Immunology has now developed into an independent discipline in medicine which covers not only germ infection which is related to immunity solely but also covers a lot of non-infectious diseases such as autoimmune disease, allergies, and others. Therefore, “The Immune Mechanism: “a double-edged sword” means that the immune mechanism (consisted of antibody mediated mechanism and T cell mediated mechanism), just like one edge playing the role of giving benefit (immunity) as it destroys the agent of infection, and another one can be detrimental as it will cause tissue/cell damages and then give rise to immune diseases (immunopathology). Now, the prevalence of these immune diseases is on the rise and has become a new challenge to our country towards developed country in 2020. Therefore, we have to make ample preparation (laboratory facilities/services, main power, and research) from now on in order to face the problems and challenges.
MeSH terms: Antibodies; Autoimmune Diseases; Hypersensitivity; T-Lymphocytes; Prevalence; Developed Countries
A 42-year-old man from Ghana presented with bilateral painful corneal perforations following ingestion of a sulphur-based antibiotic. Emergency bilateral penetrating keratoplasty was performed, with restoration of globe integrity. However, surgical complications arose such as non-healing epithelial defect, secondary infection, graft dehiscence, and mounting intraocular pressure. This case illustrates the challenges faced in managing corneal grafts in patients with already compromised ocular surfaces.
Background: β-thalassaemia is one of the most common single-gene disorders worldwide. Each ethnic population has its own common mutations, accounting for the majority of cases, with a small number of mutations for the rarer alleles. Due to the heterogeneity of β-thalassaemia and the multi-ethnicity of Malaysians, molecular diagnostics may be expensive and time consuming. Methods: A simple polymerase chain reaction (PCR) approach involving a multiplex amplification refractory mutation system (MARMS) and one amplification refractory mutation system (ARMS), consisting of 20 β-globin gene mutations, were designed and employed to investigate β-thalassaemia patients and carriers. Results: Out of 169 carriers tested with the MARMS, Cd 41/42 (–TTCT), Cd 26 (A–G) HbE, IVS 1–1 (G–T), and IVS 1–5 (G–C) were the most common mutations, accounting for 78.1%. Among the Malays, Cd 26 (A–G) HbE, Cd 41/42 (–TTCT), IVS 1–1 (G–T), and IVS 1–5 (G–C) were the most common mutations, accounting for 81.4%, whereas Cd 41/42 (–TTCT) and IVS 2–654 (C–T) were most common among the Chinese (79.1%). Conclusion: We propose the use of this cheap, easy to interpret, and simple system for the molecular diagnostics of β-thalassaemia among Malaysians at the Institute for Medical Research (IMR).
Persistent left superior vena cava (PLSVC) is one of the congenital anomalous entry of the great veins. We described a case of PLSVC which was missed and then diagnosed incidentally on second attempt of catheter insertion of the left side.
Resistance to antifungal agents has increased in Candida spp., especially in non-albicans species. Recent findings reported a strikingly low susceptibility in Candida spp. towards itraconazole in Malaysia. In this study, a colorimetric broth dilution method was utilized to determine the susceptibility of Candida spp. isolated in Kuala Lumpur Hospital within a six month period. A total of 82 isolates from blood, peritoneal and other fluids were tested against 8 antifungal agents using the Sensititre Yeast One method. These comprised of 32 (39%) C. albicans, 17 (20.7%) C. glabrata, 15 (18.3%) C. tropicalis, 13 (15.9%) C. parapsilosis, two (2.4%) C. sake and 1 (1.2%) each of C. pelliculosa, C. rugosa and Pichia etchellsii/carsonii. Overall, susceptibility of all isolates to caspofungin was 98.8%, amphotericin B, 97.6%; 5-flucytosine, 97.6%; voriconazole, 97.6%; posaconazole, 87.8%; fluconazole, 82.9%; ketoconazole, 79.3%; and itraconazole, 56.1%. A total of 18 Candida spp. isolates (22 %) were resistant to at least one antifungal agent tested, and half of these were resistant to three or more antifungal agents. C. glabrata was the most frequently identified resistant species (10 isolates), followed by C. tropicalis (4 isolates), C. parapsilosis (3 isolates) and C. albicans (1 isolate). Resistance was highest against ketoconazole (20.9%), followed by itraconazole (13.4%). However, 30.5% of isolates were susceptible-dose dependent towards itraconazole. Long-term usage of itraconazole in Malaysia and a predominance of nonalbicans species may account for the results observed in this study. In conclusion, susceptibility to antifungal drugs is species-dependent among Candida spp.; reduced susceptibility to itraconazole is concomitant with the high number of non-albicans Candida species isolated in Malaysia.
Efavirenz is a non-nucleoside reverse transcriptase inhibitor used in combination with other drugs for the treatment of patients with HIV infection. Efavirenz has been reported to cause a positive urine cannabis test reaction which may create problems between HIV-infected patients on Efavirenz and law enforcement agencies. Doctors are at loss whether to issue documents certifying the potential false positive urine cannabis test with Efavirenz to patients. We
investigated ifthe urine of HIV-infected patients onEfavirenz caused a positive urine cannabis test using the AxSYM Cannabinoids Assay®. Urine samples from 51 eligible patients on Efavirenz were tested for cannabis. All tested negative except for one who had used cannabis the day before. Efavirenz does not cause false positive urine cannabis test with the AxSYM Cannabinoids Assay®.
Certification documents from doctors are therefore unnecessary.
MeSH terms: Cannabinoids; Cannabis; Certification; Humans; Physicians; HIV-1; HIV Infections; Reverse Transcriptase Inhibitors; Law Enforcement; Benzoxazines
A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62-year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.
Left bundle branch block (LBBB) during anaesthesia is uncommon. During general anaesthesia, LBBB may be related to hypertension or tachycardia and its acute onset makes the diagnosis of acute myocardial ischemia or infarction difficult. We would like to present a case report of a healthy patient who developed LBBB intra operatively. Acute LBBB should lead to suspicion of acute coronary syndrome until proven otherwise. Inability to exclude an acute cardiac event resulted in postponement of surgery twice after general anaesthesia was administered. Cardiological investigation of our patient showed physiological left ventricular hypertrophy (LVH), “athlete’s heart” which was the most likely cause of the LBBB under anaesthesia.
Pericardial cysts occurrarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cystrequires surgicalremoval. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.
Osteo-odontokeratoprosthesis (OOKP) surgery is a technique used to replace damaged cornea in blind patients for whom cadaveric transplantation is not feasible. OOKP surgery is a complex procedure requiring lifetime follow-up. The preservation of the osteo–odontolamina is the vital feature in maintaining the stability of the OOKP. Early detection of lamina resorption enables early prophylactic measures to be taken and prevent resorption-related complications. This case illustrates the radiological findings of the first OOKP surgery in Malaysia and the role of multidetector computed tomography (MDCT) in postoperative management of OOKP surgery.
Aim of study: To determine the clinical and epidemiological characteristics of patients seen with primary immunodeficiencies referred at four Malaysian Hospitals between 1987 to 2007.
Methods: Patient data were retrospectively obtained from patient records and supplemented by information from a standardized questionnaires taken at the time of diagnosis from 4 participating hospitals. The completed data were transferred to documentrecords kept by the first author. The diagnoses made were based on criteria set by WHO Scientific Committee 1986.
Results:
Fifty one (51) patients with completed records satisfied the criteria of primary immunodeficiencies based on WHO Scientific Committee 1986.PredominantAntibody deficiency (40.4%) is the commonest of the class of primary immunodeficiency (based on modified IUIS classification) followed by phagocytic defect (17.3%), combined immunodeficiencies (15.4%) and other cellular immunodeficiencies (11.5%). The commonest clinical presentation is pneumonia (54%) . A positive Family history with a close family relative afflicted was a strong pointer to diagnosis for PID (52.6%) Primary immnodeficiencies are seen in all the major ethnic groups of Malaysia, predominantly among Malays. As observed in other patient registries, diagnostic delay remains the major cause of morbidity and mortality.
Conclusion: Primary immunodeficiencies is relative rare but is an emerging disease in Malaysia. Creating awareness of the disease, may reveal more cases within the community. It is sufficient to be a health issue in Malaysia as in other developing countries in the future.
Introduction: Tobacco smoking kills and estimated six million lives annually worldwide of which include 10,000 Malaysian lives. Twenty three per cent of Malaysian adults smoke however, similar prevalence is not known among the mentally ill. Those with mental illness often have higher prevalence rates and greater disability due to smoking. This commentary aims to update the mental health community in Malaysia on the on-going efforts made locally to assist the national tobacco control agenda. Methods: A brief report of recent updates is provided for this article. Results and Conclusion: Three major significant activities are reported, all of which will move the tobacco control agenda within psychiatry forward. These activities will allow psychiatry be in a better position to align tobacco control activities for the mentally ill
together with the general population.
This case report highlights the role of hospital-based modified assertive community treatment (ACT) in maintaining stability in a patient with dual diagnosis. We report a case of a middle-aged Indian gentleman who had schizophrenia with co-morbid alcohol abuse presented with multiple relapses, with recurrent suicidal attempts and criminal behaviour during his relapse episodes. After stabilisation of his most recent acute episode in hospital, the patient was followed-up by the community mental health team (CMHT). He was able to maintain in remission and stay free from alcohol, suicidality and criminal behaviour when provided ACT. The hospital-based modified ACT is proven to be effective in the management of this patient with co-morbidities and complications to sustain remission and prevent relapses.
A 76 year-old lady with late-onset schizophrenia was admitted with hypoglycaemia. She was later found to have a pancreatic tail insulinoma, confirmed biochemically and radiologically. She is treated medically with Diazoxide while awating laparascopic enucleation of the pancreatic tumour. The question remains if neuroglycopenia aggravates co-existing schizophrenia or if insulinoma-induced neuroglycopenia had been misdiagnosed as schizophrenia.
Objective: This study investigates the relationship between antidepressant response to escitalopram and polymorphism of the serotonin transporter gene promoter region (5-HTTLPR) in multi ethnic Malaysian patients with Major Depressive Disorder. Methods: An eight weeks prospective study of treatment response to escitalopram was conducted on 29 Malaysian patients with Major Depressive Disorder. The severity and improvement of depression were assessed with the Montgomery-Asberg Depression Rating Scale. Patients were also genotyped for long (L) and short (S) polymorphisms in 5-HTTLPR using polymerase chain reaction. Results: Response to escitalopram treatment was more frequent in patients with 5-HTTLPR SS genotype than in those with LL or LS genotypes (p = 0.04, OR = 10.0, 95% CI = 1.05-95.2). The favourable allelic variant for response was S allele (p
Depressive symptoms exist within the paediatric population. Nonetheless, clear clinical manifestations are often absent in this group. Objective: This study aimed to describe the prevalence and correlates of depressive symptoms among siblings of paediatric outpatients. The outpatients presented for acute complaints only. Methods: This was a cross-sectional study, with data collected over a 16-month period (April 2010 to July 2011). Participants were siblings of paediatric outpatients at University Malaya Medical Centre (UMMC), a tertiary hospital in Kuala Lumpur. They were recruited via convenience sampling. They were classified into high, average and low scores based on their responses to questions in the Children’s Depression Inventory (CDI; T-score >55: high, T-score 45-55: average; Tscore
Study site: paediatric outpatients at University Malaya Medical Centre (UMMC)
Background: The transition from high school to a university is a significant milestone in every student’s life. Stress experienced by students can have a detrimental effect on their academic performance. Social support has generally been found to promote psychological well-being, as well as to buffer the effects of stress. Method: The study was conducted in one of the Universities in Malaysia. The study questionnaire was designed to include questions regarding socio-demographic aspects and stress of the students; in addition, the Multidimensional Scale of Perceived Social Support scale (MSPSS) that was developed by Zimet was administered. The main aim of this study is to investigate the relationship between Perceived Social Support, Stress and Gender differences among University Students. Results: In this study only a small group of the students scored very low on the Perceived social support scale. A low significant inverse correlation was found between MSPSS and stress. Male students’ experienced greater stress than female students’. Female students had a better perception of social support from their families compared to male students. Conclusion: The fact that, as the level of social support increase the level of stress decrease clearly shows that social support acts as a buffer to stress.
MeSH terms: Demography; Female; Malaysia; Male; Perception; Surveys and Questionnaires; Social Support; Universities; Serpins
Introduction: Cognitive distortion seems to be a potential force in shaping criminals and antisocial behaviour within an individual. Unfortunately there is no valid Malay psychometric instrument available to measure cognitive distortion in Malaysian settings, especially in prisons. There is an urgent need to have a valid and reliable Malay psychometric instrument to assess the cognitive distortion among Malaysians. Therefore, the present study aimed to validate “How I Think” Questionnaire into the Malay language (henceforth, HIT-M). Methods: A cross-sectional study was conducted among inmates (n= 150) incarcerated within two prisons in Peninsular Malaysia. The validation study commenced with Forward-Backward translations and was followed by content and face validities. Later, construct validity was
performed via Exploratory Factor Analysis using Principal Component Analysis. Varimax rotation was applied in order to optimize the factor loadings on the extracted component. Finally, reliability testing was
performed to determine the internal consistency of the items which was done using Cronbach Alpha coefficient method (α). Findings: Initial factor loadings resulted in 11 factors with a total variance of 74.1%. Next, factor analysis was repeated by extracting the items into a four factor structure parallel to the theoretical construct. Items with factor loadings above 0.40 were retained as acceptable factor loadings. After considering factor loadings, item correlation and content of items, the final version of HIT-M consisted of 24 items. The internal consistency of HIT-M was 0.90 which was considered good. Conclusion: HIT-M is a valid and reliable psychometric instrument to measure and assess cognitive distortion among Malaysians.
MeSH terms: Antisocial Personality Disorder; Cognition; Cross-Sectional Studies; Factor Analysis, Statistical; Language; Malaysia; Prisons; Psychometrics; Surveys and Questionnaires; Rotation; Thinking; Translations; Reproducibility of Results; Principal Component Analysis; Criminals
Objective: This study is an attempt to produce an abbreviated Malay version of Weight and Lifestyle Inventory (MWALI), as well as to examine the psychometric properties of the eating behavior which formed part of MWALI. Methods: The MWALI was translated ‘forward–backward’ from English to Malay and then administered to 135 adolescents. The factor construct of the 24-item eating behavior and the relationships between factor scores and demographic profile, dysphoria, global self-esteem and body mass index (BMI) were examined. Results: The exploratory factor analysis yielded five factors: Negative Emotion, Poor Impulse Control, Social Cues, Snacking and Early Meals in relation to over-eating. All the factors were significantly and positively correlated with BMI. Internal consistency and test-retest reliability of the eating behavior were satisfactory. Conclusion: MWALI is appropriate for assessing eating behavior among overweight and obese adolescents in the primary care setting in Malaysia.
MeSH terms: Adolescent; Body Weight; Cues; Demography; Eating; Emotions; Factor Analysis, Statistical; Humans; Life Style; Malaysia; Obesity; Primary Health Care; Psychometrics; Reproducibility of Results; Body Mass Index; Overweight; Snacks
The holistic approach of assertive community treatment (ACT) may provide better care and lead to better outcomes in populations with difficult-to-treat comorbid mental and physical illnesses. This paper describes the complex issues in managing a person with multiple chronic medical illnesses who also
had comorbid treatment-resistant depression and poor social support. The patient achieved improvement after the implementation of the therapeutic ingredients of ACT.
MeSH terms: Community Mental Health Services; Depression; Health Services; Humans; Social Support; Comorbidity; Depressive Disorder, Treatment-Resistant