The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. Cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Tuberculous pericarditis is a complication of tuberculosis which is often diagnose late due to the difficulty in establishing this diagnosis. We present a case of pericardial tuberculosis diagnosed in a 20-year-old young retroviral disease patient who presented with signs of cardiac tamponade. His clinical condition improved post-pericardial tapping and he was discharged with anti tuberculosis medications. This case highlight the importance of having a high level of suspicion as this condition is easily curable.
Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.
MeSH terms: Accidents, Traffic; Adult; Aged; Bone Plates; Humans; Humerus; Male; Shoulder Fractures; Motor Vehicles
Anaphylactic reaction towards antibiotics is common during anaesthesia. It may present as bronchospasm, hypotension, desaturation, or urticarial. However it is uncommon for anaphylaxis reaction to present only as supraventricular tachycardia (SVT). This is a rare interesting case report on a 23-year-old healthy man whose anaesthetic categorization is American Society of Anaesthesiologist (ASA) 1, developed supraventricular tachycardia (SVT) towards intravenous cefuroxime, peri operatively. His condition resolved with carotid sinus massage. No pharmacological interventions were used. His skin prick intradermal tests showed allergies towards cefuroxime, cefazoline and cefoperazone. The patient subsequently underwent.
The number of active smokers in Malaysia is increasing despite the availability of stop smoking clinics and smoking cessation medications. Other than smokers’ level of motivation to quit smoking, competency of the healthcare professionals involved in providing smoking cessation intervention using evidence based guidelines needs to be considered. Hence, knowledge, attitude and practice (KAP) of the healthcare providers in relation to existing clinical practice guidelines on smoking cessation should be assessed. In this review, we look at the factors contributing to the KAP of medical personnel on the guidelines and also the previously available assessment tool, mainly in the form of a validated questionnaire, for the purpose of applying it to the context of the Malaysian healthcare providers.
MeSH terms: Health Personnel; Humans; Malaysia; Motivation; Surveys and Questionnaires; Smoking; Smoking Cessation
Osteochondromyxoma is a rare bone tumour. Bone tumours of the talus are also uncommon, and accounts to be between 8% to 23% in tumours of the foot. A 28-year-old man presented with chronic right ankle pain. He had underlying left knee ligament and meniscal injury. Special examination tests for ligament injury were negative. Magnetic Resonance Imaging (MRI) revealed a benign bone lesion of talus with reactive oedema of sinus tarsi. Excision of lesion was done and subsequent histopathological examination confirmed the diagnosis of ostechondromyxoma.
Prurigo nodularis (PN) is an uncommon skin condition known to be associated with underlying systemic diseases. This case report is about PN secondary to underlying Hodgkin’s lymphoma. A 30-year-old man presented with this skin condition three months before lymphadenopathy and systemic symptoms due to lymphoma. He had made multiple visits to general practitioners for the disturbing rash, given multiple courses of topical treatment without relief. His PN showed marked improvement after initiation of chemotherapy. This case reminds that an unexplained skin condition should prompt clinicians for investigating for an underlying systemic disease. This case, to our knowledge, is the first Hodgkin’s lymphoma-associated prurigo nodularis reported in Malaysia.
Synovial osteochondromatosis is an unusual, rare and benign tumour. This disease is characteristically monoarticular, most commonly found in knee joint, however it is rarely found in the elbow. A 49-year-old Indian man presented to hospital with a 6-month history of pain, swelling, intermittent locking, loss of range of motion of right elbow and a considerable size of elbow with no recollection of associated trauma. Plain radiographs of right elbow showed numerous radiopaque round and oval loose bodies within the right elbow joints. Computer Tomographic (CT) scan showed multiple bony mass within the right elbow joint. Arthroscopic synovectomy, debridement, excisional biopsy and loose body removal combined with miniarthrotomy of the right elbow was performed due to limited exposure for removal of larger loose bodies. Histopathological examination of the tissue sample is consistent with the diagnosis of synovial osteochondromatosis. The clinical and radiological evaluation at 6th month postoperatively showed marked reduction in the volume of the elbow, further improvement of elbow range of motion of this patient and the Mayo elbow performance score before surgery and at 6 months postoperative, with an increase from 50 to 80 points. Synovial osteochondromatosis of the joints is a rare condition. The signs and symptoms are not specific and may be suggestive of other pathology conditions. Arthroscopic synovectomy and removal of loose body is the standard operative procedure till today. However, combination of arthroscopy and miniarthrotomy in cases of large loose bodies may provide a good clinical and functional outcome.
As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
MeSH terms: Acetaminophen; Adult; Anesthesia, General; Common Bile Duct; Early Ambulation; Female; Fentanyl; Humans; Malaysia; Nausea; Nerve Block; Vomiting; Body Mass Index; Analgesia, Patient-Controlled; Cholecystectomy, Laparoscopic; Abdominal Cavity; Abdominal Wall; Gallstones
Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.
Apoptosis is a programmed cell death which occurs following a variety of stimuli. Physiologically the process is important for morphogenesis of organs and homeostasis of different types of cells. Apoptotic cell death is responsible for a variety of pathologic states such as elimination of cell death in mutated cells, infected cells, tumour cells and transplant rejection well as the pathological atrophy. In this review, there is discussion about the control of apoptosis, detection methods of apoptosis, its association with infectious and non-communicable diseases. Intracellular microorganisms survive through inhibition of host cell apoptosis as well as they destroy the parenchymal cells causing impaired functions. It plays important role in tumourigenesis. There are possible therapeutic roles of drugs that modify apoptosis in human diseases.
Adaptation to environmental conditions within the native range of exotic species can condition the invasion success of these species outside their range. The striking success of the Asian tiger mosquito, Aedes albopictus, to invade temperate regions has been attributed to the winter survival of diapause eggs in cold environments. In this study, we evaluate genetic polymorphisms (SNPs) and wing morphometric variation among three biogeographical regions of the native range of A. albopictus. Reconstructed demographic histories of populations show an initial expansion in Southeast Asia and suggest that marine regression during late Pleistocene and climate warming after the last glacial period favored expansion of populations in southern and northern regions, respectively. Searching for genomic signatures of selection, we identified significantly differentiated SNPs among which several are located in or within 20 kb distance from candidate genes for cold adaptation. These genes involve cellular and metabolic processes and several of them have been shown to be differentially expressed under diapausing conditions. The three biogeographical regions also differ for wing size and shape, and wing size increases with latitude supporting Bergmann's rule. Adaptive genetic and morphometric variation observed along the climatic gradient of A. albopictus native range suggests that colonization of northern latitudes promoted adaptation to cold environments prior to its worldwide invasion.
Introduction: The causes of obesity is caloric intake that, over time, is greater than the caloric expenditure. Factors that are associated with this energy imbalance include genetic predisposition, behavioural dynamics, hormonal disturbances, and environmental circumstances. Results: Food Intake: Increased portion sizes, the energy density of today’s commonly eaten foods, and the trend in consuming meals outside the home contribute to the increase in calorie consumption. Satiety helps determine food intake and is partially determined by the volume and weight of the food consumed. Foods that are high in calorie content for a given volume, such as highly processed, low-fiber foods, can lead to excessive calorie intake. Many factors contribute to overeating, including stress, boredom, nutritional insufficiencies, emotional lability, access to food, and the changing of our diet to one that is highly processed. Movement and Physical Activity: In a recent review, Denham et al. (2013) summarized the ability of physical activity to influence epigenetic modifications of histones or DNA in the brain, skeletal muscle, and peripheral blood. Aerobic exercise over many weeks was the primary variable studied that led to activity-induced benefits. Several of the studies found benefits with 30 minutes of daily moderate activity. Yoga is an effective type of movement activity for improving weight and mental well-being. Sleep: There is an association between too little or too much sleep and overweight and obesity. In a survey of more than 54,000 U.S. adults age 45 years or older, sleeping too little (≤6 hours) and sleeping too much (≥10 hours) were significantly associated with obesity. Sleep deprivation is associated with elevated ghrelin, elevated cortisol, elevated insulin, decreased leptin, and increased hunger (Patel and Hu, 2008). Psychosocial Stress: In addition to the negative influences of physiological stress from poor nutrition, insufficient appropriate activity, and inadequate sleep, psychosocial stress can also contribute to excess weight. Psychosocial stress can arise from a wide variety of environmental stressors, such as change in routine, difficult decisions, depression, chronic health issues, lack of access to health care, economic challenges, inadequate social support, abusive relationships, illiteracy, job dissatisfaction, poor adjustment to life-cycle transitions such as retirement, and legal problems. This type of stress is often associated with weight gain, elevated BMI, and poor food choices. Increased cortisol levels can lead to weight gain around the abdominal region (central adiposity). Conclusion: It is important to screen for emotional stress with patients, identify how this stress may be negatively impacting their weight, and help them incorporate stress reduction programs to achieve their weight loss goals.
Introduction: Obesity is one of the major health problems in Malaysia. It can lead to other metabolic diseases including diabetes and cardiovascular diseases. Unfortunately, effective treatment to overcome the health problem is yet to be discovered. One of the alternative solutions is by introducing a healthy diet through functional foods. Honey is well-known as one of the functional foods. However, the effectiveness in controlling obesity and then reducing the excess weight gain is still unclear. Several types of local honey were selected to observe their effects on obese-induced rats. Methods: Acacia, Gelam and Pineapple honey were harvested directly from apiaries and forest in Malaysia. Then, the quality of the honey was measured and standardized through physicochemical and antioxidant analyses. Male Sprague Dawley rats were induced to obese by consuming a high-fat diet. Then, the rats were fed with the honey for acute (one single honey consumption for 14 days) and subacute study (honey consumption daily for 16 weeks). Rats fed with orlistat (commercial drug for obesity) and fake honey were used as controls. Physical observation and biochemical analysis were conducted. Results: In the acute study, Gelam and Pineapple honey were significantly reduced the rat’s body weight, glucose, cholesterol and triglycerides level. More profound effects were observed in the subacute study, where all the honey samples were significantly reduced excess weight gain, glucose and the lipid profiles. Meanwhile, orlistat was also demonstrated a reduction in the excess weight gain but with toxicity side effects to the hepatic and renal function. In contrast, fake honey showed significantly increased body weight gain, glucose and the lipid profile in the rats. Conclusion: Based on the results, Malaysian honey samples have the potential to be a part of the daily diet in controlling obesity and reducing excess gain. However, more studies are required to confirm the findings.
Introduction: There has been growing interest in recent decades in the effect of physical activity in older people as it was believed to play an important role in maintaining functional independence while reducing health care burden at a low cost. Recent reviews showed aerobic exercises were correlated with healthy ageing outcomes, however between- study variance and variation in study population and outcome measurements warrant a more comprehensive assessment of the current evidence. This scoping review of systematic reviews aimed to evaluate and synthesize review evidence on the effect of aerobic exercises on physical and mental well-being in older adults. Methods: Electronic databases, including Cochrane Database of Systematic Reviews, PubMed/MEDLINE, Embase, PsycINFO, CINAHL were searched from inception to 31 December 2018 to identify systematic reviews, with or without meta-analyses that examined the effectiveness of aerobic exercises in older adults. Methodological quality was assessed using Risk of Bias in Systematic reviews (ROBIS) tool. Results: Two hundred and thirteen reviews met the inclusion criteria. In this scoping review, we included 56 reviews that evaluated the effect of aerobic exercises: 24 examined the effect of aerobic exercises on physical outcomes, 26 examined mental outcomes, 5 examined both physical and mental outcomes and 2 examined the effect on quality of life (QoL). Most reviews showed positive effect of aerobic exercises on physical fitness (18 out of 23), mental well-being (15 out of 26) and quality of life (2 out of 2), while others showed inconsistent or negative results. Majority of the reviews reported low to moderate quality with moderate to high risk of bias. Conclusion: Overall, current evidence showed that aerobic exercises appear to be beneficial for physical fitness and QoL in elderly. The effectiveness of aerobic exercises to improve or maintain cognitive function is inconclusive hence would require further evidence prior to recommendation.
Introduction: Neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) have become increasingly prevalent in recent years. Microglia, the resident myeloid cells of the Central Nervous System (CNS) are primarily responsible for the production of inflammatory mediators that accumulate and become toxic during a chronic inflammatory response. The accumulation of inflammatory mediators over time inadvertently contributes to the functional impairment of surrounding neurons. Hence, suppressing microglial cell activation can be a solution to control the progress of neurodegenerative disorders. Symptomatic treatments are available, but no curative treatment is currently available, and some are linked to several side effects associated with their use. Honey is a natural product derived from the nectar harvested and modified by honeybees. Its therapeutic effects are widely documented, have been tested and verified extensively in literature. Honey is recognized in modern medicine for its varied pharmacological activities. While the medicinal properties of honeys such as Manuka honey are well established, further investigation is required to elucidate the medicinal properties of locally sourced honeys, namely Tualang (TH) and Kelulut (KH) honeys. In this study, we investigated the immunomodulatory effects of local TH and KH honey on microglial cell activities. Methods: BV2 cells, an immortalized microglial cell line was used in this in vitro study to assess the cell survival when treated with the TH and KH honey. Expression of CD40, CD11b and CD86 were measured using flowcytometry. Results: BV2 cells incubated with TH at concentrations of 0.1% and 0.5%, and KH at concentrations of 0.1% and 0.25% for 24 and 48 hours showed cell survivability above 75%. Both TH and KH decreased ROS production significantly on LPS-induced BV2 cells, but increased ROS production on unstimulated BV2 cells. Additionally, the expression levels of CD40, CD11b and CD86 were also reduced on honey- treated LPS-induced BV2 cells. Conclusion: These results have demonstrated that both TH and KH are capable of suppressing microglial activation. Therefore, we propose the idea of utilizing these honeys as a complementary treatment to suppress the progression of neurodegenerative diseases.
Introduction: Alzheimer disease (AD) is the most widely recognised neurodegenerative disorder in the ageing population, characterised by progressive neuronal loss. The enhanced level of acetylcholine (ACh) in the human brain is another measure of identifying the progression of the disease. Increased acetylcholinesterase (AChE) level plays a fundamental role in the hydrolysis of Ach which worsens the cognitive function. Though there are several medications or drugs currently used in treating AD, their clinical implications remains debatable due to its adverse effects. Methods: In this study, the combined nutraceutical effect of natural plant compounds, piperine and curcumin were evaluated for acetylcholinesterase inhibitory assay using Ellman colourimetric method. Results: Results obtained from the study revealed that combined effects of natural plant compounds showed promising acetylcholinesterase inhibition activity with an IC50 of 104.1 ± 0.08 µg/mL compared to individually treated compounds, i.e., IC50 of curcumin = 134.5 ± 0.05 µg/mL and IC50 of piperine = 62.81 ± 0.00 µg/mL. Conclusion: The results suggest that the natural plant compounds taken in combination act as natural acetylcholinesterase inhibitors, and could be beneficial in the treatment of AD.
Introduction: The aging process is the most significant risk factor for developing Alzheimer’s disease (AD). AD is the most common neurodegenerative disease that causes cognitive and memory impairment in the elderly. Excessive build-up of amyloid protein leads to cell death, brain atrophy, and cognitive and functional decline in AD. The nuclear factor kappa beta (NF-κB) is a family of inducible transcription factors composed of NF-κB1, NF-κB2, RelA, RelB and c-Rel. It is activated by genotoxic agents, as well as oxidative and inflammatory stresses. It regulates expression of genes that control apoptosis, cell cycle progression, cell senescence, and inflammation. NF-κB regulates amyloid precursor protein (APP) processing by activating transcription of β and γ secretases, which promotes amyloid dysregulation in AD. In addition, NF-κB activation is linked with many of the known lifespan regulators including insulin/IGF- 1, FOXO, SIRT, and mTOR. Therefore, NF-κB pathway contributes to the pathophysiology of AD. This study aims to evaluate the effects of APP overexpression on NF-κB pathway in neuronal cells. Methods: SH-SY5Y neuronal cells were transduced with APP plasmid. Overexpression of APP in the cells was validated by western blotting. Western blot analysis using antibodies targeting NF-κB signalling pathway was performed using the APP-overexpressed cells. Results: Overexpression of APP in cells caused a significant down-regulation of phosphorylated NF-κB. Overexpression of APP also slightly up-regulated IkappaB-alpha, IKK alpha, and IKK beta. Conclusion: APP overexpression affected NF-κB pathway by down-regulating NF-κB protein.
Introduction: Acute abdomen in an elderly, especially in the right iliac fossa, is usually the common symptom that needs a precise surgical assessment with acute appendicitis being a common cause. Rarely, other conditions can mimic this presentation such as acute caecal diverticulitis.1 We describe a rare case of right iliac fossa pain in a 72- year old male which mimicked an acute appendicitis. The ability to recognize such condition is very important as its management is different at various stages. The objective of this case report is to increase awareness of this condition to ensure it is appropriately treated when encountered unexpectedly. Methods and Results: A 72-year old man was admitted with the complaint of right iliac fossa pain for 5 days. A pre-operative clinical diagnosis of acute appendicitis was made. The patient underwent an emergency laparotomy where an inflammatory mass in the caecum was found. A right hemicolectomy was performed as there was a suspicion of underlying malignancy. His histopathology report showed a single inflammatory diverticular mass. Acute caecal diverticulitis has a higher incidence in the Asian descent. In Western countries, more than 80% of all diverticula occur in the left sided colon, whereas the incidence of right-sided diverticular disease in Oriental countries can be up to 75%. The pre-operative diagnosis of right caecal diverticulitis is usually challenging to the surgeons, if without radiological imaging. Ultrasonography (USG) and computed tomography (CT) are the important investigations for the diagnosis with their specific findings. The ability to recognize the condition is very important as its management is different at various stages. The morbidity and mortality can be improved by earlier detection and proper management. Conclusion: Acute caecal diverticulitis should be considered in the differential diagnosis in elderly with right iliac fossa pain. The surgical approach can be range from a simple diverticulectomy to a more complex right hemicolectomy. The decision making should always be tailored to the severity of the condition of the patient.
Introduction: Amyloid-β (Aβ) peptides play a key role in the pathogenesis of Alzheimer disease and exert various toxic effects on neurons. Dietary phytochemicals are currently used as an adjuvant therapy to accelerate their therapeutic efficacy. Therefore, the present study was designed to investigate the effect of curcumin and its co-administration with piperine against Aβ42 induced cytotoxicity, fibril aggregation and oxidative damage in SH-SY5Y cells. Methods: The neuroblastoma SH-SY5Y cells were cultured with different treatments of Aβ42, individual curcumin and piperine and combination of curcumin and piperine. Cell viability, Aβ fibril aggregation and oxidative damage such as lipid peroxidation, catalase and glutathione were assessed. The abilities of curcumin and its combination, piperine to scavenge free radicals and to inhibit Aβ aggregation and β-sheeted formation were further assessed. Results: Curcumin and piperine preserves cell viability, which is decreased by Aβ, indicate that curcumin protects Aβ-induced neuronal damage. Under aggregating conditions in vitro, curcumin and piperine inhibited aggregation as well as disaggregated fibrillar Aβ42, indicating favorable stoichiometry for inhibition. Results also showed that curcumin and piperine as a combination was a better Aβ42 aggregation inhibitor than the individual compounds. Curcumin and piperine depresses Aβ-induced up-regulation of neuronal oxidative stress. The ability of these compounds to scavenge free radicals and inhibit the formation of Aβ aggregation are implicated from the results of this study. Conclusion: This combination of curcumin and piperine shows a more protective effect on neuronal oxidative damage when they was added into cultured neurons not later than Aβ, especially prior to Aβ. The curcumin and piperine combination prevents neurons from Aβ-induced oxidative stress, indicating a promising therapeutic in preventive medicine for Alzheimer disease.
ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019
IHMSC 2019. Accelerating Innovations in Translational and Precision Medicine. Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia, 8-9th March, 2019
Introduction: Depression is becoming increasingly prevalent as a mental health disorder worldwide. The prevalence of clinical depression is between about five and fifteen percent globally. Clinical depression has also increased in prevalence among the ageing. Some of the etiological factors associated with depression in the ageing include grief and loss, and role transitions. Interpersonal Psychotherapy (IPT), an evidenced based psychotherapy for clinical depression, has been proven to be effective for depression in the ageing. IPT addresses four main problem areas, namely - interpersonal disputes, grief and loss, role transitions and interpersonal sensitivity. The adaptation of IPT for the ageing is IPT for late-life depression or IPT – LLM which was utilized to treat the patient discussed in this case study. Methods: The patient was treated with 12 sessions of psychotherapy which is often the minimum number of sessions required in the treatment of depression with IPT. The initial sessions included the development of an Interpersonal Formulation and Interpersonal Inventory. Her problem areas were grief as her husband had passed away recently, and role transitions. The problem areas were addressed during the 8 middle IPT sessions. The final two sessions were utilized to conclude IPT treatment. Results: The patient was assessed to have a PHQ – 9 (Patient Health Questionnaire--9) score of 17 before treatment with IPT, indicating moderate depression. Her PHQ – 9 score after 12 sessions of IPT was 4 indicating minimal depression. Conclusion: This case study highlights that some of the factors that contribute to depression in the ageing are grief and role transitions, and that IPT is efficacious in the treatment of depression in the ageing.