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Autism occurs in every racial and ethnic group gives a life-long impact to their affected relative. Conducive physical learning environment deliver benefit and helps autistic children improve their skill and performance. This research aims to develop a framework of the Physical Learning Environment, and this paper to determine the respondent knowledge of awareness on physical learning environment for autism. In summary, there are nine components involved: building scale, accessibility, wayfinding, toilet provision, window, ventilation/heating, threshold, legibility, and furniture. The significance of this research could contribute towards the creation of a quality environment for autistic children within the Malaysian context. Keywords: Autism; physical learning environment; descriptive analysis. eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i17.2806

Background and Aims: Brain damage caused by stroke is associated with sensorimotor and/or cognitive impairment, depending on area of brain affected and the severity of attack. The aims of this study were to show the importance of physiotherapy associated with electrolyte and mineral balance through diet correction in patients recovering from stroke. Methods: This is a follow-up study of two patients with stroke followed at Kinshasa International Hospital Center during period from May 16 to July 1, 2020. The first had received physiotherapy with foods for correction of the existing ionic and mineral deficiency and the second had only received pharmacological management with conservative physiotherapy without making a change in diet. Clinical and electrolyte monitoring was performed at regular intervals in both patients. The variables of interest evaluated in both patients were FIM, MOTOR/SENSORY and Ionic balance. Results: The parameters of FIM, motors and sensory functions were improved during follow-up, however they remained disturbed in the control. Na+, Cl﹣, K+, Ca2+, and ionic Ca+ improved from intake to discharge. The biological parameters deteriorated during follow-up in the control. At Day 1, only K+ which was higher in the control than the case. At discharge, a significant drop in K+ control was noted (4.1 vs 3.4); of Na+ (142 vs 125) and of Cl﹣ (109 vs 85). Conclusion: The results show that ionic balance by diet correction associated with physiotherapy is more effective than conventional physiotherapy associated with pharmacological management.

Children with Autism Spectrum Disorder (ASD) have difficulty sitting still, focusing, and attending the task. Creating a sensory environment would promote a conducive environment for them. Sensory sensitivity, sensory stimulation, sensory design, and physical learning environment are the key concepts contributing to the autism environment. The study goal is to explore the design criteria for creating a conducive environment for autism. This article is to examine the reliability and validity of the four main constructs. This is important to ensure the quality of achieving the data. The study's significance is to provide a guideline during the design stage and improve the autism learning environment. Keywords: Autism Spectrum Disorder; Principal Component Analysis, Autism Environment. eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i16.2696

The increasing numbers of autism give impact to the country, community and family. The only way to help autistic children is to provide them with proper education. Thus, architects play roles in creating responsive buildings. A pilot test has carried out on a group of people similar to the research population. The objective is to assess the reliability and validity of a questionnaire. Four sections (144 items) determining the frequency of Sensory Sensitivity, Sensory Stimulation, Sensory Design and Physical Learning Environment. Respondent (N=35) completed the survey and the reliability test resultant to reveal inconsistencies and revising the criteria accordingly. Keywords: Autism; validity; reliability; pilot test; eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i15.2470.

The emergence of non-vaccine multidrug-resistant Streptococcus pneumoniae serotypes is on rise. This study was performed to investigate a highly resistant serotype 15A S. pneumoniae isolated from the blood specimen of a 20-month-old patient who died of her infection. The SS40_16 isolate was resistant to erythromycin, co-trimoxazole, tetracycline, and chloramphenicol, as well as to penicillin, ceftriaxone, and cefotaxime (using meningitis cut-off points, Clinical and Laboratory Standards Institute). The isolate belonged to sequence type 1591 (ST1591) and was related to CC81 clonal complex, suggesting the possibility of horizontal gene transfer. Scanning electron microscopy comparison between resistant and sensitive pneumococcal isolates also indicated similar phenotypic characteristics that confer high resistance. The emergence of highly resistant non-vaccine pneumococci is of great concern to public health and in the clinical setting. Pneumococcal surveillance programs represent a crucial tool, not only for determining the impact of pneumococcal conjugate vaccines, but also for monitoring the selective pressure of serotype replacement with regard to the treatment of invasive pneumococcal disease. Keywords: Emerging non-vaccine serotype, Multidrug resistant, Serotype 15A

Objective To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. Design Prospective observational cohort study. Setting Single tertiary multidisciplinary antenatal clinic in Malaysia. Population A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT. Methods Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. Main outcome measures Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile. Results Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of 10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile. Conclusion Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. Tweetable abstract Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

The designated learning environment should be created as a unique learning space for autistic children and consider the sensory issues to overcome their needs. This learning environment would help Autism Spectrum Disorder (ASD) to continue their education in different environments to survive independently in the real world. This study used the variables of sensory stimulation, sensory sensitivity, sensory design, and physical learning environment to construct a questionnaire. It would distribute to architects towards achieving their level of knowledge and awareness. Findings are useful in the future for architects and designers when making decisions to provide conducive facilities for the autistic. Keywords: Sensory stimulation; sensory sensitivity; sensory design; physical learning environment eISSN 2514-7528 © 2019 The Authors. Published for AMER, ABRA & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/jabs.v4i14.338

According to the WHO there are more than 700,000 deaths every year involving vector-borne diseases such as malaria, dengue, Chagas disease, yellow fever and Japanese encephalitis. Aedes aegypti, the principal vector of the dengue virus, is of great concern in various parts of the world, especially in tropical and subtropical countries. Vector control through insecticide application is one of the best ways to control the disease’s transmission. Thus, insecticide resistance in Ae. aegypti poses a significant threat to public health worldwide. The use of plant natural product-based insecticides that are less harmful to the environment, and without known resistance development, constitutes an alternative to chemical insecticides. Given this, a methanolic extract from Vitex ovata plants was prepared and tested for its larvicidal effect against Ae. aegypti. A susceptibility test on Ae. aegypti larvae was conducted using the standard WHO method. Results showed that the methanolic extract of V. ovata had larvicidal activity against Ae. aegypti with LC50 values of 2114 mg/L, and achieved 84% mortality with the highest concentration at 10,000 mg/L. This study showed that the crude extract of V. ovata bioactive molecules could be potentially developed as biolarvicides for Aedes mosquito vector control. This study recommends future research on using different solvents in the isolation of active ingredients from V. ovata, identification of phytochemicals with larvicidal properties, a toxicity study and lastly, an evaluation of the effectiveness of controlling Aedes in small-scale field trials for environmentally safe botanical insecticide intervention.

Spinal muscular atrophy (SMA) is an autosomal inherited neuromuscular genetic disease caused, in 95% of cases, by homozygous deletions involving the SMN1 gene exon 7. It remains the leading cause of death in children under 2 years of age. New treatments have been developed and adopted for use in many countries, including the UK. Success of these treatments depends on early diagnosis and intervention in newborn babies, and many countries have implemented a newborn screening (NBS) or pilot NBS program to detect SMN1 exon 7 deletions on dried blood spots. In the UK, there is no current NBS program for SMA, and no pilot studies have commenced. For consideration of adoption of NBS for a new condition, numerous criteria must be satisfied, including critical assessment of a working methodology. This study uses a commercially available real-time PCR assay to simultaneously detect two different DNA segments (SMN1 exon 7 and control gene RPP30) using DNA extracted from a dried blood spot. This study was carried out in a routine clinical laboratory to determine the specificity, sensitivity, and feasibility of SMA screening in a UK NBS lab setting. Just under 5000 normal DBSs were used alongside 43 known SMA positive DBSs. Study results demonstrate that NBS for SMA using real-time PCR is feasible within the current UK NBS Laboratory infrastructure using the proposed algorithm.

Mortality estimation due to work-related illness has reached up to 2.4 million each year. The current coverage of occupational health services (OHS) in Malaysia is still low. Occupational health doctors (OHDs) are one of the essential personnel to ensure proper execution of OHS. This study was conducted to explore the experiences and views of OHDs on the challenges in implementing OHS in Malaysia. Four focus group discussions were conducted with OHDs (N = 23) from four different states in Malaysia in 2016. Another five OHDs participated in in-depth interviews to implement the identified codes or themes. The discussions were recorded and transcribed verbatim. NVivo version 11.0 was used to facilitate data analysis. The data were analysed following the thematic analysis guidelines. Three themes were identified from the discussions: difficulties in diagnosing occupational diseases and poisoning; poor practices, attitudes, and commitment by both workers and employers; and non-compliance with laws and regulations related to the industries. The common challenges discussed by the participants were the lack of knowledge and skills among OHDs, and the shortage of standard procedures, leading to difficulties to screen occupational diseases. The poor cooperation and behaviour from the industries also hindered OHDs when performing their services. This study suggests better training and provision of standard tools or guideline to assist OHDs in making occupational disease diagnoses, increasing OHS awareness among the industries, and enacting OHS as part of the laws and regulations with adequate enforcement.

Rhipicephalus species are distributed globally with a notifiable presence in Southeast Asia (SEA) within animal and human populations. The Rhipicephalus species are highly adaptive and have established successful coexistence within human dwellings and are known to be active all year round, predominantly in tropical and subtropical climates existing in SEA. In this review, the morphological characteristics, epidemiology, and epizootiology of Rhipicephalus tick species found in SEA are reviewed. There are six commonly reported Rhipicephalus ticks in the SEA region. Their interactions with their host species that range from cattle, sheep, and goats, through cats and dogs, to rodents and man are discussed in this article. Rhipicephalus-borne pathogens, including Anaplasma species, Ehrlichia species, Babesia species, and Theileria species, have been highlighted as are relevant to the region in review. Pathogens transmitted from Rhipicepahalus ticks to host animals are usually presented clinically with signs of anemia, jaundice, and other signs of hemolytic changes. Rhipicephalus ticks infestation also account for ectoparasitic nuisance in man and animals. These issues are discussed with specific interest to the SEA countries highlighting peculiarities of the region in the epidemiology of Rhipicephalus species and attendant pathogens therein. This paper also discusses the current general control strategies for ticks in SEA proffering measures required for increased documentation. The potential risks associated with rampant and improper acaricide use are highlighted. Furthermore, such practices lead to acaricide resistance among Rhipicephalus species are highlighted.

Occupational injury represents a considerable part of injury burden to the society as it may affect workers in their most productive years. The objective of this paper is to estimate the Markov transition probabilities of a worker’s health states over time using the Counting Method (CM) and the Proportional Odds Model (POM), focusing on disability among the Social Security Organization (SOCSO) contributors in Malaysia. Four health states namely active/work (A), temporary disability (T), permanent disability (P) and death (D) are considered, where the transition probabilities are estimated at yearly intervals based on age, gender, year and disability category.

Pyogenic liver abscess is an uncommon but potentially lethal infection if left untreated. Enteric bacteria and anaerobes are the most common causative organisms of pyogenic liver abscess. Although most infections are of a polymicrobial nature, monomicrobial infections are possible. An immunocompromised status and the presence of periodontal disease are the risk factors for liver abscess caused by these rare, monomicrobial anaerobic infections. Here, we report on a successful non-operative management of a case of multiloculated pyogenic liver abscess caused by Fusobacterium nucleatum in a young, healthy, immunocompetent male patient. The diagnosis was established by radiological imaging and was based on a positive aspirate culture, whereas the mainstay of treatment comprised percutaneous drainage and a prolonged course of antibiotics. Thus, the patient was successfully treated with a 2-week course of intravenous imipenem/cilastatin while he was on percutaneous drainage, and he is now doing well.

Noninvasive biomarkers are clinically useful for evaluating liver fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD). The aim of the present study was to compare plasma proteins in patients with early nonalcoholic steatohepatitis (NASH) (F0-F1) versus NASH with significant/advanced fibrosis (F2–F4) to determine whether candidate proteins could be used as potential noninvasive biomarkers. Nineteen biopsy-proven NAFLD patients including ten early NASH patients and nine NASH patients with significant/advanced fibrosis were enrolled in the present study. High-resolution proteomics screening of plasma was performed with the SCIEX TripleTOF 5600 System. Proteins were quantified using two different software platforms, Progenesis Qi and Scaffold Q+, respectively. Progenesis Qi analysis resulted in the discovery of 277 proteins compared with 235 proteins in Scaffold Q+. Five consensus proteins (i.e. Complement component C7; α-2-macroglobulin; Complement component C8 γ chain; Fibulin-1; α-1-antichymotrypsin) were identified. Complement component C7 was three-fold higher in the NASH group with significant/advanced fibrosis (F2–F4) compared with the early NASH (F0-F1) group (q-value = 3.6E-6). Complement component C7 and Fibulin-1 are positively correlated with liver stiffness (P=0.000, P=0.002, respectively); whereas, Complement component C8 γ chain is negatively correlated (P=0.009). High levels of Complement C7 are associated with NASH with significant/advanced fibrosis and Complement C7 is a perfect classifier of patients included in this pilot study. Further studies will be needed in a larger validation cohort to confirm the utility of complement proteins as biomarkers or mechanistic determinants of NASH with significant/advanced fibrosis.

Autism Spectrum Disorders (ASD) is a lifelong handicap that affects the lives and the people around them. Knowing them as a unique person, designated learning environment should consider the sensory issues to overcome their needs. However, designers are lack of awareness in terms of sensory design while designing learning spaces for autistic children. This research objective is to identify the sensory design of physical learning enviroment in the Autism Centre, while the paper aims to develop the Design Criteria Checklist of sensory design for Autism Centre. The result of the study highlighted factors that relating to quality physical learning environment.eISSN: 2398-4287 © 2018. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v3i8.1392

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon, biologically aggressive soft tissue sarcomas of neural origin that poses tremendous challenges to effective therapy. MPNSTs are among the most challenging mesenchymal malignancies to treat with poor prognosis. They usually affect young and middle-aged adults, tend toward early metastasis, and often demonstrate resistance to chemotherapy. We present a case of a 23-year-old female who initially presented with the right temporal swelling for 1 month associated with constitutional symptom which progressively worsening. The right craniotomy and excision biopsy were done with histopathological examination results suggestive of MPNST. Thorax-abdominal-pelvic computed tomography and magnetic resonance imaging further revealed multiple metastatic lesions involving spine, retroperitoneal, pelvic, chest wall, and lungs. This case illustrates the typical presentation of MPNST with its known poorly outcome.

The allocation of workers’ health expenditure is a major issue to employers in Malaysia, especially SOCSO, as it is closely related to the performance and welfare of workers. Work injury and occupational disease require employers to allocate substantial costs to compensate the disability benefits and benefits of dependents or pensions. This study aims to identify the level and trend of health expenditure for employees covered under Employment Injury Scheme (EIS) in the Malaysia Social Security Organisation (SOCSO) for years 2009-2013. Retrospective descriptive analysis is carried out on a 5-year data (2009-2013) which comprises all employees who contribute under the SBP. Based on the descriptive analysis, the number of active workers contributing to SOCSO and the amount of benefits paid by SOCSO are increasing every year. Based on the Temporary Disability (HUS) data, the number of working days lost due to accidents is different according to gender and age, with more male workers than female workers, and with more young workers (25-29 years) than aged workers. These findings provide an indication to the parties involved such as employees, employers and the government, that the health of employees significantly affects health expenses, and can have a huge impact on the nation’s economy.

Background Melioidosis is a neglected tropical disease with rising global public health and clinical importance. Melioidosis is endemic in Southeast Asia and Northern Australia and is of increasing concern in Malaysia. Despite a number of reported studies from Malaysia, these reports are limited to certain parts of the country and do not provide a cohesive link between epidemiology of melioidosis cases and the nation-wide distribution of the causative agent Burkholderia pseudomallei. Methodology/principle findings Here we report on the distribution of B. pseudomallei sequence types (STs) in Malaysia and how the STs are related to STs globally. We obtained 84 culture-confirmed B. pseudomallei from confirmed septicaemic melioidosis patients from all over Malaysia. Prior to performing Multi Locus Sequence Typing, the isolates were subjected to antimicrobial susceptibility testing and detection of the YLF/BTFC genes and BimA allele. Up to 90.5% of the isolates were sensitive to all antimicrobials tested while resistance was observed for antimicrobials typically administered during the eradication stage of treatment. YLF gene cluster and bimABp allele variant were detected in all the isolates. The epidemiological distribution patterns of the Malaysian B. pseudomallei isolates were analysed in silico using phylogenetic tools and compared to Southeast Asian and world-wide isolates. Genotyping of the 84 Malaysian B. pseudomallei isolates revealed 29 different STs of which 6 (7.1%) were novel. ST50 was identified as the group founder followed by subgroup founders ST376, ST211 and ST84. A low-level diversity is noted for the B. pseudomallei isolates described in this study while phylogenetic analysis associated the Malaysian STs to Southeast Asian isolates especially isolates from Thailand. Further analysis also showed a strong association that implicates agriculture and domestication activities as high-risk routes of infection. Conclusions/significance In conclusion, MLST analysis of B. pseudomallei clinical isolates from all states in Malaysia revealed low diversity and a close association to Southeast Asian isolates., Author summary Burkholderia pseudomallei, a Gram-negative saprophytic bacterium, is the causative agent of melioidosis. The burden of human melioidosis globally is predicted at 165,000 cases and 89,000 deaths annually and in Malaysia, it is estimated that more than 2000 patients die per year which is much higher than nation-wide deaths resulting from dengue or tuberculosis. Clinical presentation and antibiotic resistance vary by geographical regions making it difficult for public health officials to outline definitive diagnostic, treatment and outbreak management options for the country. This study provides information on the genetic diversity among Malaysian B. pseudomallei clinical isolates. The epidemiological analysis shows strong correlation of the Malaysian isolates with strains from Southeast Asia especially Thailand, reflecting the regional endemicity.

Patches from three orthogonal views of selected cerebral regions can be utilized to learn convolutional neural network (CNN) models for staging the Alzheimer disease (AD) spectrum including preclinical AD, mild cognitive impairment due to AD, and dementia due to AD and normal controls. Hippocampi, amygdalae and insulae were selected from the volumetric analysis of structured magnetic resonance images (MRIs). Three-view patches (TVPs) from these regions were fed to the CNN for training. MRIs were classified with the SoftMax-normalized scores of individual model predictions on TVPs. The significance of each region of interest (ROI) for staging the AD spectrum was evaluated and reported. The results of the ensemble classifier are compared with state-of-the-art methods using the same evaluation metrics. Patch-based ROI ensembles provide comparable diagnostic performance for AD staging. In this work, TVP-based ROI analysis using a CNN provides informative landmarks in cerebral MRIs and may have significance in clinical studies and computer-aided diagnosis system design.

Developing a new questionnaire as a tool used in data collection might be the greatest challenge. The survey must be both valid and reliable.The purpose of the paper is to describe the processes undertaken to develop the questionnaire to measure awareness and knowledge among who involves in the autistic learning environment. The researcher refers to the expertise to check the quality of the tool. Each expert independently evaluated all details regarding the relevance, the clarity, and the understandability of the instrument. The overall content of the questionnaire comprises of sensory stimulation, sensory sensitivity, sensory design, and physical learning environment. Keywords: Autism, pre-testing, questionnaire;eISSN: 2398-4287 © 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v5i13.1722

The designated learning environment for autism is unique and should consider sensory issues to overcome their needs. The purpose of this paper is to review related articles to gain a better understanding of autism needs regarding sensory design, sensory issues, sensory space, internal environment, and physical learning environment. This paper will outline the sensory design of the physical learning environment that would impact the sensory design towards the physical learning environment. This research paper concludes to be a guide for the designer to overcome sensory input so that autistic can learn more efficiently and develop with less stress.Keywords: Autism; sensory design; sensory issues; physical learning environmenteISSN: 2398-4295 © 2019. The Authors. Published for AMER, ABRA & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: http://dx.doi.org/10.21834/ajbes.v4i17.180

Introduction:World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.Aim:This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.Methods:Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.Results:Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (pDiscussion:Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.

Introduction Liver biopsy is an accurate method for determining stage and grade of non-alcoholic fatty liver disease (NAFLD). Given risks and limitations of biopsy, non-invasive liver tests (NILT) are used to risk-stratify patients. Guidelines recommend tests based on routinely collected data such as NAFLD fibrosis score (NFS), APRI, Fib-4, AST/ALT ratio and BARD. Prevalence and severity of NAFLD and metabolic syndrome vary by ethnicity, yet NILTs have been developed in largely White populations. We hypothesised that scores that include metabolic syndrome parameters (NAFLD fibrosis score and BARD) are less accurate in South Asian patients, while tests relying on biochemical data alone (Fib-4, APRI and AST/ALT ratio) or liver stiffness by transient elastography are equally accurate in different ethnicities. Method In a retrospective case review of patients with histologically-confirmed NAFLD, NILTs were calculated using clinical data within 1 week of the biopsy and compared to Kleiner fibrosis stage. For each NILT, we calculated markers of accuracy including sensitivity, specificity and area under receiver operator curve (AUROC) for predicting advanced (F3-4 vs F0-2) or mild (F0-1 vs F2-4) fibrosis. Results 204 patients with biopsy-proven NAFLD and complete clinical datasets were identified. The largest ethnic groups were South Asian (n=93) and White (n=84). Although there were no significant differences in NASH stage or grade, or diabetes prevalence between the two groups, South Asians were younger (44 vs 52 years, p Area under the receiver operator curves were highest for NFS and Fib-4 in both main ethnic groups, but were consistently lower for all NILTs in South Asian than in White patients. NILTs were less sensitive at detecting advanced fibrosis in South Asians. Relative risk of correct diagnosis in White patients compared to South Asians was 1.86 (95%CI 1.4–2.6). Fibroscan data were available for 48 patients, the accuracy of which was high in both White and South Asian patients. We derived and separately validated specific cut-off values for South Asian patients that increased the accuracy of NFS and Fib-4 to levels comparable to those seen in White patients. Conclusion Blood-test based NILTs are less accurate in South Asian patients, irrespective of whether the test includes metabolic parameters. This is not the case with transient elastography. Ethnicity should be considered when devising risk-stratification algorithms for NAFLD. Disclosure of Interest None Declared

ObjectiveLiver biopsy is the most accurate method for determining stage and grade of injury in non-alcoholic fatty liver disease (NAFLD). Given risks and limitations of biopsy, non-invasive tests such as NAFLD fibrosis score, aspartate transaminase (AST) to platelet ratio index, Fib-4, AST/alanine transaminase ratio and BARD are used. Prevalence and severity of NAFLD and metabolic syndrome vary by ethnicity, yet tests have been developed in largely white populations. We tested our hypothesis that non-invasive tests that include metabolic parameters are less accurate in South Asian compared with white patients.DesignRetrospective cross-sectional.SettingSpecialist liver centre.PatientsPatients with histologically confirmed NAFLD.InterventionsScores calculated using clinical data taken within 1 week and compared with histology (Kleiner).Main outcome measuresDiagnostic test characteristics.Results175 patients were identified. South Asians (n=90) were younger, had lower body mass index and lower proportion of obesity compared with white patients (n=79), with comparable rates of diabetes and liver injury. Tests are less sensitive at detecting advanced fibrosis in South Asian compared with white patients. Relative risk of correct diagnosis in white patients compared with South Asians is 1.86 (95% CI 1.4 to 2.6). In binary logistic regression models, ethnicity and platelet count predicted accuracy. Transient elastography was equally and highly accurate in both ethnicities.ConclusionsBlood test-based non-invasive scores are less accurate in South Asian patients, irrespective of metabolic parameters. Ethnicity should be considered when devising risk-stratification algorithms for NAFLD.

Data mining techniques are widely used in classification, attribute selection and prediction in the field of bioinformatics because it helps to discover meaningful new correlations, patterns and trends by sifting through large volume of data, using pattern recognition technologies as well as statistical and mathematical techniques. Hepatitis is one of the most important health problem in the world. Many studies have been performed in the diagnosis of hepatitis disease but medical diagnosis is quite difficult and visual task which is mostly done by doctors. Therefore, this research is conducted to analyse the attribute selection and classification algorithm that applied to hepatitis patients. In order to achieve goals, WEKA tool is used to conduct the experiment with different attribute selector and classification algorithm . Hepatitis dataset that are used is taken from UC Irvine repository. This research deals with various attribute selector namely CfsSubsetEval, WrapperSubsetEval, GainRatioSubsetEval and CorrelationAttributeEval. The classification algorithm that used in this research are NaiveBayesUpdatable, SMO, KStar, RandomTree and SimpleLogistic. The results of the classification model are time and accuracy. Finally, it concludes that the best attribute selector is CfsSubsetEval while the best classifier is given to SMO because SMO performance is better than other classification techniques for hepatitis patients.

The designated learning environment for autism should consider sensory issues to overcome their needs. This paper would review related articles to gain a better understanding of autism needs regarding sensory design, sensory issues, sensory space, internal environment, and physical learning environment. This paper will outline the sensory design of the physical learning environment that would impact by the sensory design towards the physical learning environment. This research paper would be a guide for the designer to overcome sensory input so that autistic can learn more efficiently and develop with less stress.Keywords: Autism; sensory design; sensory issues; physical learning environment;eISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v4i10.1618

Autism is a lifelong handicap that affects their social skills, repetitive behaviors, speech, and nonverbal communication, as well as by unique strengths and differences. Knowing them as a unique person, designated learning environment should consider the sensory issues to overcome their needs. However, designers are lack of awareness in terms of sensory design during their design stage. The objective is to identify the sensory design of the classroom environment, while the paper aims to develop the Design Criteria Checklist of sensory design for Autism Centre. The result of the study highlighted factors that relate to the quality physical learning environment.Keywords: Autism; sensory design, physical learning environment; design criteria checklist;eISSN 2398-4295 © 2018. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that impairs verbal and non-verbal communication and social interaction by showing themselves in repetitive behaviour, sensory issues, and cognitive delay. With proper learning environment, autistic children can continue their lives with their peers who exhibit regular development. The paper aims to develop a conceptual sensory design of Autism Physical Learning Environment. The objective is to identify sensory issues for design consideration in a physical learning environment. Perhaps, this could help designers to gain better understand the variables of certain school design features and school facilities.

Diabetes mellitus is an important risk factor for the development of cardiovascular disease. The impact of diabetes on the heart in part resides in the changes in metabolic fuel availability evoked by lack of insulin or resistance to its action. This review addresses how the metabolic abnormalities associated with poorly controlled diabetes impact cardiac fuel supply and handling, with emphasis on the coordinating roles of the PPARs.

The aim of this study was to determine the effectiveness of demineralized freeze-dried bone xenograft (DFDBBX) in minimizing post-surgical recession in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were matched for the tooth type, location of defects and periodontal pocket depth (5 to 7mm). Following an initial nonsurgical treatment, recession at defects indicated for surgery was measured pre-operatively. Surgical treatment was carried out by split mouth design, where the test sites were assigned DFDBBX and the control sites were subjected to debridement without the use of DFDBBX. Recessions were measured at 3 months, 6 months and 9 months post-operatively. The results showed no statistically significant difference in mean recession at 3, 6 and 9 months post-operatively compared to baseline for both test and control groups. Thus, DFDBBX was ineffective in minimizing recession on patients with moderate to severe periodontitis, as compared to surgical debridement alone.

This study evaluated the effectiveness of demineralized freeze-dried bone xenograft in reducing post-surgical pocket depth in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were selected for this study. The bony defects were matched for tooth type, location and pocket depth. Following an initial non-surgical treatment, only pockets of 5 to 7 mm deep were indicated for surgery. Periodontal pockets were measured pre-operatively and at 3, 6 and 9 months post-surgically. The study protocol included a split mouth design, where surgical treatment was carried out at both test and control sites. The test sites were assigned demineralized freeze-dried bone xenograft and the control sites were subjected to debridement alone without the use of demineralized freeze-dried bone xenograft. The results from this study showed a statistically significant difference in the mean pocket depth at 6 and 9 months post-operatively for both test and control groups, but there was no statistically significant difference at 3 months. In conclusion, demineralized freeze-dried bone xenograft was ineffective in reducing periodontal pocket depth in patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Background The second-line anti-tuberculosis drugs used in the treatment of multidrug-resistant tuberculosis often cause adverse events, especially in patients co-infected with the human immunodeficiency virus. Severe hypersensitivity reactions due to these drugs are rare and there is little published experience to guide their management. Case presentation A 17-year old Indian female multidrug-resistant tuberculosis patient co-infected with human immunodeficiency virus developed a hypersensitivity reaction after starting second-line anti-tuberculosis treatment in Mumbai, India. The patient was being treated with kanamycin, moxifloxacin, para-aminosalicylic acid, cycloserine, clofazimine, and amoxicillin-clavulanic acid. Twenty-four hours later, the patient developed generalized urticaria, morbilliform rash and fever. All drugs were suspended and the patient was hospitalised for acute management. Skin patch-testing was used to identify drugs that potentially caused the hypersensitivity reaction; results showed a strong reaction to clofazimine, moderate reaction to kanamycin and mild reaction to cycloserine. An interim second-line anti-tuberculosis regimen was prescribed; cycloserine and kanamycin were then re-challenged one-by-one using incremental dosing, an approach that allowed clinicians to re-introduce these drugs promptly and safely. The patient is currently doing well. Conclusions This is the first case-report of a multidrug-resistant tuberculosis patient co-infected with the human immunodeficiency virus with hypersensitivity reaction to multiple second-line anti-tuberculosis drugs. Skin patch-testing and controlled re-challenge can be a useful management strategy in such patients. There is an urgent need for second-line anti-tuberculosis regimens that are more effective, safe and better tolerated.

Background: Mumbai has a population of 21 million, and an increasingly recognised epidemic of drug-resistant tuberculosis (DR-TB). Objective: To describe TB infection control (IC) measures implemented in households of DR-TB patients co-infected with the human immunodeficiency virus (HIV) under a Medecins Sans Frontieres programme. Methods: IC assessments were carried out in patient households between May 2012 and March 2013. A simplified, standardised assessment tool was utilised to assess the risk of TB transmission and guide interventions. Administrative, environmental and personal protective measures were tailored to patient needs. Results: IC assessments were carried out in 29 houses. Measures included health education, segregating sleeping areas of patients, improving natural ventilation by opening windows, removing curtains and obstacles to air flow, installing fans and air extractors and providing surgical masks to patients for limited periods. Environmental interventions were carried out in 22 houses. Conclusions: TB IC could be a beneficial component of a comprehensive TB and HIV care programme in households and communities. Although particularly challenging in slum settings, IC measures that are feasible, affordable and acceptable can be implemented in such settings using simplified and standardised tools. Appropriate IC interventions at household level may prevent new cases of DR-TB, especially in households of patients with a lower chance of cure.

Petros Isaakidis,1,2 Sharmila Pimple,3 Bhanumati Varghese,1 Samsuddin Khan,1 Homa Mansoor,1 Joanna Ladomirska,1 Neelakumari Sharma,1 Esdras Da Silva,1 Carol Metcalf,4 Severine Caluwaerts,4 Petra Alders,4 Evangelia E Ntzani,2 Tony Reid41Médecins Sans Frontières, Mumbai, India; 2Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; 3Preventive Oncology Department, Tata Memorial Hospital, Mumbai, India; 4Médecins Sans Frontières, Brussels, BelgiumBackground: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.Keywords: HIV/AIDS, HPV, women's health, cervical cancer, operational research, India

Background The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART). Methods Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation of HIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations. Results Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158–361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of seven patients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). ‘These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%). Patients with extrapulmonary TB and patients Conclusions Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai, India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.

Background: Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients. Methods: This was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment. Results: Between October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54). Discussion: High rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.

Introduction Placental growth factor (PlGF) is increasingly recognised as a marker of placental dysfunction. PlGF for the diagnosis of pre-eclampsia (PE) has recently been recommended by the NICE diagnostic assessment panel to rule out PE within one week but the significance of a positive test remains uncertain. Objectives The aim of this study was to evaluate the use of PlGF in routine practice in women with suspected placental disease with and without features of maternal disease. Methods Women with chronic disease (hypertension, renal disease ± diabetes, n = 114) with a change in maternal condition or women with suspected fetal growth restriction (FGR) (n = 146) had a PlGF performed >20 weeks. Results were revealed and standardised care pathways followed. Outcomes were checked by two independent reviewers. Results In line with previous reports, we observed a much shorter median test-delivery interval in women with a low PlGF Despite a strong association between low PlGF and poor outcome (62% delivered 14 days. 62% (n = 18) of these women had PE and 28% (n = 8) had FGR without maternal disease. There was no significant difference in the test-delivery interval between these groups (13 [0–37] compared with 11 [1–35] days, p > 0.05). There were 2 false positive cases of low PlGF without a diagnosis of PE, however these women had confounding medical comorbidities which made the diagnosis ambiguous. Similarly, 2/77 women had a false positive intermediate PlGFs associated with concurrent maternal disease. There were no normal pregnancy outcomes associated with low PlGF. Evaluation of the 7 false negative cases (a diagnosis of PE with a normal PlGF) demonstrated that none were obtained within a week of delivery (27 [7–63] days). Three of these cases had long test-delivery intervals and 3 cases were complicated by complex maternal disease. Of the women with a normal PlGF and small for gestational age (SGA) (n = 51), the median test-delivery interval was 48 [4–90] days. However, 48/51 (94%) were >7 days before delivery.9/51 of these normotensive SGA pregnancies with normal PlGF were delivered for suspected FGR (abnormal growth velocity, oligohydramnios and/or abnormal Dopplers) and had a median birthweight (BW) centile of 2.8 (0–8–8.3), 17 for suspected SGA (median BW centile 3.6 [0.1–9.6]) and 25 delivered for other reasons (median BW centile 5.25 [1–9.3]). There were 3 cases of stillbirth, one of which had a normal PlGF (23 days before delivery; BW centile 1.4). Conclusion In our cohort, a low PlGF was universally associated with a poor outcome and short test-delivery interval which was not affected by the indication (maternal or fetal) for the PlGF. Our evaluation confirms the value of PlGF as a diagnostic tool for placental dysfunction, however it has highlighted that several evidence gaps remain before this test can be implemented in routine clinical practice and confirms that abnormal PlGF levels in isolation are not an indication for delivery. Further research linking placental pathology and maternal PlGF levels is urgently needed.

Background: Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings. Methods: Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE. Results: Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen. Conclusions: AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment.

Background : There are limited data on the failure of second-line antiretroviral therapy (ART) and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Medecins Sans Frontieres (MSF) HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care. Objective : To describe the experiences and programmatic challenges during management of suspected second-line ART failure and third-line ART therapy for patients living with HIV, including the use of HIV viral load (VL) testing. Design : This was a retrospective, observational cohort study of patients with suspected second-line ART treatment failure, who were followed for at least 12 months between January 2011 and March 2014. Results : A total of 47 patients with suspected second-line failure met the inclusion criteria during the study period. Twenty-nine of them (62%) responded to enhanced adherence support, had a subsequent undetectable VL after a median duration of 3 months and remained on second-line ART. The other 18 patients had to be initiated on a third-line ART regimen, which consisted of darunavir–ritonavir, raltegravir, and one or more appropriate nucleoside or nucleotide reverse transcriptase inhibitors, based on the results of HIV genotype testing. Of the 13 patients for whom follow-up VL results were available, 11 achieved virological suppression after a median duration of 3 months on third-line ART (interquartile range: 2.5–3.0). No serious treatment-related adverse events were recorded. Conclusions : With intensive counselling and adherence support in those suspected of failing second-line ART, unnecessary switching to more expensive third-line ART can be averted in the majority of cases. However, there is an increasing need for access to third-line ART medications such as darunavir and raltegravir, for which national ART programmes should be prepared. The cost of such medications and inadequate access to VL monitoring and HIV genotype testing are currently major barriers to optimal management of patients failing second-line ART. Keywords : viral load; HIV; adherence; counselling; antiretroviral therapy; genotyping; India (Published: 30 July 2014) Citation : Glob Health Action 2014, 7 : 24861 - http://dx.doi.org/10.3402/gha.v7.24861

BackgroundLittle is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.MethodsA retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.ResultsThe median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.ConclusionsEarly mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

Introduction: Western researchers showed that oral squamous cell carcinoma (OSCC) patients exhibit lower survival rate and poorer prognosis compared to other type of cancer where several clinicopathological parameters have been implicated in the survival of patients. This study aims to assess the association between sociodemographic and clinicopathological parameters with survival of OSCC patients. Method: Data were collected from 253 histologically diagnosed OSCC patients attending selected clinics nationwide. Survival was analyzed for relation with habits, site, disease stage and nodal involvement. Results: Mean age was 58.9 ± 12.6 years with 8.3% aged less than 40. Majority is females (61.1%) and of Indian ethnic (48.0%). Most common habit was quid chewing (55.8%), followed by smoking (29.7%) and most came at stage IV (44.3%). Tongue was the most common site (38.9%), followed by buccal mucosa (35.0%). Factors associated with survival are smoking (p = 0.016), stage at presentation (p < 0.001) and nodal involvement (p < 0.001). Discussion: Majority of OSCC cases occurred among Indians where the patients were quid chewers and presents with advanced cancer. Survival of patients decreased steadily over the years. At 1 year after diagnosis, 67.2% was still alive but only 13.4% survived 5 years. Among the habits studied, only smoking was found to be associated with survival where among those smoking, only 38.7% is alive compared to 61.3% deceased. No association was found between site and survival. A highly significant association was seen for both cancer stage and nodal involvement with survival. More survivors were found among those who come at early stage (76.3%) compared to late stage (32.7%). Similarly, more than two thirds (69.1%) of those who present with negative nodal involvement were found to be alive. In conclusion, smoking, disease stage and nodal status are predictors of survival for OSCC patients in Malaysia. Acknowledgements: Grant-IRPA06-02-03-0174PR0054/05-05/, OPEX-UM 2008, 2009, 2010, Abraham, M.T., Anand, R., Tay, K.K., Mustafa, W.M.W., Yuen, K.M., Norlida, A., Rahman, Z.A.A.

Introduction: Uncoordinated data collection by different research groups prompted the initiation of Malaysian oral cancer Research Initiative (MOCRI) group. Objectives: To coordinate and standardize data and tissue collection and storage, develop a minimum dataset on risk factors, intervention techniques and quality of life of oral cancer patients. Materials and Methods: A computer software programme is currently being developed to accommodate multi-centre data collection and research activities in eight hospitals. The complete dataset includes parameters on sociodemographic, clinical, pathological, quality of life measures, details of treatment methods, vital status and dietary intake. Tissues are being collected, stored and catalogued as fresh and formalin-fixed tissues for future use in satellite researches. The networking in tissue and data collection includes the establishment of oral cancer cell-lines. These tissues are being planned for studies on genetic profile, genetic polymorphism, diagnostic and prognostic markers. Results: Tissues and data on 115 oral cancers, 9 leukoplakia and 13 lichen planus has been collected since 2003. Preliminary data from 2004 were analysed for 58 cancer patients. Majority of them are more than 60 years old (65.5%) with a mean age of 63.3. Twenty-four (41.4%) were males, 34 (58.6%) females with the majority of them being Indians (56.9%) followed by Chinese and Malays (15.5% each), Indigenous people of Sabah and Sarawak (12.1%). Eighteen (31%) respondents were smokers, 17 (29.3%) alcohol drinkers and 31 (53.4%) betel quid chewers. Five patients have had histories of family cancers where 3 included immediate family members with head and neck cancers. For the quality of life measure, only 30.2% felt that their daily activities were disrupted despite having advanced cancers. Satellite researches are in progress on genetic polymorphism and tumour markers. One oral cancer cell-line has been established. Conclusion: The establishment of oral cancer database and tissue bank in encouraging and supports on-going satellite researches.

Hedyotis corymbosa (L) (Khetpapra in Bengali), a weedy herb of Rubiaceae family is used as a traditional medicine in Bangladesh for the treatment of Jaundice and other liver disorders. In the present study, hepatoprotective and anti-bacterial activity of ethanolic extract of the herb and ursolic acid isolated from it were investigated against paracetamol induced hepatotoxicity in Long Evan's rats and also against some selective gram positive and ten gram negative bacteria. The ethanolic extract of the plant showed significant hepatoprotective effect as evident by decreased serum enzyme levels, SGPT, SGOT, SAKP and SBIL, and also by normal histological architecture of the liver when compared to the paracetamol treated group. Moreover, ethanolic extract, n-hexane fraction and ursolic acid showed maximum activity of 18, 19, 21 mm against Sarcina lutea, Klebsiella pneumonia and Staphylococcus aureus respectively when compared with standard kanamycin disc (30 μgm/disc). These results thus support Hedyotis corymbosa and ursolic acid as hepatoprotective and antibacterial agent. Key Words: Hedyotis corymbosa ; Ursolic acid; Hepatoprotective activity; Antibacterial activity. DOI: 10.3329/bjsir.v45i1.5174 Bangladesh J. Sci. Ind. Res. 45(1) , 27-34, 2010

This study was carried in BSMMU from July 2001 to June 2003. During the study period, 60 pregnant women were studied. Thirty patients were preeclamptic and thirty were normal healthy pregnant women served as control. Serum lipoprotein(a) was found significantly higher in preeclamptic women 56.63±22.6 mg/dl and found within limit in normal healthy pregnant women, 12.89±4.59mg/dl. Result is statistically highly significant (P