minor spotting after the procedure. Endometrial ablation is a safe and effective technique of treating acute menorrhagia in patients with aplastic anemia. It can reduce vaginal bleeding and decrease transfusion dependence.

Presence of both Mesenchymal and Carcinomatous Features in an In-vitro Model of Ovarian Carcinosarcoma Derived from Patients' Ascitic Fluid

We have refined the technique for isolating and propagating cultures of primary ovarian carcinosarcoma cells (OSCs) derived from ascites, which allowed the cells to obtain the biphasic features of carcinosarcoma in cell culture conditions (presence of both carcinoma and mesenchymal morphologic types). This protocol involves a simple yet rapid method for the growth and propagation of ascites OSC in a basal culture medium. Autologous ascitic fluid was used as source of growth factors, and minimal manipulation was involved to establish the culture. The methodology allowed for the direct application of multiple molecular, cellular, and functional analyses within a few weeks of initial cell isolation, with the further potential of retrospective analyses of archived cells and tissues.

Incidental Finding of Synchronous, Benign, Metastasizing Leiomyoma with Distinct Cytogenetics in the Lung and Uterus

This paper will present a case of benign metastasizing leiomyoma, incidentally found during the preoperative evaluation for acute cholecystitis. The preoperative chest X-ray revealed diffuse bilateral lung nodules suspicious for hematogenous metastasis and the densities measured 1-1.5 cm. A pelvis computed tomography (CT) scan showed in-homogeneous uterine mass with unusual vascular supply raising concern for leiomyosarcoma. Open lung biopsy revealed benign-appearing smooth-muscle neoplasm suggestive of metastatic leiomyoma. The patient was then treated with total abdominal hysterectomy with bilateral salpingo-oopherectomy which had identical pathology to the lung. As there were innumerable pulmonary metastases where complete resection was impossible, surgical castration appeared to be effective in reducing tumor size. The patient was also started on an aromatase inhibitor that subsequently improved her clinical outcome. Management strategies, cytogenetics, and histological diagnosis are discussed.

Recent Advancements in Prognostic Factors of Epithelial Ovarian Carcinoma

Ovarian cancer remains the most common cause of gynecologic cancer-related death among women in developed countries. Nevertheless, subgroups of ovarian cancer patients experience relatively longer survival. Efforts to identify prognostic factors that characterize such patients are ongoing, with investigational areas including tumor characteristics, surgical management, inheritance patterns, immunologic factors, and genomic patterns. This review discusses various demographic, clinical, and molecular factors implicating longevity and ovarian cancer survival. Continued efforts at identifying these prognosticators may result in invaluable adjuncts to the treatment of ovarian cancer, with the ultimate goal of advancing patient care.