Onychomycosis Treatment Evaluation

Onychomycosis Treatment Evaluation A synopsis on Onychomycosis in patent with high degree of glycated hemoglobin (HbA1c) Essa Ajmi Alodeani, Mohammad Asrar Izhari, Mohammad Arshad Abstract: Onychomycosis is an intercontinental disease burden and poses growing concern for the health-care establishment. It is a comparatively quotidian dermatologic manifestation. It is an infection of the nail plate or nail bed caused by fungus which leads to the imperceptible destruction of the nail plate, accounting for about half of all disordered nails and almost 30% of cutaneous mycoses. Variation in the incidence of the ailment reflects region and age. Usually it is not a self-limiting dermatologic representation and may trigger more infectious lesions at another site of the body owing to progressive nature of mycosis. Cosmetically unsightly affected nails may begin to be painful and lead to functional impairment. In case of patients with high degree of glycated hemoglobin (HbA1c) which is now days evaluated as an indicator of diabetes control, onychomycosis treatment becomes more imperative owing to the association between diabetes and the diabetic foot ulcer which one of the most s erious sequelae of diabetes in the lower extremities. Especially lower limb sequelae are great contributors to hospitalization of diabetic patients accounting for the majority of in-hospital stay and huge consumption of resource leading to the great deal of economic setback of the health care system of the country. Approximately 15% of diabetic patients develop a lower extremity ulcer during the course of their ailment. Diabetic foot syndrome (DFS) affects 1 out of 5 diabetic patients at least once in his/her lifetime. The necessity of the selected treatment in these patients must be exercised to minimize or anticipate any adverse drug interactions as they concurrently use other medications. With the avalanche of scientific evidences and keeping all the aspects of the onycomycosis, it would be worth to undertake the subject under investigation. Keywords: Onychomycosis, diabetic patients, glycated hemoglobin (HbA1c) Introduction: Onychomycosis is a global and comparatively quotidian dermatologic manifestation raising disease burden and poses growing concern for the economy of health-care establishment. It accounts for about half of all disordered nails and almost 30% of cutaneous mycoses. In case of patients with higher degree of glycated hemoglobin (HbA1c)-a diabetic monitoring marker, the treatment becomes more imperative owing to the association between diabetes and the diabetic foot ulcer which one of the most serious consequences of diabetes in the lower extremities. Which is a great contributor to hospitalization of diabetic patients accounting for the majority of in-hospital stay and huge consumption of resource leading to the great deal of economic setback of the health care system of the country. Onychomycosis is a very common nails infection globally and responsible for 30% of cutaneous mycotic infections and 50% of all nail disorders [1-3]. It is associated with morbidity and long lasting treatment with anti-fungal agents and leads to substantial patient distress, disability, pain, negative self image and can predispose to the soft tissue infection, particularly cellulitis [4-7]. It is more common in diabetic than nondiabetic patients and the patients with diabetic infection have a greater risk of serious complications from the disease such as limb amputations [9-23]. Recent epidemiologic study reveals that diabetic patients are 2.8 times more likely to have onychomycosis than nondiabetic patients. Diabetic patients are very much susceptible to fungal nail infections as they often experience impaired sensation; lack of pain sensation can make them less aware of trauma to their feet, such as nail changes that develop during onychomycosis [23]. Thickened mycotic nails can cause pressure necrosis of the nail bed in diabetic patients, and sharp infected nails can pierce the skin. In diabetic patients the minor ulcerations are serious as they are often unrecognized and can lead to serious diabetic foot infections [23]. The morbidity associated with the onychomycosis infections itself and in combination with the diabetic infection and also the hepetotoxicity of the available drugs is a great problem both at nationally and internationally. With the avalanche of scientific evidences and keeping all the aspects of the onycomycosis, it would be worth to undertake the subject under investigation. Review of literature: Glycated haemoglobin (HbA1c) was firstly identified as an â€Å"unusual† haemoglobin in diabetic patients with over 40 years ago [24]. Then studies were conducted for correlating it to glucose measurements resulting in the idea that HbA1c could be employed to measure the glycaemic control. After that it enters into clinical use in the 1980s and subsequently has become a cornerstone of clinical practice [25]. It reflects average plasma glucose over the previous eight to 12 weeks [26] and can be done at any time of the day and does not require any special preparation such as fasting. These qualities made it the preferred test for assessing glycaemic control in people with diabetes. Recently it has been used as a diagnostic test for diabetes and as a screening test for persons at high risk of diabetes [27, 28]. There are many approaches to treat onychomycosis such as mechanical debridement, surgery, sys-temic/oral interventions and topical treatment [9] and also the agents for tr eatment of onychomycosis include both systemic and topical medications showing the mycological cure rates of 76% with the use of terbinfine, 63% with the use of itraconazole pulse dosing, 61% with the use of griseofulvin, and 48% with the use of fluconazole [9]. Itraconazole which is a triazole nucleous containing anti fungal agent inhibiting fungal lanosterol 14-demethylase, an essential enzyme in ergosterol synthesis. Brod spectrum of antifungal activity is possessed by this antifungal agent in comparison to all the broadest spectrum of activity includes activity against dermatophytes, Candida species as well as some moulds [29]. It has high lipophilicity and high affinity for keratinous tissues, in which the concentration is many times greater than that obtained in plasma. Itraconazole exerts a lasting inhibitory effect due to the high and long lasting stages in the epidermis [30]. Terbinafine is well-tolerated by most patients and one study reveals that terbinafine or pulse-dose itraconazole reported greater ease and convenience, and higher overall satisfaction [31]. Safety concerns associated with oral treatments include hepatotoxicity, cardiovascular disease, hypogeusia, gastrointestinal disorders, skin rashes, menstrual disorder, visual and taste disturbance, headache and riversible evaluation of liver enzymes [31]. Erick M et al.studied the disease riskfactors and treatment responses in an urban population due to Microsporum spp. (onychomycosis) [32]. Leelavathi M. et al. reported the common microorganisms causing onychomycosis in tropical Climate [33]. Pericher et al. evaluated of onychomycosis among diabetic patients of Yazd diabetic center [34]. R.R. Hafidh1 et al. presented a case report on Cladosporium spp. as a causative agent of white superficial onychomycosis [35]. Lisa M. et al. reviewed the safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes [36]. There are many othere studies that acknowledge the complexity of treating tinea pedis and onychomycosis in people with diabetes and recommended as safe and effective treatment [37-39]. Marchetti et al. performed the first U.S.based pharmacoeconomic evaluation comparing oral griseofulvin, itraconazole, ketoconazole, and terbinafine using the previously constructed decision-analytic model by the onychomycosis study group [40]. Mahin moghaddami and Mohammad reza shidfar studied the onychomycosis infections in Tehran [41]. Mohammad Ali Boroumand et. studied the level and clinical outcomes of HbAc1in diabetic patients following coronary artery stenting [42]. Peterson et al reported that interpretation of HbAc1 can be achieved as an average of the blood glucose which is present over past 3-4 months [43]. Muhammad S. et al. isolated the causative pathogens and correlated the various clinical patterns of onychomycosis with causative pathogens in Qassim region of Saudi Arabia [44]. Ahmed Medhat M H. et al. reported the epidemiology of cutaneous mycosi s in the Medina region of Saudi Arabia correlated with studying the effect of light-induced gold nanoparticles on the in vitro growth of dermatophytes [45]. Abdulrahman Y. Al-Zoman et al. studied the pattern of skin disease in Riyadh military hospital, Saudi Arabia [46]. A steady increase in the diabetes prevalence found in Saudi Arabia due to the demographic changes such as urbanization and change in the life style [47-48]. Bacchus RA et al. estimated prevalence of diabetes in Saudi Arabia and the author concluded that prevalence of diabetes started to increase at 35 years of age reaching its peak at the 45-54 age groups [49]. Fatani HH. et al. noticed the steady increase of prevalence according to age [50]. Abu-Zeid and Al-Kassab performed a study of the prevalence of diabetes in Southern Arabia [39]. El-Hazmi MA et al. did a survey on prevalence of diabetes mellitus [52] one more survey was done by El-Hazmi and Warsy the prevalence of overweight in the Saudi population. A. Alkhie r A. reported the epidemiology of diabetes mellitus and diabetic foot problems in Saudi Arabia [53]. Epidemiology of dermatophytes in eastern province of Saudi Arabia was studied by hashem al sheikh [54]. Some other studies are also carried out by David Pariser, Richard K. Scher, et al., Phoebe Rich, et al., Boni Elewski, et al., David Pariser, et al., and presented in Seminars in cutaneous medicine and surgery [55-60]. Conclusion: The avalanche of evidences from the available scientific research comprehensively suggests that Onycomycosis is an intercontinental disease burden and poses raising concern for the health-care establishment. It is a comparatively quotidian dermatologic manifestation. It becomes extremely serious especially when it happens in case of patients with varying degree of HbA1c. The review would contribute to the understanding of clinical types and the severity of the toe nail lesions in the Saudi patients with varying level of HbA1c together with prevalence and the chief etiological agents involve in onycomycosis. Scientific research data obtained from the present review would contribute to the early prediction of susceptibility of the patients with high HbA1c to onycomycosis which would lead to a great deal of reduction in economic burden on health care establishment of Saudi Arabia, moreover it would improve the awareness of clinician and social segment as regards severity, heptotoxicity of the current treatment strategy and susceptibility to onycomycosis especially in case of the patients with high level of HbA1c.

Graphite Electrodes Production and Optimization Practices

Graphite Electrodes Production and Optimization Practices Graphite electrodes are used in both DC and AC electric arc furnaces. Companies who use electric arc furnaces have to cover the cost of these consumable electrodes during production, so optimizing the usage of graphite electrodes is a money-saving opportunity. This paper aims to discuss the production process of graphite electrodes as well as industry practices that are used to enhance the life of electrodes. To produce a graphite electrode, carbon is required. The carbon source for graphite electrodes comes from the petroleum industry as a by-product from the oil refining process. In the refining of crude oil, hydrocarbon chains are cracked in coking units and the resulting fuels are then separated as kerosene, gasoline, and diesel. As chains of hydrocarbons are being cracked in this process, pure carbon becomes deposited on the sidewalls of the coking units. The carbon on the sidewalls accumulates up to a certain point when it is the ground out of the unit. This carbon is called petroleum coke, or petcoke. This is the carbon source for graphite electrodes. After the petcoke is obtained from the oil refinery, it is blended with pitch to make a plastic-like material. (Making a UCAR ® Graphite Electrode) This blend of petcoke and pitch is then extruded through a circular die and cut off in sections. It is then baked at a temperature of above 800 degrees Celsius for a period of one to two weeks. After baking, the electrode is impregnated with more pitch to increase the density of the electrode which lowers electrical resistance and makes it stronger. The electrode is then re-baked at a slightly lower temperature to drive off volatiles found in the pitch. Finally, the electrode is heated to a temperature of about 3000 degrees Celsius to recrystallize the carbon into graphite. This final heating is called graphitization. Graphitization is very important in electrode manufacturing because it provides better mechanical strength and also improves electrical conductivity. The final step in electrode production is machining. The electrodes are machined to specific tolerances. This is especially important at the ends of the electrodes where the joints connect. (D. Klein) A good connection between joints is necessary for mechanical and electrical properties of the electrode. Electrode consumption takes on two forms: Continuous consumption and discontinuous consumption. (Richard J. Fruehan) Continuous consumption contributes 90% of total electrode consumption while discontinuous consumption only accounts for 10%. Even though discontinuous consumption accounts for far less than continuous consumption, discontinuous consumption can also account for furnace downtime which can cost a lot of money. So even though it is a small percentage, it is worthwhile to try to prevent it for the sake of productivity. In continuous consumption, the tip and sidewalls oxidize and the mass of the electrode is reduced. Tip consumption is a function of current and angle. Higher currents and steeper tip angles both yield faster oxidation rates of electrodes. (A. Lefort) Higher currents increase the temperature of the electrode which favors a faster oxidation rate. The steeper the tip angle, the closer the electrode needs to be to the steel bath to arc. Steel is more likely to splash onto the electrode if it is closer to the bath. One way to reduce the oxidation rate of electrodes is to cool them. Water cooled electrodes have been shown to reduce the oxidation rate of the sidewalls by 40% and the tip by 50%. One issue with water cooled electrodes is the flow rate of the water. If the flow rate is too high, water will pour into the furnace and increase the heat loss. The loss of heat can end up costing more than the money saved from reducing electrode consumption, so this is an important factor to conside r in this process. In discontinuous consumption, one of the most obvious techniques to prevent electrode breakage is simply to not ram the electrodes into the steel scrap. Graphite is a soft, brittle material and steel scrap is pretty hard and durable. If these two materials come head-to-head, the steel wins. Another method of discontinuous consumption is tip spalling. (A. Lefrank) This is more prevalent in DC furnaces than in AC furnaces because the DC electrodes see higher temperatures and therefore higher thermal stresses. The temperature gradient can be significant in the tip of a DC electrode and the thermal expansion of graphite can cause enough stress on the tip to break off small pieces. (J. E. Surma) Normally, the arc in a DC furnace will move about randomly, but occasionally the arc will sit in one spot, heating up that portion of the electrode tip creating thermal stresses that cause the tip to spall. Arc deflection control is a practice that has been implemented so when the arc becomes fixa ted on one spot, it will essentially â€Å"push† the arc out from that spot to get it to move about in a random fashion once more. Another practice to prevent the discontinuous consumption of electrodes is to ensure proper torque is applied when installing new electrode segments. The vibrations from the furnace and electromagnetic forces due to the flow of electricity give electrodes a good shaking. This can jostle the segments loose from their joints. This is mainly a problem in DC furnaces because AC furnaces are designed to ensure that the electromagnetic forces work to their advantage. In AC furnaces, the phase sequence is counterclockwise, so the forces on the electrodes due to the electromagnetism of the system only ever tightens the electrode joints. Below is a chart of recommended torque according to electrode diameter from SGL Carbons website and an AC furnace schematic of forces due to phase sequence. One final practice that helps prevent the failure of electrode joints is to turn off the water spray for a few minutes after the addition of another electrode segment. (Richard J. Fruehan) The temperature gradient is much steeper when the water spray operation is active. This thermal gradient can cause a problem when it reaches the joint because of the thermal expansion of graphite. Even if the electrode was tightened with the proper amount of torque, the effects of temperature on the electrode joint is enough to loosen it. This coupled with the furnace vibrations could be enough to cause the electrode joint to fail. In conclusion, graphite electrodes are an essential part of electric arc furnace steelmaking. Since they are consumable, any way to improve the life and efficiency of an electrode saves money in the steelmaking industry. Practices such as water cooling electrodes and optimizing current and tip angle are effective ways of reducing the oxidation of electrodes while taking care not to impact the scrap during melting, ensuring proper torque during installation, and turning off the water spray while adding another segment all help reduce breakage and joint failure. Works Cited: A. Lefort, M. J. Parizet, S. E. El-Fassi and M. Abbaoui. Erosion of Graphite Electrodes. J. Phys. D: Appl. Phys. 26 (1993): 1239-1243. A. Lefrank, W. J. Jones, and R. G. Wetter. DC Steelmaking Conditions and Electrode Performance. Electric Furnace Conference Proceedings 53. Warrendale: Iron and Steel Society, 1995. 337-346. D. Klein, K. Wimmer. DC Electrodes A Key Factor for Progress in EAF Production. Metallurgical Plant and Technology International 18:4 (1995): 54-63. Graphite and Carbon Electrodes. 6 December 2009 . J. E. Surma, D. R. Cohn, D. L. Smatlak, P. Thomas, P. P. Woskov, C. H. Titus, J. K. Wittle, R. A. Hamilton. Graphite Electrode DC Arc Technology Development for Treatment of Buried Wastes. Waste Management 93 Symposia. Tuscon, 1993. Making a UCAR ® Graphite Electrode. 2007. 6 December 2009 . Richard J. Fruehan, Ph.D. The Making, Shaping and Treating of Steel 11th Edition. Richard J. Fruehan, Ph.D. The Making, Shaping and Treating of Steel 11th Edition. Pittsburgh: The AISE Steel Foundation, 1998. 562-574.

Lord Of The Flies: Chapter 4-7 Notes :: essays research papers

1. When the fire goes out it symbolizes the loss of all remaining civility and the beginning of absolute savagery. The fire was the boys' only link to the past, as it was the one true technology they had. Fire symbolizes man's domination and manipulation of nature. As the fire goes out the boys are no longer people, but animals. It is also important to note that the fire was voluntarily allowed to die. This tells us that the boys voluntarily became savages, so this represents not only the loss of a civilized society, but also the betrayal of it. When the fire goes out, it also signifies the loss of hope. If the boys believed that they would be rescued, then they would not allow the fire to go out. Again, because of the fire being let out voluntarily it also represents the betrayal of hope. When the fire goes out, the boys no longer want to be a part of civilization or be rescued by it.2. The beast from the air is a dead man, who is attached to a parachute, falling from the sky. The beast from water is a figment of their imagination. Once again the loss of civilization and the old ways are represented. The dead man in the parachute, falling slowly, from the old world and civilization, represents the steady decline of the old ways which have been implemented in the new society and therefore the distinction of being civilized itself and the death of it. The beast represents mankind's fear of an outside threat as well as the evil and wrong doing that mankind brings upon itself. Fear of an outside threat has been a characteristic that mankind has had ever since we walked on two legs. Ancient peoples saw demons, and now many people claim to see UFO's and aliens; it is quite plausible that a very primitive society would see a beast. As evil and fear are created from man, so is the beast. The beast, being a fictitious creation of man and one that appears in every society, becomes no longer a physical entity, but a fear rooted deep in the human psyche; perhaps a fear of ourselves.3. The parachute symbolizes the forces of human behavior that attempt to hold the fabric of society intact. The parachute, however, fails to hold society afloat indefinitely. The parachute slowly loses to nature (in this case gravity, but symbolically mankind's animal instincts and desires). Lord Of The Flies: Chapter 4-7 Notes :: essays research papers 1. When the fire goes out it symbolizes the loss of all remaining civility and the beginning of absolute savagery. The fire was the boys' only link to the past, as it was the one true technology they had. Fire symbolizes man's domination and manipulation of nature. As the fire goes out the boys are no longer people, but animals. It is also important to note that the fire was voluntarily allowed to die. This tells us that the boys voluntarily became savages, so this represents not only the loss of a civilized society, but also the betrayal of it. When the fire goes out, it also signifies the loss of hope. If the boys believed that they would be rescued, then they would not allow the fire to go out. Again, because of the fire being let out voluntarily it also represents the betrayal of hope. When the fire goes out, the boys no longer want to be a part of civilization or be rescued by it.2. The beast from the air is a dead man, who is attached to a parachute, falling from the sky. The beast from water is a figment of their imagination. Once again the loss of civilization and the old ways are represented. The dead man in the parachute, falling slowly, from the old world and civilization, represents the steady decline of the old ways which have been implemented in the new society and therefore the distinction of being civilized itself and the death of it. The beast represents mankind's fear of an outside threat as well as the evil and wrong doing that mankind brings upon itself. Fear of an outside threat has been a characteristic that mankind has had ever since we walked on two legs. Ancient peoples saw demons, and now many people claim to see UFO's and aliens; it is quite plausible that a very primitive society would see a beast. As evil and fear are created from man, so is the beast. The beast, being a fictitious creation of man and one that appears in every society, becomes no longer a physical entity, but a fear rooted deep in the human psyche; perhaps a fear of ourselves.3. The parachute symbolizes the forces of human behavior that attempt to hold the fabric of society intact. The parachute, however, fails to hold society afloat indefinitely. The parachute slowly loses to nature (in this case gravity, but symbolically mankind's animal instincts and desires).

Essay --

As many people know, Kurt Cobain was lead singer and guitar player for the grunge band, Nirvana (Russomanno, Tony). There is truth behind the lyrics and tone of Cobain’s music. It takes people into the depths of what was really occurring behind closed doors. Cobain struggled with many adversities such as heroin, chronic stomach pains, drinking, and pills (Cobain, Kurt). Cobain, however; he did not deal with his adversities well. He was actually unable to ever overcome them. As a child, Cobain was involved in positive activities. â€Å"He participated in Little League Baseball when he was young. Cobain also spent a majority of his time with his only full-blooded sister, Kim, who was born in 1971† (Cobain, Kurt). During his childhood, Cobain often had to listen to his parents consistently fight and argue. He knew they were unhappy with each other, but he did not want them to divorce. â€Å"When Cobain turned nine, his parents finally divorced.† The divorce ultimately devoured Cobain and changed his outlook on life (Goldman, David). â€Å"After the divorce, Cobain’s father got remarried to a woman named Jenny. Cobain really felt a hatred and despise towards his step mother† (Cobain, Kurt). â€Å"He had felt that his father had always taken sides with her, and barely paid attention to him or his sister.† These issues with Cobain and his step mother also raised issues between Cobain and his father† (Cobain, Kurt). Cobain was not interested in school during his childhood. In fact, he hated going to school because he felt lonely and lost in the world. While Cobain attended high school, he participated in events such as art and music (Russomanno, Tony). He enjoyed painting and singing. During Cobain’s Jr. High and High school career he did not have to... ... still carries in her possession ( Grant, Tom). Cobain was a very famous rockstar who struggled greatly in life. He had many adversities such as heroin, alcohol, and chronic stomach pains. He dealt with his adversity of chronic stomach pain by doing drugs and drinking heavily. He did use his fame to positively advocate for those who were considered minorities. He married Courtney Love and had a daughter named Frances Bean. Cobain made many great hits during his career and soared music charts with songs known as â€Å"Lithium†, â€Å"Smells Like Teen Spirit†, â€Å"Heart Shaped Box†, and â€Å"All Apologies†. Even after death, Cobain's life carried on in his fans, clothing companies, movie companies and more. Sadly, Cobain was unable to overcome his adversities and committed suicide in April of 1994. Speaking his last words to the world, â€Å"It’s better to burn out, than to fade away..†

Marcus Garvey Essay -- essays papers

Marcus Garvey â€Å"Final Exam† Marcus Garvey, was born in Jamaica in 1887 and is considered to be the father of the Black Nationalism Movement. During the early 1900’s, after reading Booker T. Washington’s Up From Slavery, Garvey pledged to organize Blacks throughout the world with an agenda of Black unity and pride. Moreover, Garvey achieved his greatest influence in the Untied States where there was a growing ambition among Blacks for justice, wealth, and a sense of community. From the time of World War I, up until the mid-1920’s, Gravey’s Universal Negro Improvement Association(UNIA) was the largest Black organization in African-American history. An estimated million men and women from the United States, the Caribbean, and Africa belonged to it. When Garvey arrived in the United States in March 1916, the Black populace was about to suffer a severe blow that would make them ideal candidates for Gravey’s movement. During the Reconstruction period that followed the American Civil War, many African-Americans lost faith in the American political process. They were promised many reforms and reparations that were never realized. However, World War 1 bought a new sense of prosperity to blacks because they felt they had a second chance to prove themselves as well as attain their piece of the proverbial American pie. Implementing Alger’s philosophy which states â€Å"...heroes prove themselves through inspired acts of heroism and devotion,† many blacks believed if they foug...

Literary Canon Definition Essay

A literary canon is a classification of literature. It is compromised of literary works that share similar or related characteristics and are considered to be the most important of a specific time frame or place. The process in which a work is canonized is completely subjective. And just as the judgments and opinions of people change over time, so do literary canons. The status a work receives when it is entered into a literary canon is based on its relevance to the time period. Therefore a social change such as the feminist movement can determine what works are added and removed from a literary canon  Both the works of Gail Godwin’s â€Å"A Sorrowful Woman† and Karen Van Der Zee’s â€Å" A Secret Sorrow† were composed during the rise of feminism. However, the perspective of woman each work has varies greatly. â€Å" A Secret Sorrow† reflects the stereotypical view of woman that the feminist movement so strongly opposed. The view that woman are child bearing objects and should complete the role of the traditional housewife is irrelevant to the social changes happening during time period. In stark contrast, â€Å" A Sorrowful Woman† is written about a woman who is weary and unsatisfied with her role as a mother and child. She even goes as far as to detach herself from her family and isolate herself into one room. This perspective ties closely with way many women felt during the time period when feminism was rising. Thus its social and historical relevance to the time period makes â€Å"A Sorrowful Woman† a much better fit to be entered into the literary canon.

History of Oldtown

1. 2 Brief explanation of the company’s history The  OldTown White Coffee,  OTWC  (Chinese:   ) is the largest  kopitiam  restaurant  chain in  Malaysia. Its main headquarters is in  Ipoh, Perak,  Malaysia. Established in 1999, the co-founders and Executive Director, Mr. Goh Ching Mun and Mr. Tan Say Yap are the incorporation of White Cafe and provide quality white coffee to Malaysian households and the food services industry. It manufactures instant beverage mixes and products, in addition to operating over 180 cafe outlets throughout Malaysia and the region.With more than 10 years of experience in the coffee beverage industry, both of co-founders were instrumental in the growth of the Oldtown Group of companies. Next, Mr. Lee Siew Heng, Group of Managing Director who played a significant role in implementing the overall vision, strategy and development of the Oldtown Group is the one of support them to incorporation Oldtown Group. In 1999, they successful ly to commercialize the instant 3-in-1 coffee mix under the â€Å"OLDTOWN† brand name for the retail sector.By end of 2009 October, the â€Å"OLDTOWN† 3-in-1 instant coffee mix was sold in approximately 1,348 retail outlets nationwide in Malaysia, approximately 550 retail outlets in Singapore and approximately 2,100 retail outlet in Hong Kong. In 2000, the â€Å"OLDTOWN† brand of 3-in-1 instant coffee mix is the first export to Singapore. In 2001, White Cafe marketing commenced operations as the marketing arm for the Group’s beverage products. During the same year, the product line is expanded and includes different variations of the instant coffee mix.In addition, instant coffee mix has also expanded export to Hong Kong markets. In year 2002, White Cafe obtained a HALAL certification from the Islamic Religious Department of Perak for the Group’s beverages. This is the part of OLDTOWN Group’s intentions, which is to produce the beverages in accordance with the Islamic law. In the same year, OLDTOWN Group’s have successfully expanded to nationwide retail distribution of 3-in-1 instant coffee mix to cover East and West Malaysia through major hypermarkets and supermarkets.In 2003, OLDTOWN Group’s have also successfully commercialized the new blend of 3-in-1 instant milk tea for the retail market under the â€Å"OLDTOWN† brand name. In view of expanding OLDTOWN manufacturing activities, OLDTOWN Group’s incorporated Gongga Food in 2003 and commenced operations in 2004 manufacturing roasted coffee powder for the road services sector using the Group’s proprietary bean roasting process. OLDTOWN Group’s also distributed the roasted coffee powder to traditional coffee shops in Ipoh and other states in Malaysia.In addition to the food services sector, roasted coffee powder is also marketed to the retail sector under the â€Å"NANYANG† brand. In 2004, it also further penetrated the export markets for 3-in-1 instant coffee to cover the United States, Canada and United Kingdom and subsequently in 2005, Taiwan and Indonesia. In 2005, OLDTOWN Group’s expanded vertically into the food services sector by opening a chain of cafe outlets based on the traditional Ipoh coffee shop setting and ambience under the â€Å"OLTOWN WHITE COFFEE† brand name.This is part of the Group’s strategy of capitalizing and reinforcing on the â€Å"OLDTOWN WHITE COFFEE† brand in the food services industry. In the same year, Kopitiam Asian Pacific commenced operations in the licensing, supply of food, beverages and other item, and provision of management services to â€Å"OLDTOWN WHITE COFFEE† cafe outlet. Since the opening of the first â€Å"OLDTOWN WHITE COFFEE† cafe outlet in Ipoh in 2005, the chain of cafe outlets have expanded to reach 137 cafe outlets in Malaysia and Singapore as at 31 October 2009. This included fully and partially owned, and franchised cafe outlets.In 2005 and 2006, OLDTOWN Group’s has established the subsidiaries namely as Old Town Kopitiam, Old Town Kopitam Butterworth, Old Town Kopitiam Kuala Lumpur, Old Town Kopitiam Cheras, Conneczone to focus on operating cafe outlets in different areas and states within Malaysia. To support the cafe outlet business operations, their established the following subsidiaries as central food processing centres between year 2005 and 2007:  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Emperor’s Kitchen commenced operations in 2005;  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Esquire Chef commenced operations in 2007;   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Dynasty Confectionery commenced operations in 2007. In 2005, Gongga Food’s business activities also expanded to cater to the procurement of food items for â€Å"OLDTOWN WHITE COFFEE† cafe outlets. In the same year, Gongga Food also obtained a HALAL certification from the Islamic Religious Department of Perak for the production of its roasted coffee powder. Furthermore, OLDTOWN Group’s has obtained a HACCP certification from BM TRADE Certification Ltd for the processing and manufacturing of beverage roducts. In 2006, the company also expanded the product export to Japan and China markets. In the same year, the company incorporated Dynasty Kitchen as a distribution centre, which commenced operations in 2007. During this year, group’s company also incorporated Oldtown Berhad, which will focus on investment holding and provision of management services pursuant to its listing on the Main Market of Bursa Securities. Subsequently the OLDTOWN Group’s also started exporting to Thailand and Philippines.In view of group’s company plans to expand more cafe outlet business operation to Singapore, OLDTOWN company also incorporated Oldtown Singapore in 2007 to provide management services, supply of food and beverage items to cafe outlets in Singapore. OTK Singapore commenced operations in 20 08 with the launch of the first â€Å"OLDTOWN WHITE COFFEE† cafe outlet in Singapore. In 2008, the company of Dynasty Confectionery and Esquire Chef obtained HALAL certifications from the Islamic Religious Department of Perak for the processing of various foods.On other food-processing subsidiary, Emperor’s Kitchen obtained HALAL certification from the IFRC ASIA. To further affirm, OLDTOWN Group’s adherence to international food safety standard and White Cafe achieved ISO 22000:2005 certification and ISO 9001:2000 from BM TRADA Certification in 2008 in addition to GMP certification by the Department of Public Health, Ministry of Health Malaysia in the same year. Within 2008, OLDTOWN Group’s has expanded the product lines to include 3-in-1 instant coffee mix with cane sugar.In 2009, Gongga Food obtained a HACCP certification from BM TRADA Certification Ltd for the production of roasted coffee powder. OldTown White Coffee now exports its instant beverage mi xes to more than 10 countries worldwide and plans to expand its cafe outlet network in the region. The group has an extensive chain of cafes in Malaysia via 194 outlets as of end Nov 2011, and also operates a few outlets that are open 24/7 in certain areas. This tally includes fully and partially owned outlets, franchise outlets and licensed outlets.