Search

This study investigates the level of learning media among form-six students. A quantitative approach using a questionnaire instrument was employed. The sample size includes 201 form-six students using a simple random sampling technique where the analysis involved is a mean score scale. The findings showed that utilization levels were moderate. Pre-university students were selected due to the importance of learning media in furthering studies at the university level. A lack of learning media knowledge will result in the students being unable to compete with others at the university level. Students have less practical experience in using learning media while in class.

A concept map is deemed a useful teaching and learning tool. It offers many potential advantages over just representing the students’ knowledge and understanding during learning, and have been widely used to support learning. Kit-Build concept map is one learning framework that incorporate digital concept map for its learning activities. Learning with Kit-Build concept map has been found to have better learning effects towards students' understanding and knowledge retention. Incorporating Kit-Build concept map into collaborative learning have been reported to have better outcome than the traditional collaborative learning. However, collaborative learning with Kit-Build concept map cannot be accomodated with the current Kit-Build system where learning activity is conducted online. This study presents the design and development of online collaborative learning platform of Kit-Build Concept Map. A prototype of the collaboration system to support collaborative learning with Kit-Build concept map is developed and be evaluated to portray its potential usability for further development and practical use. The result suggested that incorporating Socket.IO as a real-time communication middleware is effective to deliver online collaborative learning features into the Kit-Build system. Preliminary evaluation to the system also suggested that the system has the potential for actual use in supporting distant collaborative learning with Kit-Build concept map.

E-waste is any refuse created by discarded electronic devices and components as well as substances involved in their manufacture or use. Minimising the production of e-waste helps preserve resources and reducing the amount of energy drawn from the earth. One of the strategies to address this problem is raising e-waste disposal awareness in a sustainable manner among the community. This article aims to identify the level of e-waste disposal awareness among the Malaysia community. This study involved 500 people from nine districts in Selangor, Malaysia by using stratified random sampling method. A questionnaire instrument was used to obtain feedback. The three variables of e-waste disposal awareness studied were e-waste disposal knowledge, e-waste disposal attitudes and e-waste disposal practices. Each variable was divided into three sub-variables; environmental, social and economic. The results showed that the respondents’ e-waste disposal knowledge and e-waste disposal attitudes were at a high level, while their e-waste disposal practice were at a medium level. The findings and issues studied can be used as a reference for the government, non-governmental organisations, the authorities and the community when seeking to develop a more sustainable community life.

Myelodysplastic syndrome (MDS) merupakan gangguan klonal sel stem hematopoietik berupa sitopenia, displasia, dan cenderung bertransformasi menjadi leukemia mieloid akut. Diagnosis MDS ditegakkan berdasarkan pemeriksaan hematologi, morfologi sel darah tepi, sumsum tulang, pemeriksaan lanjutan sitogenetika dan imunofenotiping, namun dua pemeriksaan terakhir ini tidak tersedia di semua rumah sakit di Indonesia sehingga diagnosis MDS terbatas pada pemeriksaan morfologi sel darah tepi dan sumsum tulang. Tujuan penelitian ini adalah mengetahui gambaran hematologi pasien MDS di RSUP Dr. M. Djamil Padang, merupakan penelitian deskriptif di laboratorium sentral RSUP Dr. M. Djamil Padang dari bulan November 2016 sampai dengan Oktober 2017. Populasi adalah semua pasien yang melakukan pemeriksaan sumsum tulang. Sampel penelitian adalah semua pasien yang telah didiagnosis MDS dari hasil pemeriksaan hematologi, sediaan hapus darah tepi dan sumsum tulang. Didapatkan 19 penderita MDS yang terdiri dari laki-laki 52,6% dan perempuan 47,4%, dengan perbandingan 1,1 : 1; rata-rata usia 40,6 tahun. Hasil pemeriksaan fisik: anemia 68,4%, anemia+organomegali 31,6%. Pemeriksaan hematologi: anemia+leukopenia+trombositopenia 57,8%, anemia+leukopenia 21,1%, anemia+trombositopenia 21,1%. Pemeriksaan sediaan hapus darah tepi: gambaran eritosit, ukuran: anisopoikilositosis 73,6%, normositik 26,4%; warna: polikrom 57,8%, normokrom 42,2%, ditemukan blast pada 42,1% penderita. Pemeriksaan sediaan hapus sumsum tulang, selularitas: hiposelular 73,6%, hiperselular 21,1%, normoselular 5,3%. Displasia seri eritropoietik+granulopoietik+trombopoietik 47,4%; seri eritropoietik+granulopoietik 31,5%; seri eritropoietik+trombopoietik 15,8%; seri eritropoietik saja 5,3%. Gambaran hematologi pasien MDS terbanyak pada penelitian ini adalah anemia, anisopoikilositosis, polikrom, selularitas hiposelular, dan ditemukannya displasia seri eritropoietik, granulopoietik dan trombopoietik.

The purpose of this study is to compare the quality of groundwater during wet and dry seasons in Malaysia especially in Kuala Krai District which frequently involved in annual monsoon floods and the question whether the wells can be used during floods as well as an alternative source when there are no floods. Six sampling stations were selected using six main parameters which included DO, pH, BOD, COD, TSS and NH3N. The assessment was conducted based on the standards set by Malaysian INWQS and the classification of WQI. The results of the analysis showed that most of the water samples taken during the wet season had concentration values that did not meet the DOE standards such as the DO, BOD, and NH3N parameters. Based on the WQI classification, majority stations during the wet season were in moderately contaminated except for station T6 which was clean. On the contrary, during a dry season were found to be clean except for station T1 which was moderately contaminated.

Sepsis neonatorum merupakan penyebab utama morbiditas dan mortalitas neonatus di negara berkembang. Baku emasnya adalah kultur darah, namun sulit dilakukan. Pemeriksaan hematologi sederhana diperlukan untuk membantu klinisi menegakkan diagnosis sepsis neonatorum. Hematologic Scoring System (HSS) memiliki keunggulan terutama kemudahan dan kemurahannya. Tujuan penelitian untuk mengetahui gambaran HSS pada tersangka sepsis neonatorum. Penelitian ini merupakan penelitian deskriptif dengan rancangan potong lintang pada 34 pasien dengan diagnosis tersangka sepsis neonatorum awitan dini. Penelitian dilaksanakan mulai Desember 2015 hingga September 2016. Masing-masing parameter dalam skor HSS diperoleh dari pemeriksaan dengan alat hematologi otomatis dan sediaan hapus darah tepi. Hasil penelitian disajikan dalam bentuk tabel distribusi frekuensi. Tersangka sepsis neonatorum lebih banyak bayi laki-laki (58,8%), bayi berat badan lahir rendah (61,8%), dan bayi kurang bulan (64,7%). Sebanyak 14 pasien (41,2%) memiliki skor HSS 5 (sepsis). Skor terbanyak diperoleh dari peningkatan jumlah PMN dan penurunan jumlah trombosit, yaitu masing-masing 64,7% dan 50%. Pada skor HSS 5. Sebagian besar pasien tersangka sepsis neonatorum memiliki skor HSS

During Coronavirus Disease 2019 (COVID-19) pandemic, the use of telemedicine services in Indonesia rose. Telemedicine service policies were released as an emergency condition during the pandemic. Meanwhile, the post-pandemic policies on telemedicine have never been formulated. This study aimed to construct the policy recommendation related to telemedicine services in Indonesia in the COVID-19 post-pandemic. The policy recommendations were developed after an initial analysis of user needs. The respondents were 102 telemedicine users who were over 18 years old. Results showed that most telemedicine users (61%) were worried about misdiagnosis, and others (52.9%) were worried about data security and confidentiality. The conceptual policy recommendation was developed based on the situation analysis. Multi-stakeholder cooperation across institutions such as the Indonesian Ministry of Health, the Ministry of Information Technology, the Food and Drug Administration, the Association of Health Service Facilities, professional organizations, and telemedicine startups. Such cooperation may harmonize the implementation of policies.

A study of the water quality of the former tin mining lakes in Ipoh City was carried out to determine the Water Quality Index (WQI) and classification based on the Malaysia National Water Quality Standards, in order to determine its suitability to be developed as a water recreation area. Five former mining lakes were chosen: Gunung Lang, Taman Indah, Kg. Temiang, Lahat and Kg. Engku Husin. The parameters measured were pH, dissolved oxygen, suspended solids, biochemical oxygen demand, chemical oxygen demand and ammonical nitrogen (NH3N), while the heavy metals measured were lead (Pb), copper (Cu), zinc (Zn) and arsenic (As). The analytical study shows that four former mining lakes in this research are suitable to be developed for water recreation purposes as they are classified under class II with a WQI greater than 81, which holds a clean status. Only one lake, Kg. Engku Husin, is categorised as class III, which requires an intensive treatment before it can be used for recreational purposes. Meanwhile, heavy metals such as Zn, As and Cu were at the standard level except for Pb, which exceeded the set guidelines. The local authorities and project developers should take appropriate measures to ensure that this former mining lake is well maintained and managed so that it is preserved and suitable to be developed as a recreational area.

Tujuan yang ingin dicapai dari aplikasi ini adalah mengoptimalkan Aplikasi Mobile Zagiyan ( Zaringan Digital Nelayan) Dalam Menunjang Produktivitas Dan Keselamatan, Dan Kesehatan Nelayan ( Studi Kasus Kelompok Nelayan Percut) . Target utama Pengabdian ini adalah mengimplementasikan software dan system aplikasi mobile Zagiyan denganberbagai fitur seperti Fitur Harga ikan, Laporan Pendapatam , Info koperasi , info puskesmas, check in, report , panic dan lain lain. Hasil dari kegiatan ini adalah Nelayan mengenal aplikasi android Zagiyan untuk Peningkatan produktivitas, keselamatan dan kesehatan masyarakat pesisir. Tingkat Keakuratan aplikasi ini mencapai 90% . Aplikasi ini juga telah diterapkan di beberapa daerha yaitu Bagan Deli dan Percut .Aplikasi ini diharapkan menjadi solusi bagi seluruh nelayan Indonesia.

The purpose of this research are to know the beneficiaries and symbols contained in sugar palm plants in traditional ceremony Sipaha Lima. The method used in this research are the method of observation and depth interview. The data obtained in the form of plant parts used, how to obtain it and the meaning of symbol of the plant.The results is obtained eight types of use of sugar palm in traditional ceremony Sipaha Lima. Part of the plants used are: stems, leaves, and midrib. These plants are obtained from forests and crops.

Research about "Identification the type of fish in Sungai Batang Gadis Muarasipongi subdistrict Mandailing Natal Sumatra Utara" The study aims to determine the types of fish and Chemical Physics parameters. Research using descriptive methods and determination of observation stations is purposive sampling, that the sampling technique. The results of the study there are five types of fish that are grouped into two orders, namely the Cypriniformes and Siluriformes,and 3 Family namely Cyprinidae, Balitoridae, Sisoridae. The conclusion of the study there are 5 types of fish are included in the 2 Order and 3 Family entirely included into the group Osteichthyes. Most of the Order Cypriniformes and Siluriformes smallest. Most are family Cyprinidae. Results Physical and chemical parameters including water temperature 22oC; pH 7,53; brightness 1.40m; a depth of river 2.28 m; the flow velocity of river 2.09 m / sec; river width of 18 m.

This research was conducted to determine the species diversity of macrozoobenthos and determine the condition of physical and chemical factors in the waters of estuary river in Nipah Village Perbaungan District Serdang Bedagai Sumatera Utara. The result of diversity of macrozoobenthos obtained 28 species with one phylum, 2 class, 7 orders, 18 families and 20 genera. Measurement of physical and chemical factors waters obtained an average pH 7 both ebb and tide conditions; in conditions of salinity waters receded an average of 0 and at high tide the average of 5; the ebb and tide conditions an average temperature of 27-30°C; Average current speed 10,5-19,1 cm/s; Brightness average water 14-16,3cm; and an average depth of 40,3-150cm. Values obtained by the abundance of species which are 3378-5322 ind/m2. Macrozoobenthos types that dominate the river mouth Nipah are gastropods. Values Diversity Index (H ') macrozoobenthos of 2.152 to 2.762 were classified into well water. Uniformity index (E) showed a value of 0.397 to 0.532 (deployment is not uniform or uneven). Value Dominance Index (C) showed a value of 0.074 to 0.170 (the dominance of low or no kind dominance). In general, relatively good water conditions and suitable for life macrozoobenthos.

Research on Inventory type of shrimp in the waters of Kampung Nipah Perbaungan Bedagai Serdang District of North Sumatra, aims to determine the types of shrimp. The method used in this research is descriptive by surveying the catch. Data collection was performed by a sample of shrimp fisherman catch sea and river waters Nipah home twon village it selp Nipah arrest shrimp sample. Results of research on the waters of the River and Sea waters found 13 species belonging to four families. The families that most species are Panaeidae, while families Squillidae has one endemic species in the waters of the Sea. The families that most species Palaemoidae, while families Atydae has one endemic species in the waters of the river.

This research was conducted to determine the type of substrate and its composition in Kampung Nipah ecosystems Perbaungan Serdang Bedagai District of North Sumatra in February to March 2016. Sampling by using the pipe with descriptive methods and the purposive random sampling technique, while the measured variable is the biology variables that includes physical and chemical factors waters. Physical and chemical factors include pH, salinity, temperature. The study of these types of substrates include gravel, sand is very coarse, coarse sand, medium sand, fine sand, very fine sand, silt and clay. Measurement of physical and chemical factors waters obtained an average pH 7 both estuaries, mangrove rehabilitation and natural; salinity of estuarine waters at 200/00 and the rehabilitation of 280/00 natural mangrove 240/00; average temperature of 29-30°C. At the mouth of the river, gravel 0.95%, 97.56% sand and mud of 1.58%, obtained ma sand and mud of 1.58%, obtained mangrove rehabilitation of gravel 0.16%, 93.53% sand, and mud 6.12%, while the natural mangrove 0% gravel, sand 29.88%, 69.89% and mud. So we get the type of substrate on river estuaries nypa and mangrove rehabilitation is the sandy substrate and on a natural mangrove is a muddy substrate.

ἀis article aims to develope the Structural Equation Model (SEM) on Education for Sustainable Development (ESD) student awareness around Sustainable Schools in Malaysia. ἀe cluster sampling technique was used in selecting the school samples and the respondents were then also selected through simple random sampling among upper second-ary pupils. A questionnaire survey was administered for 447 pupils, to evaluate the aḀer eᴀects of the SLAAS. ἀe results showed that the model has been developed to provide an overview of each construct (knowledge on SLAAS Program, ESD content knowledge, ESD practices knowledge, attitudes of ESD and behavioral constructs of ESD) formed a ᰀt model. ἀe implication of this article showed that SLAAS Program implemented in Malaysia can be an indicator for the achievement of sustainable school.

AbstrakPeningkatan kadar urea (uremia) ditemukan pada gagal ginjal terminal.Tujuan penelitian ini adalah untuk mengetahui hubungan kadar urea dengan homocitruline pada pasien gagal ginjal terminal. Penelitian ini menggunakan rancangan analitik observasional cross sectional pada 23 pasien gagal ginjal terminal yang menjalani Hemodialisis di RSUP. Dr. M. Djamil Padang. Penelitian berlangsung sejak Februari hingga Oktober 2014. Subjek diambil dengan consecutive sampling. Sampel serum diperiksa kadar ureanya dengan metode enzimatik glutamate dehidrogenase. Homocitruline diperiksa secara indirek ELISA. Analisis statistik menggunakan uji korelasi Pearson. Hasil penelitian ini menunjukkan jumlah subjek sebanyak 52,2% perempuan dan 47,8 % laki-laki, dengan rerata umur 48,6+10,6 tahun, kadar urea 102,1+26,0 mg/dL, kadar homocitruline 1,2+0,7 ng/mL. Penelitian ini menunjukan ada korelasi negatif yang tidak signifikan (r=-0.2, p > 0.05) antara kadar urea dengan homocitruline pada pasien gagal ginjal terminal.AbstractIncrease urea (uremia) can be found at end stage renal disease. This study was know correlation between urea with homocitruline level at end stage renal disease. This is cross sectional observational analytic study at 23 patients with end stage renal disease on hemodyalisis in M. Djamil Hospital, Padang, from February 2014 until October 2014, with consecutive sampling. Urea level was determined from serum sample by kinetic enzymatic glutamate dehydrogenase, and homocitruline by indirect ELISA. Statistical analysis was done by pearson correlation. The research showed that 52.2% are women and 47.8% are men with mean age is 48.6+10.6 years old, mean urea level is 102.1+26.0 mg/dL, homocitruline level is 1.2+0.7 ng/mL. The correlation between urea level and homocitruline was not significant (r=-0.2, p > 0.05). There was negative weak correlation between urea level and homocitruline at end stage renal disease.

Endothelial instability is reported to be involved in the pathogenesis of COVID-19. The mechanism that regulates the endothelial dysfunction and disease virulence is not known. Studies on proteins that are released into circulation by activated endothelial cells may provide some means to understand the disease manifestation. The study investigated the circulating levels of two molecules Endoglin (Eng) and Syndecan-1 (SDC-1) that are presumed to be involved in the maintenance of endothelial integrity and their association with hypercoagulation marker in COVID-19 patients. The serum levels of Eng, SDC-1, D-mer were evaluated using ELISA at the time of admission (DOA) and day 7 post-admission among COVID-19 patients (N = 39 with 17 moderate and 22 severe cases). Compared to the time of admission, there was an increase in sEng and sSDC1 levels in all COVID-19 cases on day 7 post admission. The serum levels of sEng and sSDC-1 was significantly (P ≤ 0.001 & P ≤ 0.01 respectively) elevated in severe cases including the four deceased group compared to moderate cases on day 7 post admission. Further, the study molecules showed a strong positive association (P ≤ 0.001) with the hypercoagulation marker D-mer. The results show an early shedding of the endothelial proteins sEng and sSDC-1 into circulation as a host response to the viral infection during the febrile phase of infection. Increased levels of sEng and sSDC-1 along with D-mer could be beneficial in predicting COVID-19 disease severity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background & Objectives: Rickettsial diseases are important re-emerging infections that mostly go unnoticed or are misdiagnosed. Though few case reports of Indian tick typhus have been reported in Indian literature in the past 10 yr, prevalence surveys are few and far between. The objective of this research was to study the seroprevalence of spotted fever (SF) group rickettsiosis and its coinfection with scrub typhus (ST) in Puducherry region of south India, as these two diseases may show similar clinical presentations., Methods: During 2012-2015, paired sera of 320 febrile patients were examined for Rickettsia conorii IgM/IgG by ELISA and OX19 and OX2 agglutinins by Weil-Felix test. Additionally, patients were screened for ST IgM ELISA. Statistical analysis was performed for clinical and laboratory parameters in children and adults using Fisher's exact test and chi-square test with Yates correction., Results: Out of 320 patients, 142 (44.38%) had R. conorii IgM and/or IgG antibodies. Only IgM was present in 72 (22.5%) patients, while 36 patients were positive for IgG only and 34 were positive for both IgG and IgM. A total of 68 patients (21.25%) showed only OX19 and/or OX2 antibodies (titres ≥ 1 : 80). SF and ST coinfection was observed in 47 cases (14.69%)., Interpretation & Conclusion: Seroprevalence of SF in Puducherry was found to be quite high (44.38%). ST and SF coinfection was observed in 34.50% of the SG IgG positive patients, however, this require further evaluation by PCR to rule out cross-reaction or false positivity. At present ELISA seems to be an affordable alternative to highly subjective and technically demanding immunofluorescence assay (IFA) for serodiagnosis of SF., Competing Interests: None

Aim: Triacylglycerol/High density lipoprotein (TAG/HDL) ratio, a surrogate marker of LDL particle size (small dense) was included in our study to observe the link with insulin resistance and thyroid co-morbidity., Methods: Ninety three patients with T2DM of both genders were enrolled from a tertiary health care unit in Puducherry, during the latter half of 2015. The cardio-metabolic risk factors were assessed through body mass index (BMI), blood pressure, fasting blood glucose and lipid profile, glycated haemoglobin and homeostasis model assessment of insulin resistance (HOMA-IR). Serum free T4, T3 and TSH were also measured to evaluate the thyroid co-morbidity as a function of insulin resistance., Results: In addition to insulin resistance, results of our study were focussed on thyroid comorbidity. In overweight diabetic patients, the ROC curve analyses demonstrated that the best marker for insulin resistance was Triacylglycerol/High density lipoprotein (TAG/HDL), with the area under the ROC curve being 0.902. Thyroxine (T4) was less significant when compared to TAG/HDL with area under the ROC curve of 0.583. Triiodothyronine (T3) and T4 were more significant in obese group with areas under the curve being 0.842 and 0.816 respectively when compared against insulin resistance (cut-off value for HOMA-IR 2.69). The optimal cut-off points for overweight were: TAG≥101mg/dl; T4≥1.16ng/dl; TAG/HDL≥2.26 whereas for obese: TC≥163.5mg/dl; TAG≥141.5mg/dl; T3≥2.42pg/ml; T4≥0.96ng/ml., Conclusions: In overweight type 2 diabetics, TAG/HDL ratio could be used as a reliable marker for insulin resistance with thyroid co-morbidity and T3, T4 were better objective markers in obese type 2 diabetics., (Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: Clostridium difficile, a most important nosocomial enteric pathogen, is recognized globally as responsible for antibiotic-associated diarrhea and colitis. It is associated with considerable morbidity and mortality due to widespread use of antibiotics., Aims: The study was done to determine the prevalence of C. difficile infection (CDI) among the patients attending a tertiary care teaching hospital in Puducherry., Settings and Design: We performed a prospective cohort study in Mahatma Gandhi Medical College and Research Institute., Materials and Methods: Around 150 patients were evaluated along with the patient details. C. difficile toxin detection was done as per the standard algorithm using the C. Diff Quik Chek Complete® assay (TECHLAB, Blacksburg, VA, USA)., Statistical Analysis Used: Analysis was done using statistics software (SPSS 16.0, SPSS Inc., Chicago, IL, USA)., Results: The prevalence of CDI was found to be 4%. More toxin-positive cases were between 50 and 60 years of age, and there was no difference in gender. Intensive Care Unit showed more toxin-positive cases; however, there was no significant association between the occurrence of CDI and the primary diagnosis of the patients., Conclusions: The prevalence of CDI in our hospital was found to be 4%, which was relatively lower compared to other Indian studies. However, awareness of the risk factors may assist in identifying patients at higher risk for CDI, guide implementation of appropriate preventive measures, and modulate potential intervention measure during management.

Background & Objectives: The southern part of India has witnessed an increase in scrub typhus (ST) during the past ten years. ST outbreaks occurred during winter months but at intervals of one to three years. With only a few reports of ST in Puducherry, this study was undertaken to look for the persistence of ST cases in Puducherry and Tamil Nadu in the winter months., Methods: During relatively cooler months of September, 2012 to March, 2013, a total of 45 patients with fever and clinical suspicion of ST and who provided both acute and convalescent blood samples were included. Total WBC, platelet counts, serum creatinine, liver enzymes levels and a rapid immunochromatographic test (RICT) for ST were first done. Paired serum samples were analysed by two specific tests - ST IgM and IgG ELISA- and a non-specific, but widely used Weil-Felix (WF) test., Results: Of the 45 patients, 21 adults and seven children were confirmed as ST based on clinical and laboratory findings, and positivity in specific serological test(s). Setting ST IgM and IgG ELISA as reference, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for RICT were 91.67, 85.71 per cent; 90.48, 100 per cent; 91.67, 100 per cent and 90.48, 80.95 per cent, respectively. Similarly, for WF the values were 83.33, 75 per cent; 95.24, 100 per cent; 95.24, 100 per cent and 83.33, 70.83 per cent, respectively., Interpretation & Conclusions: ST continues to persist in the cooler months in Puducherry and neighbouring Tamil Nadu with fever and myalgia as prominent features. None of the tests evaluated in this study was found to be ideal, but ST IgM/IgG ELISA was useful for batch testing and the non-specific WF test can be used in resource poor settings.

A mass in right supraclavicular fossa in a diabetic patient mimicking tuberculosis (TB) adenitis that ultimately proved to be subcutaneous zygomycosis. A high degree of clinical suspicion is needed for diagnosis especially when these lesions occur at typical sites for the more common indolent infections like TB. This case is being presented not only because of its rarity, but to emphasize the role of early diagnosis and appropriate treatment to prevent serious complications due to proximity to major structures. Fluconazole was used despite not being the ideal drug, solely due to cost constraints. Our patient responded well. However, we do emphasize that response to fluconazole is the exception rather than the rule.

Objectives: To investigate whether Ramadan fasting has any effect on patients with heart disease., Methods: We prospectively studied 465 outpatients with heart disease who were fasting during the month of Ramadan from October 24 to November 24, 2003. These studied subjects were from various medical centers in the Gulf region; State of Qatar, Kuwait, United Arab Emirates, and Bahrain. We performed detailed clinical assessments one month before Ramadan, during Ramadan and one month after Ramadan and analyzed predictors of outcome., Results: Overall, the mean age was 55.9+/-11.3 years (age range 32-72). Of the 465 patients treated, 363 (78.1%) were males and 102 (21.9%) females. Among them, 119 (25.6%) patients had congestive heart failure, 288 (62%) patients with angina, 22 (4.7%) patients with atrial fibrillation and 11 (2.4%) patients with prosthetic metallic valves. Three hundred and seventy (79%) had prior myocardial infarction (MI), 195 (17.2%) had prior coronary artery bypass surgery (CABG), and 177 (38%) had prior percutaneous coronary interventions (PCI). At the time of follow-up, we found that 91.2% could fast and only 6.7% felt worse while fasting in Ramadan. Of the studied subjects, 82.8% were compliant with cardiac medications and 68.8% were compliant with dietary instructions. We hospitalized 19 patients during Ramadan for cardiac reasons (unstable angina, worsening heart failure, MI, uncontrolled hypertension, subtherapeutic anticoagulation or arrhythmias), Conclusion: The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. Most patients with stable cardiac disease can fast.

We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.