Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery.
GIST are rare tumor and uncommon to occur in rectum where it accounts about 5% of all GIST [1] and rarer to develop simultaneously. Several surgical options are available, large tumours with aggressive features have been commonly treated with abdominoperineal resection.This is the first reported case of synchronous GIST of the rectum and jejunum. Case report: 66 year old man who presented with rectal bleeding and altered bowel habit. Colonoscopy revealed submucosal tumor on anterior wall of the rectum. Computerized Tomography (CT) of abdomen and Magnetic Resonance Imaging (MRI) of pelvis demonstrated a mass of approximately 88 AP x 88 W x 89mm CC in size on the anterior wall of the rectum at a distance of 2.3 cm from the anal verge, without any invasion to the prostate or evidence of metastasis, Histological examination of the biopsy sample via the rectum showed spindle cell neoplasm suggestive of GIST. An abdominoperineal resection was performed with wedge resection of small bowel lesion who discovered intraoperatively as yellow mass measuring 1.5 cm in its diameter involving the serosa. Histopathological examination of the sample confirmed the diagnosis of GIST of both rectal and small bowel specimen with positive CD117 on immunohistochemical assessment. Patient recovered post operatively. Discussion: Incidence of GIST as overall are about 1/100000 per year and commonly found in stomach (60-70%), small intestine (20-25%) but rarely occur in rectum (5%). Because of the low incidence of rectal GISTs, cases of simultaneous development of a GIST in rectum and jejunum are scarce. Simple coincidence could be the reasonable explanation in our case. For rectal GIST, surgical procedures may be considered, including abdomino-perineal resection. Conclusion: Simultaneous GISTs in the rectum and jejunum is extremely rare. Resection is the treatment of choice, suspicious lesions discovered during operation should be biopsied or removed as GIST could appear synchronously.
The prevalence of oral cancer has been reported annually along with high mortality rate. Probiotics have been suggested to possess anti-cancer properties, however the role of these microorganisms on oral cancer is remain unclear. The objective of the present study is to identify the mechanisms exerted by probiotics on oral carcinogenesis by using systematic review and meta analysis with the hypothesis that probiotics inhibit oral carcinogenesis. Materials and method: Comprehensive literature search was conducted on PubMed, Scopus and Web of Science electronic database from January 2019 until April 2019. Main keywords that were used are “probiotic” AND “oral cancer”. Articles that were published in English language were included in this review. Articles were selected independently by three authors and inspected independently by another researcher. The titles and abstracts of the studies were screened to identify studies that meet the inclusion criteria. Full text articles of the remaining studies were assessed to determine the availability to be included in the review. Meta-analysis was conducted by using RevMan 5 software, and the result was graphically plotted on the forest plot. This review was done according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) 2015 guidelines. Results: After thorough screening of the full text articles, seven papers were eligible to be included in the systematic review. The included articles were mainly discussed on the association of probiotics and oral cancer. Two from the seven papers were selected to be analyse for quantitative synthesis (meta-analysis). The present study also showed that, Lactobacillus salivarius REN produces protective effect from developing neoplastic tongue lesions with odd ratio < 1. Conclusion: Probiotics were found to confer positive effect as an inhibitory agent against the oral carcinogenesis thus supported the hypothesis of the present study that probiotics can inhibit oral carcinogenesis.
We report a 38-year-old gentleman who presented with painless haematuria for 6-months duration. Contrast-enhanced CT renal revealed a large, calcified intrapelvic mass with calyceal extension confined within the right kidney with moderate pelvicalyceal dilatation but no evidence of synchronous lesion elsewhere. Histopathological analysis showed high grade urothelial carcinoma of the renal pelvis with invasion of the renal parenchyma. Upper tract urothelial carcinoma (UTUC) which was once thought similar to urothelial carcinoma of the bladder (UCB), is increasingly being recognized as a different entity. However, heterogenous array of imaging manifestations of UTUC is also increasingly being encountered and pose diagnostic challenges though UTUC is not as prevalent as UCB which is easier to diagnose. Despite distinctive features against renal cell carcinoma (RCC), UTUC may mimic numerous other renal pathology especially the benign ones hence imaging plays a pivotal role to ascertain the diagnosis. This disease is usually treated with radical nephroureterectomy with superadded neoadjuvant chemotherapy for high risk cases. Less invasive endoscopic resection is also offered in certain cases but stringent surveillance of the whole urinary tract as well as post-operative follow-up are mandatory.
Dental caries has remained a major oral health problem worldwide. Streptococcus mutans is considered as a vital cariogenic agent in the oral cavity. It can synthesise soluble and insoluble glucans from sucrose by glucosyltransferases enzymes and develops stable biofilm on the tooth surface. In the previous study, the fatty acids profile of activated virgin coconut oil (AVCO) have been described, and it includes the excellent antimicrobial activity of the oil. The current study aims to evaluate the antibiofilm effect of AVCO against the Streptococcus mutans ATCC 2157 biofilm in vitro. Materials and method: The minimum biofilm inhibition concentration (MBIC) and the minimum biofilm eradication concentration (MBEC) for antibiofilm activity were determined by serial dilution method, and biofilm thickness on S. mutans was quantified by confocal laser scanning microscopy (CLSM). Results: At the concentra-tion of 15.63 mg/ml of AVCO, it successfully inhibits the development of S. mutans ATCC 21575 biofilm and AVCO (62.52 mg/ml) eradicate biofilm that was formed by the bacteria. The z-stack images obtained from CLSM allows the construction of 3-D biofilm structure and a significant difference in the thickness of S. mutans ATCC 21575 biofilm pre and post-treatment with AVCO were observed. Conclusion: AVCO showed good potential as anticaries where it possesses the ability to inhibits and eradicate S. mutans ATCC 21575 biofilm. A future study to evaluates the interaction of individuals fatty acids present in AVCO against proteins that relate to biofilm formation of S. mutans can be performed utilising the molecular docking tools.
Colorectal cancer (CRC) is the second most common cancer in Malaysia. In general, patients aged > 65 years comprise the majority of the population with CRC. However, recent reports indicate its increasing incidence in younger populations. We describe 4 cases of early onset colorectal cancer in Kuantan. Materials and method: This is a descriptive study of a small series of patients. Data between 2018 and 2019 were obtained from medical charts. Results: We diagnosed four patients under the age of 50 with colon cancer (75% male), the median age was 36 (23-47), with no comorbidities. None of the patient had family history of colorectal cancer. The majority of our patients presented with complication of tumour (2 perforation, 1 obstruction) required emergency surgeries. Only one patient presented with with rectal bleeding and was found to have tumor of the rectosigmoid junction. Two patients had tumor at descending colon and one at the splenic flexure. From this case series, we found there were one patient for every stage of colorectal cancer. Carcinoembryonic (CEA) levels were elevated at baseline in only two patients. Conclusion: Incidence of colon cancer rises among young patients in Kuantan. Further studies are needed to clarify the clinical and biological characteristics of colon cancer, improve its treatment strategies, and promote better outcomes in young patients.
Accurate corneal wavefront aberration measurements are essential in determining patient’s suitability, vision outcomes and patient satisfaction in laser refractive surgeries. This study aimed to evaluate the reliability measurement of higher-order aberration (HOA) using corneal videokeratograph Atlas 9000. Materials and method: 38 eyes of 19 participants were recruited in this study. Comprehensive eye examination was done to ensure all participants eligibility, and any conditions in which obstruct the central cornea were excluded. Corneal wavefront aberrations were measured based on Zernike polynomials. In assessing repeatability, three repetitive measurements in five minutes in a single session were taken by 2 experience examiners. For reproducibility measurement, similar approach was done with the time-interval between measurements was set at one week. Bland-Altman, limits of agreement (LoA) and intraclass correlation coefficients (ICCs) were used to evaluate the reliability measurement. Results: Bland-Altman and LoA findings revealed no significant differences for both repeatability and reproducibility measurement. For repeatability testing, the mean differences for vertical trefoil, oblique trefoil and spherical aberration were -0.096 ± 0.493, 0.001 ± 0.048, 0.008 ± 0.035, 0.004 ± 0.029, 0.010 ± 0.053 with LoA of 1.930, 0.188, 0.138, 0.114, and 0.208 respectively. Intraclass correlation coefficient (ICC) excellent reliability of 0.841 for all parameters. Likewise, reproducibility testing showed similar findings with the mean difference were -0.018 ± 0.091, 0.016 ± 0.061, -0.0004 ± 0.036, -0.002 ± 0.042, 0.003 ± 0.026, with LoA of 0.356, 0.24, 0.141,0.164, and 0.102 respectively. Intraclass correlation coefficient (ICC) shows excellent reliability of more than 0.9 for all parameters. LoA of less than 1.0 were observed in all measurements (except for repeatability of vertical trefoil) indicates high consistency of the measurements. Conclusions: Corneal videokeratograph Atlas 9000 provides excellent HOA measurement reliability.
Diabetes Mellitus is a major global health concern worldwide with increasing trend as reported in the National Health Morbidity Survey 2015. Due to the fact that diabetes mellitus is a life long chronic illness and incurable, it contributes to the increased tendency of seeking Traditional Complementary Medicine (TCM). The objective of this study is to measure the prevalence of CM use among diabetic patients and its association with diabetic control. Materials and Method: A cross-sectional study was performed at Hospital Tengku Ampuan Afzan, between July to August 2018. 136 Type II adult diabetic patients in medical ward and diabetic clinic were interviewed regarding the use of CM, and their blood investigations results were collected from patients' medical records. A data collection form was used as the study instrument. Descriptive statistic was used to measure the prevalence while Fisher exact test and Independent t-test were used to find associations between CM usage with study background and diabetic control. Results: Low prevalence of Traditional Complementary Medicine use (16.9%) was found with retired group of respondents was identified to be the predominant group (p-value=0.025). Majority of patients used CM as an additional treatment for diabetes (60.9%). Friends, family members and advertisement were the main influential factors in starting and using CM. A significant difference in eGFR value was reported between inpatient and outpatient CM users with a p-value of 0.001. No positive association was observed for HbA1c level. Conclusion: 1 in every 6 diabetic patients in HTAA, Kuantan were using Traditional Complementary Medicine along with conventional diabetic medications in which retirees were the major group identified. eGFR was the diabetic control parameter that had been found to have a significant association with diabetic inpatients and outpatient CM users in this study.
Carbon monoxide measurement is one of the biomedical risk assessments in smoking cessation. With the advancement in medical devices, risk assessment among smoker using carbon monoxide can be an effective intervention for quit smoking. A systematic review was conducted on the effectiveness of using carbon monoxide measurement in smoking cessation intervention. Material and methods: A systematic review and narrative synthesis were done using PRISMA guideline. A broad database search on English literature was conducted including Medline, PubMed, Scopus and Science Direct from 2008 till 2017. Additional studies were also searched through snowballing technique by searching the bibliographies of selected studies. Five studies met the criteria with two studies were done in clinical settings while the other was done at population settings. The studies were conducted in the United States of America, United Kingdom and South Korea. All study were two-arm randomized controlled trials with variation in the outcome measurement mainly intention to quit, quit attempt and smoking abstinence. There was also variation in the duration of follow up ranging from 1 week to 12 months. Results: Only three studies found statistically significant increased in motivation or intention to quit smoking but only at 1 month follow up. All five study found no significant difference in frequency of quit attempt or smoking abstinence. Most of the studies recruited participants based on voluntary participation thus limiting the generalizability of the results. Conclusions: The present review has found limited studies on the effect of carbon monoxide measurement intervention for quit smoking. It may only be beneficial at the motivational level and not translated into behavioural changes. However, the effect too was short term and not sustained in the long term.
Pediculosis capitis has been a worldwide concern among the vulnerable population of primary school children due to the physical, economical and psychological consequences that it brings to both the children and their caretakers. It is observed that there were only limited studies conducted in Malaysia and no previous study was done in Kuantan despite the health concern that it bears. Since both local and worldwide studies show that Pediculosis capitis is more prevalent among female as compared to male school children, thus, this study aims to investigate the prevalence and predictors of Pediculosis capitis among female primary school children in Kuantan. Materials and method: An analytical crosssectional study using cluster random sampling was carried out in Kuantan, Pahang, Malaysia. A self-administered validated questionnaire was used to collect the data among female primary school children from standard one to six. Hair and scalp examination was performed to identify presence of Pediculosis capitis infestation. Multivariate logistic regression was used to control for potential confounding and determine the predictors Results: 10 schools participated in the study with total number of 636 female students as respondents. The overall prevalence of Pediculosis capitis among female primary school children was 17.6% (n=112). Multivariate logistic regression analysis showed that Indian (OR=5.634, 95% CI= 3.157-10.055), history of contact with infested person (OR=2.822, 95% CI=1.6193.691) and those who had number of family members more than four (OR=0.065, 95% CI=0.008-0.550) were predictors for Pediculosis capitis Conclusion: The prevalence of Pediculosis capitis among female primary school children in Kuantan, Pahang is endemic (17.6%) and predictors are Indian, history of contact with infested person and having family members of more than 4. Hence, there is a need for health intervention to reduce the burden of Pediculosis capitis infestation.
Colorectal cancer is the third most common cancer worldwide. Microsatellite instability (MSI) contributes to be one of the main mechanisms in colorectal cancer. Individuals with MSI tumors have loss of expression of one or more Mismatch Repair proteins. MSI tumors have better survival rate than microsatellite stable (MSS) tumors, poor response to 5FU-based adjuvant chemotherapy and relatively successful immunotherapy in metastatic MSI tumors. Immunohistochemistry recognizes altered gene by recognizing loss of its protein product. Based on the presence or absence of Mismatch repair proteins, groups are classified into Mismatch repair proficient (MMR-p) and Mismatch repair deficient (MMR-d). Aim: To investigate the immunohistochemical profile of Mismatch repair proteins namely: hMLH1, hMSH2, hMSH6, and hPMS2 in surgically resected colorectal cancer specimens. Materials and Method: A total of 76 cases were selected from the Histopathology Department of HTAA to determine MMR protein expression status. Cases were either MMR-p or MMR-d. Results: Of the specimens which were properly immunostained, seventeen out of seventy-six cases (22.37%) showed loss of one or more MMR proteins expression and thus were MMR-d. MLH1, MSH2, MSH6 and PMS2 protein expression was detected as 85.53% (65/76), 81.6% (62/76), 88.16% (67/76), and 76.32% (58/76), respectively. Conclusion: Mismatch repair proteins profile should be done using immunohistochemistry in local laboratories on these selected cases before referring for the expensive molecular test.
Deep Neural Networks (DNN) has been successfully applied in a variety of medical image analysis. However, in building a good DNN model, it requires validated label from medical experts. The task of getting labels validated by the medical expert is quite a challenge due to the complexity of the image as well as large variability between the experts. Thus, this research investigates the effect of corrupted medical label on deep neural network for analysing diseases. Materials and method: In investigating this issue, a chest X-ray dataset comprising of 2560 images with 14 multilabel diseases from the National Institutes of Health (NIH) are examined. The DNN models that are explored are MobileNet, which is a base network that uses a depth-wise separable convolutional in building lightweight DNN and Xception, which is also utilised depth-wise separable convolutional with inception modules as an intermediate step in between regular convolutional and the depthwise convolutional. Different training and testing sizes are presented to the models with different ranges of corrupted labels from 10% to 50%. The training and validation accuracy is compared for each of the test cases together with other statistical analysis. Results: Based on the conducted experiments, it can be highlighted that both models can classify the diseases with the accuracy of more than 80% if the images have been previously trained by the model for different sizes of the corrupted labels. For the unseen or previously untrained images, the models can reach the accuracy of 70% and as the sizes of corrupted label increases, the accuracy will decreases as low as 50%. Conclusion: To conclude, corrupted labels have a critical effect on the DNN models. Thus, it is very essential to study the effect of the corrupted medical images label to ensure the reliability of the DNN models for medical imaging.
Axillary nerve supplies deltoid muscle long head of triceps and teres minor in the arm and supply regimental batch area over the inferior part of shoulder. Anterior dislocation of shoulder, latrogenic injury to the nerve during shouder injection and brachial plexus injury can cause axillary nerve injury. Case report: We report a rare case of isolated axillary nerve injury in a 20 year old lady. She was admitted following a low speed fall from motorcycle and sustain abrasion wound over the right side of the face and shoulder. There was no direct or tractional injury to the shoulder during the incidence.During admission she complaint of progressive right shoulder weakness with MRC power of 2 and sensory loss over regimental patch area. On examination there was no tenderness to the shoulder area or neck and she was unable to abduct her right shoulder with full passive range of motion. Patient was subjected to nerve conduction study four months later and revealed slower sensory conduction and deltoid muscle amplitude decreased compared the left side. At 7 months post trauma she is recovering with deltoid power of 4 after multiple physiotherapy session. Isolated axillary nerve injury following a blunt trauma is a rare condition with multiple reported cases showed poor recovery. One should wait for regeneration of nerves to complete before offering any surgical intervention to the patient. As in our case, patient showed remarkable improvement after seven months with conservative management thus avoiding the complication of surgery.
Perioperative hyperglycemia resulted from known diabetes mellitus, occult diabetes or stressed-induced hyperglycemia. It is associated with increasing risk of surgical-site infection (SSI). This research is to evaluate relationship between perioperative hyperglycemia and early SSI in stable trauma patients with orthopaedic injuries. Materials and method: We conducted an observational cohort study in Hospital Sultanah Nur Zahirah, Kuala Terengganu over 15 months. We included patients 18 years and older with operative orthopaedic injuries and excluded those with steroid use, multisystem injuries, critically ill or unstable and patients with perioperative infection. Demographics, medical comorbidities, body mass index, type of fracture, HbA1c level in diabetic patients and length of hospital stay were recorded. Fingerprick glucose values were obtained twice daily. Hyperglycemic index (HGI), an area under the glucose curve above the normal range divided by the length of stay, were calculated. Perioperative hyperglycemia was defined by HGI greater than 1.76. SSI was defined by gross purulence or positive intraoperative culture at reoperation within 30 days. The categorical data were analysed using chi square test while continuous data were analysed using T-test. Results: Total of 90 patients, 15-diabetic and 75 non-diabetic. 10 diabetic and 1 non-diabetic patients were hyperglycemic (p=0.001). Perioperative hyperglycemia was associated with mean age 54.3 year old, having 1 or more co-morbidity or mean admission glucose 13.1 mmol/L (p=0.001). There were 12 early SSI giving infection rate 13.3%. Early SSI was associated with HGI 1.76 and more (p=0.001), patients with 1 or more co-morbidity (p=0.006), mean admission glucose of 9.63 mmol/L (p=0.001). Conclusion: Our study showed perioperative hyperglycemia in stable trauma patients with orthopaedic injuries were associated with SSI. More patients are needed to find association of other variables and more studies are required in determining the acceptable glucose level and optimal treatment of perioperative hyperglycemia in stable trauma patients.
Pediculosis capitis among primary school children is a global problem which poses significant consequences among school children and caregivers alike. Previous studies showed an association between pediculosis capitis and sociodemographic factors such as school location, age, gender, ethnicity, parental education, monthly household income, number of siblings and number of family members. Primary schools in Malaysia consist of National School and National-type school (Chinese) and (Tamil), all of which have different sociodemographic backgrounds. Thus, this study aims to investigate and compare the prevalence of pediculosis capitis among children of different types of primary school in Kuantan to properly plan for future intervention. Materials and method: An analytical crosssectional study using stratified random sampling was carried out. The schools were stratified according to their types. Number of respondents from each school was determined by proportionate-to-size. Respondents from standard one to six were given self-administered validated questionnaire. Then, their hair and scalp were examined for the evidence of pediculosis capitis. Data was analysed using descriptive statistics. Results: There were 1,365 respondents involved in this study; consisting of students from National Schools (n=791), Chinese Schools (n=424) and Tamil Schools (n=150). The overall median age was 8.0 years. Majority of them were males (53.41%), of Malays ethnicity (60.29%), with household income between RM1000-RM2999 (31.87%) and from urban school location (98.68%). The overall prevalence of pediculosis capitis was 9.6% (n=131). The prevalence of pediculosis capitis among the selected schools was found to be the highest in National-type school (Tamil) at 33.33% (n=50), followed by National School at 7.33% (n=58) and National-type school (Chinese) at 5.42% (n=23). Conclusion: Pediculosis capitis showed an endemicity in all types of primary schools. Hence, preventive measures are necessary to reduce the transmission of head lice among school children.
Quinolone resistance and extended spectrum beta lactamase production has increased in E.coli and considered a serious problem worldwide. It is worth to monitor resistance mechanism in E.coli to provide guidance for optimizing antimicrobial treatments,control and spread of resistance. The objective of this study was to molecularly characterize gyrA, parC genes and plasmid mediated qepA efflux pump gene, in QR-ESBL E. coli isolates obtained from patients in HTAA, Kuantan. The antibiotic susceptibility profile was also studied. Materials and Method: 32 QR-ESBL and six quinolone-susceptible E. coli isolates from September 30 November,2018) included in the study. The isolates were reconfirmed with known phenotypic tests and antibiotic susceptibility test was performed. PCR and DNA sequencing were performed for the identification of mutations in quinolone resistance determining region. Result: Resistance to ampicillin, tetracycline, nalidixic acid was (100%) followed by cefotaxime (96.9%), ciprofloxacin (78.1%) trimethoprim sulfamethoxazole (75%), ceftazidime (56.3%), cefepime (43.8%) and gentamycin (25%). None of the isolates was resistant to piperacillin-tazobactam, amikacin, imipenem, meropenem, ertapenem, and colistin. PCR successfully amplified the gyrA and parC genes, however, qepA gene was not detected by PCR in the isolates. Majority of the isolates had point mutation in (QRDR) of GyrA at codons 83 and 87 and in ParC at codons 80 and 84. Two isolates had mutations outside of QRDR at codons 144 and 167 in ParC. Strong positive correlation was found between MIC levels of ciprofloxacin and the number of resistance mutations. Sequencing of 6 (QS-ESBL) E. coli revealed absence of resistance mutations. Conclusion: Quinolone resistance in the isolates was mainly due to mutations in gyrA, ParC genes. Acquisition of multidrug resistance genes through innate gene mutations and mobile genetic elements contribute to the emergence of (MDR). This study reinforces the importance of being vigilant in utilizing molecular techniques to monitor for emergence of resistance genes in different locations.
Colorectal cancer (CRC) constitutes one of the most aggressive malignancies worldwide and in Malaysia. Due to high recurrence rate and toxic side effects associated with radiation and chemotherapies, new agents are urgently needed. CARP-1 is a peri-nuclear phospho-protein which plays a dynamic role in regulating cell growth and apoptosis. CARP-1 functional mimetics (CFMs) are a class of compounds that stimulate CARP-1. CFM-4, a lead compound, was shown to suppress growth and metastasis of various cancers, other than CRC. We hypothesized that CFM-4 inhibits proliferation and metastasis in CRC. Materials and method: CFM-4 anti-cancer effects of on CRC cells were investigated using MTT assay, Annexin V/Propidium iodide (PI) apoptosis assay, cell cycle analysis, quantitative real-time PCR (qRT-PCR) and Western blotting. Antimetastatic activities were assessed by migration, colony formation and invasion assays. Results: CFM-4 inhibited CRC cell proliferation and was much more potent than the classical anti-CRC 5-fluorouracil. These effects were shown to be mediated at least in part by stimulating apoptosis, as indicated in our Annexin V/PI assay results. Cell cycle analysis showed that CFM-4 induced G2/M phase arrest. Molecularly, qRT-PCR results revealed that CFM-4 promoted intrinsic apoptosis by upregulating expression of caspase-8 and -9 , p53, PUMA and Noxa, and stimulated extrinsic apoptosis by enhancing expression of death receptors (DR4 and DR5). CFM-4 upregulated NF- k B signaling inhibitor A20-binding inhibitor protein and the PI3K negative regulator PTEN. Western blot analysis results revealed that CFM-4 enhanced expression of CARP1, caspase-8 and executioner caspase-3. Metastatic properties of the CRC cells were reduced by CFM-4 through blocking their capabilities to form colonies, migrate and invade through the matrix-coated membranes. Conclusion: The potent antitumor and anti-metastatic properties of CFM-4 against CRC are due to collective pro-apoptotic, anti-proliferative and anti-metastatic activities. Together our data warrants further investigations of CFM-4 as potential anti-tumor agent for CRC malignancy and metastasis.
Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article.
The process of anaesthesia is one of the most important anxiety precipitating factors for both parent and child who is going for operation. Parental anxiety may adversely affect the children during perioperative period. Studies have shown that anxious parents would want to be provided with more information prior to their child’s surgery. We examined the effects of additional paediatric information leaflet on parents and children in reducing pre-operation anxiety. Materials and methods: This was a randomized controlled trial involving 70 parentchild dyads in Hospital Raja Perempuan Zainab II (HRPZ II), Kelantan. Inclusion criteria were child aged 3 to 12 years old who underwent elective surgery. Parents were assigned to intervention and control groups. The former received the information leaflet and the later received standard preparation.. Parents were compared on their anxiety level using Depression Anxiety Stress Scales 21 (DASS-21) (anxiety domain) in the holding area. Children were compared on their emotional state level before induction of anaesthesia using Children’s Emotional Manifestation Scale (CEMS). Results: The number of parents who were anxious was similar in both groups (11 (31%) vs. 7 (21%), p =.34). There were no differences in the children’s anxiety state between interventional and control groups as depicted by the CEMS score (7.5 (6.0-9.75) vs. 8.0 (7.0-15.0), p= .12). Conclusion: Parent-child dyads in HRPZ II did not show improvement in the anxiety level with the inclusion of paediatric anaesthesia information leaflet. Further study is needed with larger number of participants involving other selected tertiary hospitals in Malaysia.
Monosodium methylarsonate (MSMA) is an organic arsenical pesticide widely used in agriculture. Humans are exposed to arsenic through drinking water and anthropogenic activities. Exposure to inorganic arsenic has been linked with multiple health problems. However, studies focusing on chronic organic arsenic exposure and its adverse effects on kidney were limited. The purpose of current study was to determine the effects of chronic organic arsenic exposure in rats kidney by light and electron microscopy. Materials and Method: Thirty-six male SpragueDawley rats were divided into six groups (n=6); three control and three treatment group respectively. All the control group was given distilled water via oral gavage. The treatment group was given oral gavage of MSMA at 42.10 mg/kg body weight (BW) which is equivalent 1/30 LD50 of MSMA. The control and treatment groups were sacrificed at two month, four month and six months interval. Both kidneys harvested for light microscopy and electron microscopy study. Results: Showed progressive changes. The changes initially focal and became diffused involving glomerular; such as glomerular hypercellularity, glomerular shrinkage and dilated Bowman's space. Meanwhile, in proximal tubules, showed diminished brush borders, detachment of nucleus and basement membrane thickening. Electron microscopy showed flattened cell bodies of podocytes, effacement and fusion of podocytes foot processes, thickening of glomerular basement membrane, and discontinuity of brush border. The control and two-months treated group appeared to be normal. Conclusion: Chronic organic arsenic (MSMA) exposure induced chronic kidney injury.