bluuebunny/crossref_metadata_2025 huggingface dataset:
Landscapes of the central ecological zone of the Baikal natural territory within the Buryat republic and their resistance to recreational load: evaluation and mapping
Authors: Rasputina Е.А. , Tsygankova M.V. , Bilichenko I.N. , Korolkova E.E. , Sofronov A.P. , Bardash A.V.
Published: November 2019

The approaches and natural preconditions of territorial differentiation of recreational activities within the boundaries of Baikal natural territory (Buryat republic) are considered in the article on a landscape basis. The intensity of tourism development in different landscapes should correspond to their resistance to recreational loads. The integral estimation of stability was calculated in qualitative categories on the basis of a combination of indicators of average and minimum componentwise stability, taking into account their importance in recreational action and the presence of component stability zero values. The low-mountain pine, larch-pine and cedar-larch landscapes, light coniferous and dark coniferous landscapes of valleys, as well as arable land are characterized by the highest indicators of recreational stability. Goltzy and sub-walnut landscapes, as well as wetlands are characterized by low stability. The map of the landscapes stability to the impact of tourism activities has been created by the method of landscape-interpretation mapping. This map will allow further planning of recreational loads in the Central Ecological Zone of the Baikal Natural Territory (Republic of Buryat).
Analysis of optical- and radio-wave bands data in built-up environment studies
Authors: Zanozin V.V. , Barmin A.N.
Published: November 2019

Monitoring and mapping development areas is a key task in solving a number of applied studies, for example in urban planning, geoecology, etc. Development is a key indicator in calculating the degree of landscape naturalness. In the first part of this article the author a briefly overviews the problem of identifying the degree of anthropogenic pressure on natural territorial complexes. The experience of using optical band data on the example of Landsat 8 (OLI) and Sentinel-2B and the process of processing radar data Sentinel-1A specifically for analyzing areas of development are described the second part of this paper. The research area is the central part of the Volga delta. Thus, as a result of a combining Landsat 8 (OLI), Sentinel-2B and Sentinel-1A satellites data, the density of the Volga Delta territory central part was obtained (190 km2). These materials provide a basis for further research in the field of revealing the degree of anthropogenic impact on natural landscape, serve as an informative source for scientific and applied research in various directions. The obtained data can be transferred to the Department of the Federal Service for State Registration, Cadastre and Cartography of the Astrakhan region for updating the archive information.
Handheld Laser Scanner Research
Authors: Komissarov A.V. , Remizov A.V. , Shlyakhova M.M. , Yambaev K.K.
Published: November 2019

The authors consider hand-held laser scanners, as a new photogrammetric tool for obtaining three-dimensional models of objects. The principle of their work and the newest optical systems based on various sensors measuring the depth of space are described in detail. The method of simultaneous navigation and mapping (SLAM) used for combining single scans into point cloud is outlined. The formulated tasks and methods for performing studies of the DotProduct (USA) hand-held laser scanner DPI?8X based on a test site survey are presented. The accuracy requirements for determining the coordinates of polygon points are given. The essence of the performed experimental research of the DPI?8X scanner is described, including scanning of a test object at various scanner distances, shooting a test polygon from various scanner positions and building point cloud, repeatedly shooting the same area of the polygon to check the stability of the scanner. The data on the assessment of accuracy and analysis of research results are given. Fields of applying hand-held laser scanners, their advantages and disadvantages are identified.
The experience of using mathematical statistics methods when analyzing the results of state land supervision
Authors: Sizov A.P.
Published: November 2019

Application of mathematical statistics methods as a possibility of implementing the principle of “minimum initial information – maximum justified generalizations” when analyzing the results of Supervisory and control measures in land management makes it possible to come to non-trivial conclusions. Significant correlation between indicators of state land supervision and General characteristics of the subjects of the Siberian Federal district (area, number and population density) were identified. High number of the eliminated violations is possible only at a large number of the revealed violations, but just 35–45 % of the revealed violations are eliminated in 33% of the general number of the areas with the revealed violations. The Amount of fines imposed is closely correlated with the amount of fines collected (r = 0,95) with a low – 65 % share of the money gathered. The role of fines for violating land legislation is not decisive in the formation of the SFD subjects’ budgets. Indicators of state land supervision closely connected with the area of land settlements, this data is system-forming in the eliminating land law violations. In proportion to the availability of these lands revenues to local budgets are formed as well. To increase the effectiveness of state land supervision as to the number of eliminated violations, the area of land with eliminated violations and the amount of fines collected, it is necessary to focus on bringing cases for each violation to a logical conclusion.
A reconnaissance survey for Collared Pika (Ochotona collaris) in northern Yukon
Authors: Cannings Sydney G. , Jung Thomas S. , Skevington Jeffrey H. , Duclos Isabelle , Dar Saleem
Published: November 2019

Collared Pika (Ochotona collaris) is a cold-adapted Beringian species that occurs on talus slopes and is sensitive to climate warming. Collared Pikas are patchily distributed throughout the sub-Arctic mountains of northwestern Canada and Alaska; however, information on their occurrence in the northern part of their distributional range is limited. In particular, no survey information is known from the southern Richardson Mountains and the Nahoni Mountains. We conducted aerial- and ground-based surveys to document Collared Pika occurrence and general habitat suitability in northern Yukon. We flew 505 km of aerial survey (not including ferrying to targetted survey areas) and performed ground surveys at 22 sites within the Richardson Mountains (including a portion of Dàadzàii Vàn Territorial Park) and the Nahoni Mountains in and adjacent to Ni’iinlii Njik (Fishing Branch) Territorial Park. Overall, suitable habitat for Collared Pikas was patchy in the mountains of northern Yukon—talus was sparse and many patches of talus appeared to be unsuitable. Collared Pikas were detected at eight of 22 (36%) sites visited, representing important new records for the species in the northern portion of their range. Our reconnaissance provides a first approximation of habitat suitability for Collared Pikas of the mountains of northern Yukon, as well as new records for the species in the region. These data are useful in better determining the contemporary distribution of Collared Pika through species distribution modelling, and may serve to identify areas for more detailed survey and monitoring initiatives for this climate-sensitive mammal.
Effects of Finishing and Polishing Methods on the Surface Roughness and Surface Free Energy of Bulk-fill Resin Composites
Authors: Ishii R , Takamizawa T , Tsujimoto A , Suzuki S , Imai A , Barkmeier WW , Latta MA , Miyazaki M
Published: November 2019

The purpose of this study was to determine the influence of finishing and polishing methods on surface properties of bulk-fill resin composites through surface roughness (Ra) and surface free energy (SFE) measurements, and scanning electron microscopy (SEM) observations. Three bulk-fill resin composites, Tetric EvoCeram Bulk Fill (TB), Filtek Bulk Fill (FB), and Filtek Bulk Fill Flowable Restorative (FF), and two conventional resin composites, Clearfil AP-X (AP) and Estelite ∑ Quick (EQ) were used. Seventy cured specimens of each resin composite were prepared and divided into seven groups of 10 specimens. Ra, SFE measurements, and SEM observations were conducted after finishing and polishing procedures. Three groups of specimens were finished with a fine grit diamond bur (FDB), and three with a tungsten carbide bur (CBB). After finishing, one group from each type of finishing was polished with aluminum oxide flexible disks (SSD) and one group from each type of finishing was polished with diamond particles embedded in a silicone point (CMP). A baseline group of samples that were neither finished nor polished after removing the translucent strips from the surface was examined. Although the baseline group showed significantly lower Ra values than the other groups, most resin composites showed lower Ra values with CBB+SSD than with the other finishing and polishing groups. Among the tested resin composites, EQ showed significantly lower Ra values than the other resin composites, regardless of the finishing and polishing methods. On the other hand, AP showed significantly higher Ra values than the other resin composites in all finishing and polishing groups, apart from FB with FDB. For the finished specimens, most resin composites showed higher SFE values with CBB than with FDB. For the polished specimens, all the tested resin composites with CMP showed lower γS values than those with SSD, regardless of the finishing method. The baseline groups of TB and FB showed significantly lower SFE values than the other finished and polished groups. In the SEM observations, all the examined resin composites showed rougher surfaces after finishing with FDB than with CBB. However, when comparing the different polishing methods (CMP and SSD), surface smoothness appeared to be material dependent.
Efficacy and Adverse Effects of Whitening Dentifrices Compared With Other Products: A Systematic Review and Meta-analysis
Authors: Devila A , Lasta R , Zanella L , Agnol MA Dall , Rodrigues-Junior SA
Published: November 2019

Whitening dentifrices (WDs) are widespread and accessible worldwide, claiming to whiten teeth. Therefore, this systematic review aimed to assess the extrinsic stain removal (ESR), the whitening potential, and the adverse effects of WDs. Randomized controlled trials comparing WDs with regular dentifrices (RDs) and other home-based whitening products were searched at NCBI-PubMed, Cochrane-CENTRAL, EBSCO-Host, and clinicaltrials.gov. The studies were screened and had data extracted by two independent researchers. Eligible studies presented outcomes of ESR, color change, and adverse effects, with no restriction of publication date. Data were meta-analyzed using RevMan 5.3, and the level of evidence was rated according to GRADE criteria. Eleven studies (n=1962) assessed reduction of stain area and intensity through Lobene Stain index, with a mean difference (MD) of −0.33 ([−0.41;−0.25]; p=0.00001) and −0.34 ([−0.44;−0.25]; p=0.00001), respectively. When the modified Lobene Stain index was used (six studies; n=2576), MD was −0.42 ([−0.58;−0.25]; p=0.00001) and −0.30 ([−0.39;−0.21]; p=0.00001), respectively. Mean color change through shade guide tabs (three studies; n=1322) was −1.80 ([−2.33;−1.26]; p=0.00001). All differences were in favor of the WDs, which also produced a risk of adverse effects (RR=1.74; [1.20, 2.52]; p=0.003; four studies; n=1322). The comparison of WDs with paint-on gel (two studies; n=58) yielded similar efficacy and adverse effects (p>0.05), whereas the comparison of WDs with white strips (two studies; n=87) yielded higher efficacy of the latter (p=0.00001) and similar adverse effects (p=0.52). The quality of evidence varied from low to moderate. WDs are more effective in reducing extrinsic stain and producing a whitening-like effect in teeth than RDs, although they also produce more adverse effects. Whitening efficacy of WDs is similar to paint-on gel and lower than white strips. Higher-quality evidence demands larger, well-conducted, independent studies.
Influence of CAD/CAM Fabrication and Sintering Procedures on the Fracture Load of Full-Contour Monolithic Zirconia Crowns as a Function of Material Thickness
Authors: Zimmermann M , Ender A , Mehl A
Published: November 2019

Objective:

The purpose of this in vitro study was to analyze the effect of computer-aided design/computer-aided manufacturing (CAD/CAM) fabrication and sintering procedures on the fracture load of monolithic zirconia crowns with different material thicknesses adhesively seated to methacrylate dies fabricated with stereolithography technology.

Method:

Monolithic zirconia crowns were fabricated from inCoris TZI C material with a chairside CAD/CAM system (CEREC MCXL) comprising three material thicknesses (0.5/1.0/1.5 mm, n=8 each). Two CAD/CAM fabrication procedures (milling, MI; grinding, GR), two chairside sintering procedures (superspeed, SS; speedfire sintering, SF), and one labside sintering procedure (classic, CL) were evaluated. In total, 144 crowns were fabricated. Restorations were adhesively seated to methacrylate dies fabricated with SLA technology. Thermomechanical cycling (TCML) was performed before fracture testing. Loading forces until fracture were registered and statistically analyzed with one-way analysis of variance (ANOVA), post hoc Scheffé test, and three-way ANOVA (α=0.05).

Results:

Test groups showed statistically significant differences (p<0.05). The highest mean value was found for 1.5-mm crowns of group GR_SF with 3678.6 ± 363.9 N. The lowest mean value was found for group 0.5-mm crowns of group MI_SF with 382.4 ± 30.7 N. There was a significant three-way interaction effect between thickness, sintering, and processing [F(4,126)=9.542; p<0.001; three-way ANOVA, significance level α=0.05].

Conclusions:

CAD/CAM fabrication and sintering procedures influence the maximum loading force of monolithic zirconia crowns with different material thicknesses. A material thickness of 0.5 mm should be considered as a critical thickness for monolithic zirconia crown restorations.
CHAPTER 3 Against Liberals: Multi-layered and Multi-directed Invocation in Dylan’s Christian Songs
Authors: Aadland Erling
Published: November 2019

Bob Dylan’s conversion to Christianity was a long time coming. So was his protest against protest, his hostility to politics. In this essay Dylan’s gospel songs are appreciated as the pivot of his songwriting, augmenting the multi-layered sense and multi-directed meaning in the invocatory design of his songs, a pattern which of course is also to be found both earlier and later in his oeuvre.
CHAPTER 6 Bob Dylan’s Conversions: The “Gospel Years” as Symptom and Transition
Authors: Selnes Gisle
Published: November 2019

This contribution analyzes Bob Dylan’s evangelic conversion in light of other conversions throughout his oeuvre, emphasizing the theological moment of the event of conversion as such. Two important aspects of conversion inaugurate Dylan’s born-again output: on the one hand, the isolation and purification of the figure of Christ as the all-pervading “object” of his quest; on the other, the “re-coding” of a series of figures and motifs from his earlier work, most of them derived, of course, from the proverbial American songbook. Before and after Dylan’s evangelical ruse, the legacy of 18th Century American Transcendentalism as well as Christ as an emblem of the rebel and/or artist constitute two relatively stable religious aspects of his art.
Estudio diagnóstico sobre hábitos relacionados con estilos de vida saludable en alumnos de una escuela primaria
Authors: Unzueta Vargas Denisse Alejandra , Fernández Escárzaga Jaime , Martínez Martínez Patricia Lorena
Published: November 2019

La promoción de estilos de vida saludable ha cobrado importancia en los últimos años debido a los altos índices de sobrepeso y obesidad que presentan los niños en edad escolar en México. Sin embargo, los resultados obtenidos después de más de 10 años de implementar diferentes estrategias indican que los esfuerzos no han generado el impacto esperado. Por esto, la atención se ha colocado en las escuelas, en tanto que estas deberían de ser comunidades de promoción social: espacios donde se adopten modelos inclusivos que promuevan acciones e implementen políticas a fin de proporcionar a los alumnos herramientas y recursos personales para superar las barreras que limitan el desarrollo integral, como pueden ser las condiciones de salud, higiene y hábitos poco saludables influenciados por el contexto sociocultural.

El objetivo de este estudio fue elaborar un diagnóstico que revelara cuáles son las prácticas inclusivas que se realizan en un entorno escolar en relación con los estilos de vida saludable. Se llevó a cabo en una escuela de educación primaria de la periferia de la ciudad de Durango, Durango, México; y se utilizó un enfoque cualitativo de investigación de tipo observacional fenomenológico. Los resultados encontrados indican que los alumnos están en situación de exclusión y vulnerabilidad debido a las condiciones socioculturales de precariedad que tienen que enfrentar, por lo que resulta importante dar atención a la necesidad de mejorar las condiciones de salud, higiene y hábitos de estilo de vida saludable de los alumnos para que se den las condiciones para lograr conseguir un bienestar capaz de conducir al desarrollo de su potencial humano. El diagnóstico que aquí se presenta generó los elementos necesarios para desarrollar un proceso de intervención fundamentado en la psicología educativa con un modelo de investigación-acción, del cual aún no se pueden reportar resultados debido a que está todavía en período de intervención.
PENGEMBANGAN BUKU AJAR BAHASA INDONESIA BERBASIS PENDIDIKAN KARAKTER DENGAN MODEL ASSURE PADA SISWA SEKOLAH DASAR
Authors: Wicaksono Alam Antonius , Fikri Bariska Hanif
Published: November 2019

Text book is material used by the students for helping the achievement of the competency standard , the purpose of education of primary and competence have (Depdiknas.2006). Of research, development text book based character education with a assure model on primary school student aimed at for (1) know the process of development text book Indonesian language based character education by using assure kind of classroom in primary school student, (2) know the quality of teks book Indonesian language based character education by using assure kind of classroom in primary school student. This research using kind of research development (research and development). A design study on four-D oriented model consisting of 4 steps in the define, design , develop, and disseminate. Data collection techniques used in the process of define used technique documentation main competence (KI) and basic competence (KD) in 2013 curriculum. Data collection techniques used in the process of design validation the technique, observation, the survey, and tests used to measure product quality based on terms of use.The result of developing teks book based character education with a assure model on primary school student that have been validated to the quality of the books according to components teaching material, the appearance of, language and graphic reached the percentage of the respective components 98,9 % , 100 % , 96,4 % , 94,8 % . The result of the observation for the use of the activity of teachers text book components, the activity of students and response students show the percentage of the respective components 93.5 %, 93,75 %, statements of some 91.7 %; and for the results of character of students to being honest, responsibility, tolerance and work together in a row the scores were 4 , 4 , 4 and 3.
Analytical Review of Application of Problem Tree Analysis As a Project Design Tool For Enhancing Performance of Community Based in Kenya
Authors: Walubengo Wasike Wilbefrorce , Kyalo Dorothy Ndunge , Mulwa Angeline Sabina
Published: November 2019

The purpose of this study was to establish how application of problem tree analysis influences performance of community based projects in Kenya. The study was employed descriptive research design.  A sample of 128 was obtained from a target population of 192 respondents through stratified random sampling procedure from different community based organizations. Data were collected by a questionnaire and an interview guide. Qualitative data was analyzed through checking data, developing codes, identifying themes and patterns. Data was summarized then linked to the objectives and hypotheses. Quantitative data was analyzed where both descriptive and inferential statistics was generated. Descriptive results were presented as frequency tables, percentages, arithmetic means and standard deviation. Inferential statistics were analyzed using Pearson’s Product Moment correlation (r) from simple regression and multiple regression analysis. F-test was used to test the hypotheses. Tests of statistical assumptions were carried out before analysis. In this study; R2=0.214; F (8.971) at p=0.000<0.05; therefore, H0 was rejected and it was concluded that the application of project tree analysis has statistically significant influence on the performance of community based projects. In conclusion, the most dominant indicator was project problem identified, followed by project root causes and project effects. The application of project tree analysis had a statistically significant influence on the performance of community based projects. The findings add to Project Management Body of Knowledge by empirically proving that the application of project tree analysis had statistically significant influence on the performance of community based projects.
Detection of Fraudulent Financial Statement; Can Perspective of Fraud Diamond Theory be applied to Property, Real Estate, and Building Construction Companies in Indonesia?
Authors: Rahmatika Dien Noviany , Kartikasari Maulida Dwi , Indriasih Dewi , Sari Inayah Adi , Mulia Armya
Published: November 2019

The increasing number of cases related to accounting scandals in the world has caused various parties to assume that management has commited fraudulent financial statement. Detection of fraudulent financial statements must be carried out so it can be prevented fraud and the possibility of a scandal is prolonged. This research examines the effects of pentagon fraud theory (pressure, opportunity, rationalization, competence and arrogance toward fraudulent financial statement: The property, real estate and building construction companies listed on Indonesia Stock Exchange (IDX) in 2014-2018 periods The data used were the secondary data based on the purposive sampling method, the number of companies were 29 companies with 5 years observation. Based on logistic regression analysis, pressure has an impact on fraudulent financial statements on the significant value of 0.045. Opportunity has no impact on fraudulent financial statements on the significant value of 0.077. Rationalization has no impact on fraudulent financial statements on the significant value of 0.291. Competence has no impact on fraudulent financial statements on the significant value of 0.107. Arrogance has an impact on fraudulent financial statements on the significant value of 0.001.
Proposing a Stochastic Model for Failures of the Upstream Grid While Optimally Scheduling of Microgrid
Authors: Niaz Azari Amir
Published: November 2019

In this paper, optimal scheduling of home appliancesas well as dispatchable distributed generators are determinedwithin a residential microgrid for a specific day. In this regard,stochastic nature of non-dispatchable distributed generators suchas wind and solar is modeled taking advantages of Markov model.Also, there are other uncertainties in the model stem from time offailure as well as duration of failure in the upstream grid which istaken into account in the problem formulation. The effectivenessof the proposed method is shown by minimizing cost of providingcustomers with electricity in a residential microgrid.
A Prescriptive Logic Model for Software Application Root Cause Analysis
Authors: Wong Hoo Meng , Amalathas Sagaya Sabestinal , Zitkova Tatana
Published: November 2019

Software application stops functioning in the production environment can be due to the error either within the software application layer or any other factor outside the software application layer. With the complexity of an enterprise level of software application involving multiple tiers, it is has log file at each tier. The root cause analysis activity will easily prolong as more than one log file required for the root cause analysis activity. This would increase the total time taken on restoring the software application service back to the users. To identify the root cause of software application error in a more accurate manner, and shorten the duration of root cause analysis activity conducting on software application error. A Prescriptive Analytical Logic Model (PAL) incorporates with Analytic Hierarchy Process (AHP) is proposed. The logic model contributes a new knowledge in the area of log file analysis to shorten the total time spent on root cause analysis activity. At the same time it contributes the knowledge in AHP to close the knowledge gap.
Role of Cardiac MRI in Detecting Familial Hypertrophic Cardiomyopathy: Review
Authors: Koshy Marymol , Johari Bushra , Hamdan Mohd Farhan , Hanafiah Mohammad
Published: November 2019

Hypertrophic cardiomyopathy (HCM) is a global disease affecting people of various ethnic origins and both genders. HCM is a genetic disorder with a wide range of symptoms, including the catastrophic presentation of sudden cardiac death. Proper diagnosis and treatment of this disorder can relieve symptoms and prolong life. Non-invasive imaging is essential in diagnosing HCM. We present a review to deliberate the potential use of cardiac magnetic resonance (CMR) imaging in HCM assessment and also identify the risk factors entailed with risk stratification of HCM based on Magnetic Resonance Imaging (MRI).
Students’ Perception of Teaching Methods in Pharmacology in a Malaysian Medical School
Authors: Agarwal Renu , Mohd Ismail Nafeeza
Published: November 2019

Introduction: The study attempts to evaluate the students’ perception of pharmacology as a subject, its usefulness in future practice, teaching methods currently used, and their patterns of learning and preparing for exams. Methods: A structured, self-administered questionnaire was distributed to second year medical students. Results: Of the 125 students who participated, 22.73 % considered pharmacology more important than any other subject. The students found small group sessions most interesting followed by directed self-learning, computer aided learning and lectures. Of those who responded, 79 and 66 % suggested to increase the small group and directed-self-learning sessions respectively. Up to 40 % of the students felt that pharmacology teaching must be through case-based discussions and 20 % requested for more practical sessions. Conclusions: It appears that majority of students entering the medical schools has little prior knowledge of pharmacology. While going through the preclinical years they understood the importance of pharmacology and its application in future practice, however, they tend to develop interest in one or other topics. Students prefer to have a greater number of small group sessions as they feel that these sessions are most useful for learning. Majority of the students tend to use both the textbooks and lecture notes and study regularly for better performance in examinations. The students also preferred to have more case-based learning sessions incorporated into the small group sessions.
The Prevalence of Depression and its Relationship to Health Related Quality of Life among Prostate Cancer Patients in Tertiary Centres, Kuala Lumpur
Authors: Isa Mohamad-Rodi , Moy Foong-Ming , Abdul Razack Azad Hassan , Mohd Zainuddin Zulkifli , Zainal Nur Zuraida
Published: November 2019

Introduction: To determine the prevalence of depression and its relationship with health related quality of life among prostate cancer patients in tertiary medical centres, Kuala Lumpur. Methods: A hospital-based, cross-sectional study was conducted at the Surgical Clinic, University Malaya Medical Centre and Universiti Kebangsaan Malaysia Medical Centre over a period of fifteen months. Depression level was measured using Depression Anxiety Stress Scale (DASS-21) and the health related quality of life was measured using the Short Form-36 (SF-36). Results: The prevalence of depression was 11.9% (95% CI: 7.0 – 17.0). The total quality of life for non-depression group was 72.30 ± 13.38 and depression group was 54.11 ± 14.59. All the domains in the health related quality of life and coefficient summaries showed significant differences. Univariate analysis showed significant differences in the physical coefficient summary (p < 0.001), mental coefficient summary (p < 0.001) and total quality of life (p = 0.002) among groups with different depression status. In multivariate analysis, the adjusted mean score of the quality of life was associated with age category of the patients (p = 0.012), urinary complaint of hematuria (p = 0.009) and history of orchidectomy (p = 0.023). Conclusions: The prevalence of depression among prostate cancer patients was relatively low. Treatment of the urination and prostate related problems may improve the quality of life among prostate cancer patients with depression.
A case of pustular psoriasis in a young boy.
Authors: Kuppusamy Meera , Taib Tarita
Published: November 2019

A case of pustular psoriasis in a young boy.AbstractMeera K, MD (IMU),MRCP (UK), T. Taib, MD, MMed, Advn.MDerm.  We report on a 13-year-old boy who presented with erythroderma secondary to generalised pustular psoriasis. He presented with generalised erythematous skin with patchy areas of pustules for one week duration. He was well until one month prior when he started having small scaly plaques on his scalp and extensors of his legs.  During the acute episode, he also had joint pain and bilateral eye conjunctivitis. Skin biopsy confirmed pustular psoriasis. He developed leucocytosis and transaminitis during the acute phase of the pustular eruption while on azathioprine and therefore was withheld. Subsequently, treatment with oral cyclosporine induced remission for his skin and joint disease.Conclusion    The case is hereby reported because of its rarity in its presentation and clinical features. Oral cyclosporine should be considered in patients with generalised pustular psoriasis complicated with transaminitis. Word count : 133
Quintuplex PCR to Detect Antibiotic Resistance Genes in Streptococcus pneumoniae
Authors: Palanisamy Navindra Kumari , Navaratnam Parasakthi , Sekaran Shamala Devi
Published: November 2019

Introduction: Streptococcus pneumoniae is an important bacterial pathogen, causing respiratory infection. Penicillin resistance in S. pneumoniae is associated with alterations in the penicillin binding proteins, while resistance to macrolides is conferred either by the modification of the ribosomal target site or efflux mechanism. This study aimed to characterize S. pneumoniae and its antibiotic resistance genes using 2 sets of multiplex PCRs. Methods: A quintuplex and triplex PCR was used to characterize the pbp1A, ermB, gyrA, ply, and the mefE genes. Fifty-eight penicillin sensitive strains (PSSP), 36 penicillin intermediate strains (PISP) and 26 penicillin resistance strains (PRSP) were used. Results: Alteration in pbp1A was only observed in PISP and PRSP strains, while PCR amplification of the ermB or mefE was observed only in strains with reduced susceptibility to erythromycin. The assay was found to be sensitive as simulated blood cultures showed the lowest level of detection to be 10cfu. Conclusions: As predicted, the assay was able to differentiate penicillin susceptible from the non-susceptible strains based on the detection of the pbp1A gene, which correlated with the MIC value of the strains.
A Rare Case of Tuberculous Prostatitis
Authors: Mohd Esa Nurul Yaqeen , Hanafiah Mohammad , Koshy Marymol , Abdullah Hilmi , Ismail Ahmad Izuanuddin , Abdul Rani Mohamed Fauzi
Published: November 2019

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.
Prevalence of Urinary Incontinence, Its Risk Factors and Effect on the Quality of Life in Women after Their First Delivery
Authors: Abdullah Bahiyah , Ayub Siti Hajar , Mohd Zahid Akmal Zulayla , Abd Rahman Noorneza , Isa Mohamad Rodi
Published: November 2019

Introduction: Although urinary incontinence is commonly associated with increasing parity, there is however a lack of published data on urinary incontinence among primiparous women. This study aims to determine its prevalence among primiparous women at 6-8 weeks postpartum, its risk factors and effects to their quality of life. Methods: This is a crosssectional study involving primiparous women at 6-8 weeks postpartum. Women in their third trimester were recruited using convenience sampling. Data were obtained using a study proforma, and International Consultation on Incontinence Questionnaire – Short Form (ICIQSF) over a face-to-face interview. The same questionnaire with additional enquiries on delivery was completed over a telephone interview at 6-8 week postpartum. Data were analysed using chi-square and simple logistic regression tests contained in the Statistical Package for Social Science version 20.0. Results: Three hundred and six women participated in this study. The prevalence of urinary incontinence in the third trimester of pregnancy was 34.3% (95%CI: 29.0, 39.7) and dropped to 5.2% (95% CI: 2.7, 7.7) at 6-8 weeks postpartum. Childhood enuresis and postpartum body mass index were the two factors that showed significant association with postpartum urinary incontinence. Urinary incontinence in 95 (31%) women had resolved by 6-8 weeks postpartum, whereas 10 (3.3%) women still had persistent symptom. A small proportion of women (2.0%) developed urinary incontinence in the postpartum period. Majority of women with urinary incontinence did not feel it significantly affected their quality of life. The ICIQ- SF mean score was 6.13 (range 2- 12). Conclusions: Postpartum urinary incontinence is rather uncommon among primiparous women and does not seem to affect their quality of life. Childhood enuresis and postpartum BMI were risk factors associated with postpartum urinary incontinence.
Shrinking Lung Syndrome – A rare cause of recurrent dyspnoea in SLE
Authors: Baharuddin Hazlyna , Mohd Zim Mohd Arif , Rosman Azmillah , Mohd Zain Mollyza
Published: November 2019

Here we present a 24-year-old lady with systemic lupus erythematosus (SLE) whom we diagnosed with shrinking lung syndrome (SLS), a rare manifestation of SLE. The initial SLE manifestation was alopecia, thrombocytopenia, serositis and vasculitis. Anti-nuclear antibody (ANA), anti-double stranded DNA (dsDNA) antibody, anti-ribonucleic (RNP) and anti-Ro antibody were positive. A year after diagnosis, she started to develop intermittent dyspnea and was hospitalised on three occasions. Lung examinations revealed reduced breath sounds at both bases and dullness at the right base. Multiple chest radiographs showed bilateral raised hemi-diaphragms. Other investigations including CT pulmonary angiogram, high resolution CT of the thorax, ventilation-perfusion scan and echocardiogram were not significant. On the third hospital admission, we noticed bilateral small lung volumes in the previous high resolution CT scan. Inspiratory and expiratory chest radiographs were performed and showed minimal change in lung volumes and a diagnosis of shrinking lung syndrome (SLS) was made. Her SLE remained active with lupus nephritis despite multiple immunosuppression and she passed away two years later due to sepsis with multi-organ failure.
Development of folliculitis in a patient with recalcitrant pustular psoriasis following acitretin treatment: A case report
Authors: Ahmad Nur Ashikin , Taib Tarita , Kuppusamy Meera
Published: November 2019

Oral retinoids are among the drugs of choice for pustular psoriasis. Therapy with retinoids, including acitretin, is potent teratogens with other common side effects such as mucocutaneous involvement. Mucocutaneous side effects including dry lips (cheilitis), skin peeling, hair loss (alopecia), dry skin, or rhinitis are dose-related, with cheilitis occurring in more than 75% of patients receiving the highest doses of acitretin (75 mg/day). We report on a 37-year-old woman who developed folliculitis with acitretin which is a rare cutaneous side effect. She presented with eruptions pruritic papules with follicular pattern on anterior thigh and forearms after almost 1 year of treatment with acitretin (50mg OD) for pustular psoriasis. The skin lesion was treated successfully with skin dressing and antibiotic treatment and skin biopsy is suggestive of folliculitis. Several treatments for pustular psoriasis including topical steroids, methotrexate and oral prednisolone were ineffective or not tolerated. Treatment with acitretin which are 50mg OD provided partial resolution of skin lesions. The case is hereby reported because of its rarity and folliculitis must be considered in the differential diagnosis of a popular eruption, especially in patients with high dose acitretin.
Selected Recommendations from International Guidelines on Obstructive Sleep Apnoea
Authors: Mohd Esa Nurul Yaqeen , Ismail Ahmad Izuanuddin
Published: November 2019

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally. However, it is still underdiagnosed mainly among Asian population partly due to lack of understanding on the pathophysiology, and limited access to the diagnostic and management aspect of the disease. Recurring complete and/or partial collapses of the upper airways define OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is categorized as mild, moderate and severe. Both the American Association of Sleep Medicine (AASM) and American College of Physicians (ACP) has published guidelines regarding the management of OSA in adults. Three recommendations have been suggested by the guidelines which can be used to tailor the management of OSA. The aim of this article is to select relevant recommendations from these guidelines in epidemiology, pathophysiology, diagnostic procedures and treatment for proper management of OSA, while considering specific patient populations, such as hypertensive, diabetic, obese and Asian patients.
Spontaneous Spinal Subarachnoid Haemorrhage: A Rare Complication of Dengue Fever
Authors: Mohd Sharif Nur Hidayati , Misnan Nor Arisah , Saidon Norashikin , Ooi Phaik Yee , Hashim Hilwati
Published: November 2019

A 37-year-old woman presented with a short history of fever and bilateral lower limb weakness. She also had impaired sensory function up to T4 spine level and lax anal tone. Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite medical and surgical interventions, her lower limb weakness persists. A high index of suspicion is needed to recognise dengue-related neurological complications. This diagnosis should be considered in any patients from dengue endemic areas presenting with acute febrile illness with atypical neurological manifestations.
Determination of the Optimum Time for Preparation of Half-Boiled Eggs Free from Salmonella Enterica Enteritidis
Authors: Akmar Omar Mohamad Fithri , Abdul Manaf Nurdiyana Syahirah , Mohd Sufian Siti Nurnajwa Nadhirah , Zakaria Norsuhaida , Ayub Nur Farhah Najwa , Mohd Nawi Siti Farah Alwani , Mohd Zain Zaini
Published: November 2019

Introduction: Consuming half-boiled eggs during breakfast is popular among Malaysians. The eggs are usually prepared by submerging them in freshly boiled water for about 20 minutes duration. As chickens have the likelihood of harbouring Salmonella enterica Serovar Enteritidis in their eggs, it is feared that consumption of half-boiled eggs contaminated with S. Enteritidis could lead to gastroenteritis. Hence, this study was carried out to determine the optimum time required for boiled water to kill S. Enteritidis in half-boiled eggs. Methods: Grade C chicken eggs (average weight 54.5 g) were obtained from a local sundry shop and were confirmed to be Salmonella-free prior to the experiment. Fifteen eggs that were previously spiked with 106 colony-forming units (CFU) of S. Enteritidis were completely submerged into freshly-boiled water (≈100ºC) for a maximum of 20 min. Positive controls consisted of eggs that were inoculated but were not treated. At every 5 min interval, three eggs were taken out and checked for presence of viable S. Enteritidis on MacConkey agar, and the respective water temperature was recorded. Results: Results of two independent trials showed that after 10 min of submerging the eggs in the hot water, there were an average of 3 log reductions in the CFU of S. Enteritidis but after 15 min, no viable S. Enteritidis was detected. Conclusion: A half-boiled egg should be prepared by submerging it in freshly boiled water for at least 15 min to ensure that it is safe to be consumed.
Iatrogenic Lingual Neuralgia Following Laryngoscopy
Authors: Ab Rani Aziah , Nadarajah Sanjeevan
Published: November 2019

Tongue pain attributed to lingual neuralgia has been reported following dental and oral surgical procedures. Lingual nerve insult through traction and compression during laryngoscopic examination has been proposed as possible etiology for lingual nerve neuralgia. We report a case of tongue ischemia during laryngoscopic procedure which resulted in lingual neuralgia. We recommend that intermittent release of pressure by relaxing the instrument or gag and monitoring the perfusion state of the tongue will reduce the risk of this lingual neuralgia.

KEYWORDS: Lingual neuralgia, Laryngoscopy, Tongue ischaemia
The Primary Health Care Performance Initiative (PHCPI): Issues and Challenges for Malaysia as a Trailblazer Country
Authors: Ramli Anis Safura , Taher Sri Wahyu , Zakaria Zainal Fitri , Ali Norsiah , Shamsuddin NurAinul Hana , Wong Ping Foo , Talib Nor Hazlin , Ismail Shaiful Bahari
Published: November 2019

A strong and robust Primary Health Care system is essential to achieving universal health coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs Profiles (VSP). However, the VSP project requires an honest and transparent data collection and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in support of Primary Health Care reform. This is a huge commitment and can only be materialised if there is a collaborative partnership between Primary Care and Public Health providers. Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and ‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system. This review aims to differentiate between Primary Care, Primary Health Care and Public Health, describe the relationships between the three entities and redefine the role of Primary Care and Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care system.
IOP Lowering Effects of Ocimum basilicum Seed Extract in Two Rabbit Models of Ocular Hypertension
Authors: Agarwal Renu , Gupta SK , Srivastava Sushma , Saxena Rohit
Published: November 2019

Introduction: Ocimum basilicum (OB), a herb known for its antihypertensive, anticholinesterase and antioxidant properties was investigated for possible intraocular pressure (IOP) lowering effects in rabbits with ocular hypertension (OHT). Methods: The IOP lowering effect of a single drop of OB extract (OBE) was evaluated in oculonormotensive rabbits using three concentrations (0.25, 0.5 and 1% w/v). The concentration showing maximum IOP reduction was further evaluated in rabbits with water-loading and steroid-induced OHT. Results: IOP lowering effect of OBE 0.5% in oculonormotensive rabbit eyes was significantly greater compared to OBE 0.25% (p<0.05) but was comparable (p>0.05) to OBE 1%. Therefore, 0.5% concentration was selected for further evaluation. Pretreatment with OBE (0.5%) caused significantly lower increase in IOP after water loading amounting to 23.39% above baseline as compared to 54.00% in control eye, 15 minutes post water loading. At 60 minutes, post water loading, mean IOP rise was 95.12% and 63.58% in control and test eyes, respectively. Significant difference between the mean IOP of two eyes persisted during the 2nd hr. In rabbits with steroid induced OHT, OBE 0.5% produced a mean IOP reduction of 24.73% at the end of first hr and the mean peak IOP reduction of 31.63% was observed at the end of 2 hr. A significant difference between the IOP of test and control eyes persisted from 1 to 6 hr. Conclusions: Ocimum basilicum seed extract showed significant IOP lowering effect in rabbits with water loading and steroid induced OHT, however, its utility as an effective antiglaucoma medication needs further investigations.