Orbital metastasis from renal cell carcinoma (RCC) is uncommon. Orbital tumor, as the first presentation of RCC, is rare as the majority of orbital metastases occur after a confirmed diagnosis of primary cancer. We report a case of the metastatic orbital tumor as the first manifestation of RCC, which presented with painless left eye proptosis for two months' duration, associated with blurring of vision and diplopia. Otherwise, the systemic review was unremarkable. Examination showed left eye non-axial proptosis with a pulsatile, multilobulated mass over the left supraorbital area extending to the left frontal region, limited ocular motility, and impaired optic nerve functions. CT of the orbit showed a mass arising from the left frontal and greater wing of the left sphenoid bone, with infiltration to the left lateral rectus, left superior oblique, and lacrimal gland. Further systemic investigation with CT thorax, abdomen, and pelvis revealed left RCC with para-aortic nodes, lungs, and bone metastases. The patient was planned for palliative care.
Forrestiacids A (1) and B (2) are a novel class of [4+2] type pentaterpenoids derived from a rearranged lanostane moiety (dienophile) and an abietane unit (diene). These unprecedented molecules were isolated using guidance by molecular ion networking (MoIN) from Pseudotsuga forrestii, an endangered member of the Asian Douglas Fir Family. The intermolecular hetero-Diels-Alder adducts feature an unusual bicyclo[2.2.2]octene ring system. Their structures were elucidated by spectroscopic analysis, GIAO NMR calculations and DP4+ probability analyses, electronic circular dichroism calculations, and X-ray diffraction analysis. This unique addition to the pentaterpene family represents the largest and the most complex molecule successfully assigned using computational approaches to predict accurately chemical shift values. Compounds 1 and 2 exhibited potent inhibitory activities (IC50 s <5 μM) of ATP-citrate lyase (ACL), a new drug target for the treatment of glycolipid metabolic disorders including hyperlipidemia. Validating this activity 1 effectively attenuated the de novo lipogenesis in HepG2 cells. These findings provide a new chemical class for developing potential therapeutic agents for ACL-related diseases with strong links to traditional medicines.
MeSH terms: ATP Citrate (pro-S)-Lyase/antagonists & inhibitors*; ATP Citrate (pro-S)-Lyase/metabolism; Biological Products/pharmacology*; Biological Products/chemistry; Enzyme Inhibitors/pharmacology*; Enzyme Inhibitors/chemistry; Humans; Molecular Conformation; Magnetic Resonance Spectroscopy; Terpenes/pharmacology*; Terpenes/chemistry; Lipogenesis/drug effects
Between 2016 and 2020, the Medical and Veterinary Entomology unit of the Institut Pasteur du Cambodge collected over 230,000 mosquitoes. Based on this sampling effort, a checklist of 290 mosquito species in Cambodia is presented. This is the first attempt to list the Culicidae fauna of the country. We report 49 species for the first time in Cambodia. The 290 species belong to 20 genera: Aedeomyia (1 sp.), Aedes (55 spp.), Anopheles (53 spp.), Armigeres (26 spp.), Coquillettidia (3 spp.), Culex (57 spp.), Culiseta (1 sp.), Ficalbia (1 sp.), Heizmannia (10 spp.), Hodgesia (3 spp.), Lutzia (3 spp.), Malaya (2 spp.), Mansonia (5 spp.), Mimomyia (7 spp.), Orthopodomyia (3 spp.), Topomyia (4 spp.), Toxorhynchites (4 spp.), Tripteroides (6 spp.), Uranotaenia (27 spp.), and Verrallina (19 spp.). The Cambodian Culicidae fauna is discussed in its Southeast Asian context. Forty-three species are reported to be of medical importance, and are involved in the transmission of pathogens.
Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.
Black jelly mushroom (Auricularia polytricha) is a well-known Chinese traditional food that has therapeutic effects. This study evaluated the effects of different cooking methods (boiling, steaming, microwaving, and stir-frying) on the physicochemical characteristics (i.e., total phenolic content, antioxidants, α,α-diphenyl-β-picryl-hydrazyl [DPPH] free radical scavenging, and ferric reducing antioxidant power [FRAP]) along with color, texture, moisture, and sensory properties of black jelly mushrooms. Lightness (L*) was significantly lower for the stir-frying method (29.93) compared to the control (34.62). Stir-fried mushrooms had significantly lower firmness force (texture) and moisture content (80.13 N and 61.98%, respectively) compared to the control (2000.37 N and 86.52%). The steaming method contributed significantly higher total phenolic content (11.23 mg gallic acid equivalents/g) and antioxidant activity measured using the FRAP (33.54 mg Trolox equivalents/g) and DPPH (90.41% inhibition) assays compared to the respective controls.
In this study, crude extracts of Ganoderma lucidum (NGCs) were compared to the crude extracts of G. lucidum that has antler-like fruiting bodies (AGCs) for their cytotoxicity, inhibitory effects on the attachment of human immunodeficiency virus (HIV)-1 glycoprotein 120 (gp120) to cluster of differentiation 4 (CD4), identification and molecular docking simulations of chemical compounds to predict the best ligand inhibitor and the binding mechanism. Results showed that AGCs had a higher percentage of inhibition (54.3% ± 6.2%) at 150 ppm and higher cytotoxicity (half maximal cytotoxic concentration [CC50] < 300 ppm) than NGCs (CC50 < 400 ppm). Quadrupole time-of-flight (QTOF) liquid chromatography- mass spectrometry (LC-MS) results successfully identified 32 chemical compounds in AGCs and NGCs, comprising mostly ganoderic acids (62%) and their derivatives. Molecular docking simulations of ganolucidic acid A/D and ganoderic acid A/B predicted the strongest binding affinity via hydrogen bonding, suggesting the inhibition of HIV-1 gp120 attachment to CD4. The highest and lowest occupied molecular orbital (HOMO and LUMO, respectively) gap energies of ganoderic acids tended to have less negative HOMO energy and smaller HOMO-LUMO gap energy, implying increased interactions of ligands to the gp120 protein receptor. AGCs showed higher inhibition against HIV-1 gp120 than NGCs due to a higher abundance of ganoderic and ganolucidic acids, whereby both acids contributed the highest number of hydrogen bonds and polar interactions from the hydroxyl and carboxylic functional groups.
MeSH terms: Agaricales*; Humans; Triterpenes/pharmacology; HIV-1*; HIV Envelope Protein gp120; Reishi*; Fruiting Bodies, Fungal; Molecular Docking Simulation
Nuclear factor κB (NFκB) is a unique protein complex that plays a major role in lung inflammation and respiratory dysfunction. The NFκB signaling pathway, therefore becomes an avenue for the development of potential pharmacological interventions, especially in situations where chronic inflammation is often constitutively active and plays a key role in the pathogenesis and progression of the disease. NFκB decoy oligodeoxynucleotides (ODNs) are double-stranded and carry NFκB binding sequences. They prevent the formation of NFκB-mediated inflammatory cytokines and thus have been employed in the treatment of a variety of chronic inflammatory diseases. However, the systemic administration of naked decoy ODNs restricts their therapeutic effectiveness because of their poor pharmacokinetic profile, instability, degradation by cellular enzymes and their low cellular uptake. Both structural modification and nanotechnology have shown promising results in enhancing the pharmacokinetic profiles of potent therapeutic substances and have also shown great potential in the treatment of respiratory diseases such as asthma, chronic obstructive pulmonary disease and cystic fibrosis. In this review, we examine the contribution of NFκB activation in respiratory diseases and recent advancements in the therapeutic use of decoy ODNs. In addition, we also highlight the limitations and challenges in use of decoy ODNs as therapeutic molecules, cellular uptake of decoy ODNs, and the current need for novel delivery systems to provide efficient delivery of decoy ODNs. Furthermore, this review provides a common platform for discussion on the existence of decoy ODNs, as well as outlining perspectives on the latest generation of delivery systems that encapsulate decoy ODNs and target NFκB in respiratory diseases.
Effect of selenium and acidification in freshwater environment was assessed solitary but no reports are available on the impacts of both factors act together. In the present study, effects of combined simultaneous exposure to selenium (Se) and low pH were assessed in Mozambique tilapia, Oreochromis mossambicus. Responses were measured based on antioxidant defenses (enzymatic SOD, CAT, GPx and non-enzymatic GSH), biotransformation enzyme (GST), metallothionein levels (MT), oxidative damage (LPO, CP), Na+/K+-ATPase (NKA) activity in gills and liver tissues and neurotoxicity (acetylcholinesterase, AChE) response in brain tissue. Fish were exposed to combined treatment at different pH levels (7.5, control (optimum pH for tilapia growth); 5.5, low pH) and Se concentrations (0, 10, and 100 μg L-1). Toxicity levels of Se were not significantly different under control and low pH indicating that pH did not affect Se toxicity. Levels of GSH and MT were enhanced in Se-exposed fish at both pH. Combined effects of high Se concentration and low pH decreased SOD and CAT activities and increased those of GPx and GST. However, organisms were not able to prevent cellular damage (LPO and CP), indicating a condition of oxidative stress. Furthermore, inhibition of Na+/K+-ATPase activity was showed. Additionally, neurotoxicity effect was observed by inhibition of cholinesterase activity in organisms exposed to Se at both pH conditions. As a result, the combined stress of selenium and freshwater acidification has a slight impact on antioxidant defense mechanisms while significantly inhibiting cholinesterase and Na+/K + -ATPase activity in fish. The mechanisms of freshwater acidification mediating the toxic effects of trace non-metal element on freshwater fish need to investigate further.
The present study examines historical perspectives of the macrobenthic community in response to different phases of anthropogenic perturbations in Kakinada Bay, a tropical embayment on the east coast of India. Multivariate analysis of the snapshot data (1958-2017) revealed considerable changes in the Bay environment following a breakwater construction across the Bay mouth in 1997. Subsequently, port expansion activities, industrialization, urbanization, and geomorphic alterations in the Godavari delta brought deterrent changes in the Bay. The fluctuations over the years in hydrographical and sediment characteristics increased environmental heterogeneity and caused significant spatio-temporal shifts in the macrobenthic community between 1995-1996 and 2016-2017. The observed variabilities were suggestive of anthropogenic perturbations of the system with future repercussions on Bay ecosystem functioning. Overall, this study provides evidence on the long-term impact of anthropogenic activities on coastal marine communities and stresses the importance of macrobenthos as bioindicators of such changes in tropical systems.
Microplastics are tiny plastic particles with size below 5 mm, prevalence in marine environments and the occurrence have been reported in commercial marine fish worldwide. Microplastics' abilities to absorb various marine contaminants raised considerable concern on their role as a vector to spread harmful pollutants to the alienated environment. This study focussed on the occurrence of microplastics in gastrointestinal tract (GIT) and gills of 158 fishes across 16 species from two locations in Malaysia coastal waters. Microplastics were detected approximately 86% in the GIT and 92% in the gills of examined fish. High incident of microplastics was detected in fishes from the area that is close to an urban area with average microplastics incident reaching up to 9.88 plastics items/individuals. Meanwhile, only 5.17 microplastics per individual were recorded in fishes from a less urbanised area. Isolated microplastics comprised 80.2% of fibres, 17.7% of fragments and the remaining was derived from filaments (3.1%). Infrared and Raman spectroscopy analysis of selected microplastics revealed the chemical composition of microplastics which comprised of polyethene (PE), polypropylene (PP), acrylonitrile butadiene styrene (ABS), polystyrene (PS) and polyethylene terephthalates (PET). FESEM images indicate, different surface characteristics of microplastics as a result of environmental exposure. Further, elemental analysis using EDX for green PE fragments showed the uneven distribution of chromium (Cr) and iron (Fe) on the surface, suggesting the adherence of heavy metals on the surface of microplastics. Overall findings indicate the widespread distribution of microplastics in commercial marine fishes from Malaysia waters and could potentially lead to human exposure through fish consumption.
Cancer is the leading cause of death worldwide. Capecitabine (CP) shows severe side effects because of early metabolism in stomach that affects the normal cells and organs, particularly liver and stomach. In this scope, we report the biocompatible, nontoxic polymeric thin films loaded with anti-cancer drug, CP for target specific, sublingual delivery of CP. Chitosan (CS) and polyvinyl alcohol (PVA) were used as biodegradable polymers alongwith glutaraldehyde (GLA) cross linker. CP-loaded thin films (TFCP1-TFCP5) were fabricated by solvent casting method. The results of Fourier transform infrared spectroscopy confirmed the presence of CP and polymers (CS and PVA) with GLA which binds through hydrogen bonding, and compatibility of drug with different excipients. Thermogravemetric analysis showed that the thin films are highly stable while differential scanning calorimeter thermograms confirmed the complete miscibility/entrapment of CP within PVA/CS thin film matrix. X-ray diffraction patterns revealed the molecular ineractions between CP and polymer matrix. High degree of swelling index of thin films at pH 7.4 was observed in comparison to pH 5.5. CP release studies in acetate (pH 5.5) and phosphate buffer (pH 7.4) showed that the thin films swell and result in drug diffusion faster in phosphate buffer through diffusion governed by Higuchi's model. Cytotoxicity results displayed that CPTFs killed MCF-7 and T47D (human breast adenocarcinoma) cells more effectively as compared to CP alone. The results of adhesion assay also showed that the PVA and CS both are safe and biocompatible. TFCP1 and TFCP3 thin films efficiently induced the apoptosis as compared to CP alone. The improved ability of TFCP1 and TFCP3 to induce cytotoxicity in MCF-7 cells reflects the potential of these thin films for targeted drug delivery. The CPTFs were stable for 4 months at 4 °C/60% ± 2%RH and 25 °C/70% ± 2%RH. In conclusion, the thin film formulations showed target specific controlled and burst release properties and thus could prove to be effective for human breast cancer treatment.
The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management.
The term non-alcoholic fatty liver disease (NAFLD), and its definition, have limitations for both adults and children. The definition is most problematic for children, for whom alcohol consumption is usually not a concern. This problematic definition has prompted a consensus to rename and redefine adult NAFLD associated with metabolic dysregulation to metabolic (dysfunction)-associated fatty liver disease (MAFLD). Similarities, distinctions, and differences exist in the causes, natural history, and prognosis of fatty liver diseases in children compared with adults. In this Viewpoint we, an international panel, propose an overarching framework for paediatric fatty liver diseases and an age-appropriate MAFLD definition based on sex and age percentiles. The framework recognises the possibility of other coexisting systemic fatty liver diseases in children. The new MAFLD diagnostic criteria provide paediatricians with a conceptual scaffold for disease diagnosis, risk stratification, and improved clinical and multidisciplinary care, and they align with a definition that is valid across the lifespan.
Studies have shown that monosodium glutamate (MSG) can enhance satiety and reduce appetite among infants and adults. In a multi-ethnic country such as Malaysia, it is also important to consider whether ethnic variations will influence the effects of MSG on appetite regulation. Thus, this crossover study aimed to investigate the effects of MSG on the subjective appetite and subsequent energy intake among Malaysian children from the three major ethnic groups, namely the Malays, Chinese and Indians. A total of 92 participants aged 9-11 years from the three ethnic groups were recruited for this study. A cup of low-energy vegetable preload soup (100g, with MSG or without MSG) was served to each of the participants on the day of the study, followed by an ad libitum meal 45 min later. Appetite ratings of hunger, fullness, desire to eat and desire to snack were recorded using visual analogue scale (VAS) before the preload, after the preload, before the ad libitum meal and after the ad libitum meal. Results showed that the subjective appetite of the children did not differ between preload conditions (MSG+ or MSG-) throughout the study. Malay, Chinese and Indian children had similar total energy intake during the subsequent meal after the consumption of preload soups. In conclusion, the addition of MSG to low energy preload neither influenced the perception of appetite nor total energy intake in a subsequent ad libitum meal among children. No difference attributable to the participants' ethnicity was observed. Future studies should be conducted to examine whether repeated ingestion of MSG-containing protein-rich preload has potential longer-term effects on appetite and subsequent meal intakes among children from different ethnicities.
Despite the immense genetic heterogeneity of B-lymphoblastic leukemia [or precursor B-cell acute lymphoblastic leukemia (B-ALL)], RNA sequencing (RNA-Seq) could comprehensively interrogate its genetic drivers, assigning a specific molecular subtype in >90% of patients. However, study groups have only started to use RNA-Seq. For broader clinical use, technical, quality control, and appropriate performance validation are needed. We describe the development and validation of an RNA-Seq workflow for subtype classification, TPMT/NUDT15/TP53 variant discovery, and immunoglobulin heavy chain (IGH) disease clone identification for Malaysia-Singapore acute lymphoblastic leukemia (ALL) 2020. We validated this workflow in 377 patients in our preceding Malaysia-Singapore ALL 2003/Malaysia-Singapore ALL 2010 studies and proposed the quality control measures for RNA quality, library size, sequencing, and data analysis using the International Organization for Standardization 15189 quality and competence standard for medical laboratories. Compared with conventional methods, we achieved >95% accuracy in oncogene fusion identification, digital karyotyping, and TPMT and NUDT15 variant discovery. We found seven pathogenic TP53 mutations, confirmed with Sanger sequencing, which conferred a poorer outcome. Applying this workflow prospectively to the first 21 patients in Malaysia-Singapore ALL 2020, we identified the genetic drivers and IGH disease clones in >90% of patients with concordant TPMT, NUDT15, and TP53 variants using PCR-based methods. The median turnaround time was 12 days, which was clinically actionable. In conclusion, RNA-Seq workflow could be used clinically in management of B-cell ALL patients.
Bacterial infection is amongst the most common diseases in community and hospital settings. Fluoroquinolones, exerting the antibacterial activity through binding to type II bacterial topoisomerase enzymes, DNA gyrase and topoisomerase IV, are mainstays of chemotherapy. At present, fluoroquinolones are the most valuable antibacterial agents used popularly. However, the emergence of more virulent and resistant pathogens by the development of either mutated DNA-binding proteins or efflux pump mechanism for fluoroquinolones results in an urgent demand to develop new fluoroquinolones to withstand the drug resistance and to obtain a broader spectrum of activity. This review aims to outline the recent advances of fluoroquinolone derivatives with antibacterial potential and to summarize the structure-activity relationship (SAR) so as to provide an insight for rational design of more active candidates, covering articles published between January 2018 and June 2021.