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Assessment of factors affecting Agrobacterium-mediated genetic transformation of the unicellular green alga, Chlorella vulgaris

Cha TS, Yee W, Aziz A

World J Microbiol Biotechnol, 2012 Apr;28(4):1771-9.
PMID: 22805959 DOI: 10.1007/s11274-011-0991-0

The successful establishment of an Agrobacterium-mediated transformation method and optimisation of six critical parameters known to influence the efficacy of Agrobacterium T-DNA transfer in the unicellular microalga Chlorella vulgaris (UMT-M1) are reported. Agrobacterium tumefaciens strain LBA4404 harbouring the binary vector pCAMBIA1304 containing the gfp:gusA fusion reporter and a hygromycin phosphotransferase (hpt) selectable marker driven by the CaMV35S promoter were used for transformation. Transformation frequency was assessed by monitoring transient β-glucuronidase (GUS) expression 2 days post-infection. It was found that co-cultivation temperature at 24°C, co-cultivation medium at pH 5.5, 3 days of co-cultivation, 150 μM acetosyringone, Agrobacterium density of 1.0 units (OD(600)) and 2 days of pre-culture were optimum variables which produced the highest number of GUS-positive cells (8.8-20.1%) when each of these parameters was optimised individually. Transformation conducted with the combination of all optimal parameters above produced 25.0% of GUS-positive cells, which was almost a threefold increase from 8.9% obtained from un-optimised parameters. Evidence of transformation was further confirmed in 30% of 30 randomly-selected hygromycin B (20 mg L(-1)) resistant colonies by polymerase chain reaction (PCR) using gfp:gusA and hpt-specific primers. The developed transformation method is expected to facilitate the genetic improvement of this commercially-important microalga.
Influence of nitrogen availability on biomass, lipid production, fatty acid profile, and the expression of fatty acid desaturase genes in Messastrum gracile SE-MC4

Anne-Marie K, Yee W, Loh SH, Aziz A, Cha TS

World J Microbiol Biotechnol, 2020 Jan 07;36(1):17.
PMID: 31912247 DOI: 10.1007/s11274-019-2790-y

In this study, the effects of limited and excess nitrate on biomass, lipid production, and fatty acid profile in Messastrum gracile SE-MC4 were determined. The expression of fatty acid desaturase genes, namely stearoyl-ACP desaturase (SAD), omega-6 fatty acid desaturase (ω-6 FAD), omega-3 fatty acid desaturase isoform 1 (ω-3 FADi1), and omega-3 fatty acid desaturase isoform 2 (ω-3 FADi2) was also assessed. It was found that nitrate limitation generally increased the total oil, α-linolenic acid (C18:3n3) and total polyunsaturated fatty acid (PUFA) contents in M. gracile. The reduction of nitrate concentration from 1.76 to 0.11 mM increased the total oil content significantly from 32.5 to 41.85% (dry weight). Palmitic (C16:0) and oleic (C18:1) acids as the predominant fatty acids in this microalgae constituted between 82 and 87% of the total oil content and were relatively consistent throughout all nitrate concentrations tested. The expression of SAD, ω-6 FAD, and ω-3 FADi2 genes increased under nitrate limitation, especially at 0.11 mM nitrate. The ω-3 FADi1 demonstrated a binary up-regulation pattern of expression under both nitrate-deficient (0.11 mM) and -excess (3.55 mM) conditions. Thus, findings from this study suggested that limited or excess nitrate could be used as part of a cultivation strategy to increase oil and PUFA content following media optimisation and more efficient culture methodology. Data obtained from the expression of desaturase genes would provide valuable insights into their roles under excess and limited nitrate conditions in M. gracile, potentially paving the way for future genetic modifications.
Effective removal of p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- from landfill leachate using locust bean gum

Aziz A, Agamuthu P, Fauziah SH

Waste Manag Res, 2018 Dec;36(12):1146-1156.
PMID: 30067147 DOI: 10.1177/0734242X18789062

The widespread distribution of persistent organic pollutants (POPs) in landfill leachate is problematic due to their acute toxicity, carcinogenicity and genotoxicity effects, which could be detrimental to public health and ecological systems. The objective of this study was to evaluate the effective removal of POPs - namely, p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- - from landfill leachate using locust bean gum (LBG), and in comparison with commonly used alum. The response surface methodology coupled with a Box-Behnken design was employed to optimize the operating factors for optimal POPs removal. A quadratic polynomial model was fitted into the data with the R2 values of 0.97 and 0.96 for the removal of p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl), (S)-, respectively. The physicochemical characteristics of the flocs produced by LBG and alum were evaluated with Fourier Transform Infrared (FTIR) spectroscopy and Scanning Electron Microscopy (SEM). The infrared spectra of LBG-treated floc were identical with LBG powder, but there was some variation in the peaks of the functional groups, signifying the chemical interactions between flocculants and pollutant particles resulting from POPs removal. The results showed that p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- obtained 96% and 100% removal using 500 mg/L of LBG at pH 4. pH have a significant effect on POPs removal in leachate. It is estimated that treating one million gallons of leachate using alum (at 1 g/L dosage) would cost US$39, and using LBG (at 500 mg/L dosage) would cost US$2. LBG is eco-friendly, biodegradable and non-toxic and, hence, strongly recommended as an alternative to inorganic coagulants for the treatment of POPs in landfill leachate.
Removal of bisphenol A and 2,4-Di-tert-butylphenol from landfill leachate using plant- based coagulant

Aziz A, Agamuthu P, Fauziah SH

Waste Manag Res, 2018 Oct;36(10):975-984.
PMID: 30058954 DOI: 10.1177/0734242X18790360

Landfill leachate contain persistent organic pollutants (POPs), namely, bisphenol A (BPA) and 2,4-Di-tert-butylphenol, which exceed the permissible limits. Thus, such landfill leachate must be treated before it is released into natural water courses. This article reports on investigations about the removal efficiency of POPs such as BPA and 2,4-Di-tert-butylphenol from leachate using locust bean gum (LBG) in comparison with alum. The vital experimental variables (pH, coagulant dosage and stirring speed) were optimised by applying response surface methodology equipped with the Box-Behnken design to reduce the POPs from leachate. An empirical quadratic polynomial model could accurately model the surface response with R2 values of 0.928 and 0.954 to reduce BPA and 2,4-Di-tert-butylphenol, respectively. Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM) were performed on treated flocs for further understanding. FTIR analysis revealed that the bridging of pollutant particles could be due to the explicit adsorption and bridging via hydrogen bonding of a coagulation mechanism. SEM micrographs indicated that the flocs produced by LBG have a rough cloudy surface and numerous micro-pores compared with alum, which enabled the capture and removal of POPs from leachate. Results showed that the reduction efficiencies for BPA and 2,4-Di-tert-butylphenol at pH 7.5 were 76% and 84% at LBG dosage of 500 mg·L-1 and 400 mg·L-1, respectively. Coagulant dosage and pH variation have a significant effect on POPs reduction in leachate. Coagulation/flocculation using LBG could be applied for POPs reduction in leachate as a pre-treatment prior to advanced treatments.
Fulltext The Integrated Care Pathway for Managing Post Stroke (ICAPPS) Patients in the Community: A Cost -Effectiveness Analysis

Abdul AA, Muhammad Nur A, Sulong S, Aljunid S

Value Health, 2014 Nov;17(7):A761.
PMID: 27202786 DOI: 10.1016/j.jval.2014.08.259
Non-seeded synthesis and characterization of superparamagnetic iron oxide nanoparticles incorporated into silica nanoparticles via ultrasound

Sodipo BK, Abdul Aziz A

Ultrason Sonochem, 2015 Mar;23:354-9.
PMID: 25315418 DOI: 10.1016/j.ultsonch.2014.09.011

A non-seeded method of incorporating superparamagnetic iron oxide nanoparticles (SPION) into silica nanoparticles is presented. Mixture of both SPION and silica nanoparticles was ultrasonically irradiated. The collapsed bubbles and shockwave generated from the ultrasonic irradiation produce tremendous force that caused inelastic collision and incorporation of SPION into the silica. Physicochemical analyses using transmission electron microscope (TEM), electronic spectroscopic imaging (ESI), X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy demonstrated the formation of SPION/silica composite nanoparticles. The prepared composite nanoparticles exhibited superparamagnetic behaviour and nearly 70% of the initial saturation magnetization (Ms) of the SPION was retained. The presence and reactivity of the silica were demonstrated via assembling decanethiol monolayer on the composite nanoparticles. The silanol group of the silica provided the binding site for the alkyl group in the decanethiol molecules. Therefore, the thiol moiety became the terminal and functional group on the magnetic composite nanoparticles.
Mechanistic analysis of cavitation assisted transesterification on biodiesel characteristics

Sajjadi B, Abdul Aziz AR, Ibrahim S

Ultrason Sonochem, 2015 Jan;22:463-73.
PMID: 24981808 DOI: 10.1016/j.ultsonch.2014.06.004

The influence of sonoluminescence transesterification on biodiesel physicochemical properties was investigated and the results were compared to those of traditional mechanical stirring. This study was conducted to identify the mechanistic features of ultrasonication by coupling statistical analysis of the experiments into the simulation of cavitation bubble. Different combinations of operational variables were employed for alkali-catalysis transesterification of palm oil. The experimental results showed that transesterification with ultrasound irradiation could change the biodiesel density by about 0.3kg/m(3); the viscosity by 0.12mm(2)/s; the pour point by about 1-2°C and the flash point by 5°C compared to the traditional method. Furthermore, 93.84% of yield with alcohol to oil molar ratio of 6:1 could be achieved through ultrasound assisted transesterification within only 20min. However, only 89.09% of reaction yield was obtained by traditional macro mixing/heating under the same condition. Based on the simulated oscillation velocity value, the cavitation phenomenon significantly contributed to generation of fine micro emulsion and was able to overcome mass transfer restriction. It was found that the sonoluminescence bubbles reached the temperature of 758-713K, pressure of 235.5-159.55bar, oscillation velocity of 3.5-6.5cm/s, and equilibrium radius of 17.9-13.7 times greater than its initial size under the ambient temperature of 50-64°C at the moment of collapse. This showed that the sonoluminescence bubbles were in the condition in which the decomposition phenomena were activated and the reaction rate was accelerated together with a change in the biodiesel properties.
Could antiseptic gargling prevent COVID-19?

Mohamed NA, Ahmad Zainol Hady A, Abdul Aziz AH, Isahak I

Trop Biomed, 2020 Dec 01;37(4):1141-1145.
PMID: 33612766 DOI: 10.47665/tb.37.4.1141

Coronavirus Disease 2019 (COVID-19) has infected more than 8 million people globally since its discovery in December 2019. For COVID-19 prevention, the World Health Organization recommended regular handwashing with soap, cough etiquette, mask wearing and social distancing. However, COVID-19 is rather difficult to contain because of its high transmissibility property. Gargling is effective for reducing infection in the respiratory tract. Most antiseptic gargles have antimicrobial properties against common respiratory pathogens. No published study on the effectiveness of antiseptic gargling among COVID-19 patients has been available to date. This article reviewed available literature on methods and solutions available for gargling and their effect on respiratory tract infections.
Bacterial pathogens isolated from cockroaches trapped from paediatric wards in peninsular Malaysia

Oothuman P, Jeffery J, Aziz AH, Abu Bakar E, Jegathesan M

Trans R Soc Trop Med Hyg, 1989 1 1;83(1):133-5.
PMID: 2603192

A survey was conducted in 4 paediatric wards in Malaysia to determine the distribution of various species of cockroaches and to examine their gut contents for bacteria. Cockroaches were trapped from food dispensing areas (kitchens), store rooms, cupboards and open wards. 104 cockroaches were caught, consisting of Periplaneta americana (67.3%), Blattella germanica (26%), P. brunnea (4.8%), and Supella longipalpa (1.9%). Bacteria were isolated from all cockroaches except 3 P. americana. Many bacterial species were identified, including the pathogenic and potentially pathogenic species Shigella boydii, S. dysenteriae, Salmonella typhimurium, Klebseilla oxytoca, K. ozaena and Serratia marcescens.
Fulltext Current trends in water-in-diesel emulsion as a fuel

Yahaya Khan M, Abdul Karim ZA, Hagos FY, Aziz AR, Tan IM

ScientificWorldJournal, 2014;2014:527472.
PMID: 24563631 DOI: 10.1155/2014/527472

Water-in-diesel emulsion (WiDE) is an alternative fuel for CI engines that can be employed with the existing engine setup with no additional engine retrofitting. It has benefits of simultaneous reduction of both NO x and particulate matters in addition to its impact in the combustion efficiency improvement, although this needs further investigation. This review paper addresses the type of emulsion, the microexplosion phenomenon, emulsion stability and physiochemical improvement, and effect of water content on the combustion and emissions of WiDE fuel. The review also covers the recent experimental methodologies used in the investigation of WiDE for both transport and stationary engine applications. In this review, the fuel injection pump and spray nozzle arrangement has been found to be the most critical components as far as the secondary atomization is concerned and further investigation of the effect of these components in the microexplosion of the emulsion is suggested to be center of focus.
Fulltext Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NAR, Siti Asma H

Med J Malaysia, 2013 Aug;68(4):323-5.
PMID: 24145260 MyJurnal

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.
Fulltext Computed tomography (CT) of bowel and mesenteric injury in blunt abdominal trauma: a pictorial essay

Hassan R, Abd Aziz A, Mohamed SKC

Med J Malaysia, 2012 Aug;67(4):445-51; quiz 452.
PMID: 23082464 MyJurnal

Computed tomography (CT) is currently the diagnostic modality of choice in the evaluation of clinically stable patients with blunt abdominal trauma, including the assessment of blunt bowel and mesenteric injuries. CT signs of bowel and/or mesenteric injuries are bowel wall defect, free air, oral contrast material extravasation, extravasation of contrast material from mesenteric vessels, mesenteric vascular beading, abrupt termination of mesenteric vessels, focal bowel wall thickening, mesenteric fat stranding, mesenteric haematoma and intraperitoneal or retroperitoneal fluid. This pictorial essay illustrates CT features of bowel and/or mesenteric injuries in patients with blunt abdominal trauma. Pitfalls in interpretation of images are emphasized in proven cases.
Fulltext The National Mental Health Registry (NMHR)

Aziz AA, Salina AA, Abdul Kadir AB, Badiah Y, Cheah YC, Nor Hayati A, et al.

Med J Malaysia, 2008 Sep;63 Suppl C:15-7.
PMID: 19227671

The National Mental Health Registry (NMHR) collects information about patients with mental disorder in Malaysia. This information allows us to estimate the incidence of selected mental disorders, and to evaluate risk factors and treatment in the country. The National Mental Health Registry (NMHR) presented its first report in 2004, a year after its establishment. The report focused on schizophrenia as a pioneer project for the National Mental Health Registry. The development of the registry has progressed with data collected from government-based facilities, the academia and the private sector. The 2003-2005 report was recently published and distributed. Since then the registry has progressed to include suicides and other mental illnesses such as depression. The NMHR Report 2003-2005 provides detailed information about the profile of persons with Schizophrenia who presented for the first time to various psychiatry and mental health providers throughout Malaysia. More detailed description regarding pharmacotherapy is reported and few cross tabulations done in an effort to provide better understanding and more clinically meaningful reports.
Fulltext Usage of traditional and complementary medicine (T & CM): Prevalence, practice and perception among post stroke patients attending conventional stroke rehabilitation in a teaching hospital in Malaysia

Ali MF, Abdul Aziz AF, Rashid MR, Che Man Z, Amir AA, Lim YS, et al.

Med J Malaysia, 2015 Feb;70(1):18-23.
PMID: 26032524

INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital.
METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data.
RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%).
CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.
Study site: Medical Rehabilitation Services Department, Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Medication noncompliance--a thriving problem

Aziz AM, Ibrahim MI

Med J Malaysia, 1999 Jun;54(2):192-9.
PMID: 10972029

A study was conducted among out-patients attending the Melaka Tengah Health Clinic to determine their compliance status towards antihypertensive, antidiabetic and antiasthmatic drugs. A total of 585 patients were enrolled in this study. Assessment of compliance was carried out using pill-counting and house-to-house interviews 14 days from the date of medication dispensed at the counter. The noncompliance rate among the 464 successfully interviewed patients was 56%. The mean noncompliance percentage was 78.0 +/- 43.1% (range: -10.0-314.3%). Among the four variables of compliance studied, race was not seen as a determinant of compliance. The older age group and those taking two or more drugs were statistically significant to be a noncomplier. Females were highly likely not to comply with drug therapy. Patients who conform to their refill dates were not really drug compliers. Forgetting to take their drugs and inability to read instructions on drug labels were the main reasons given. Underdosing was more common than overdosing, with an estimated cost of RM20,261.00 of unused medications per year.
Study site: Klinik Kesihatan Melaka Tengah, Melaka, Malaysia
Fulltext Societal risk perception of death among workers in a security company in Malaysia

Jefferelli SB, Rampal KG, Aziz AJ, Agus Salim MB

Med J Malaysia, 2003 Dec;58(5):653-6.
PMID: 15190649 MyJurnal

How people perceive risk influences their behaviour towards these risks. We do not know how workers perceive risk of dying from diseases or accidents. This study was conducted among 198 workers of a security company in Malaysia. The workers were asked to score on a Likert scale of 1 to 5 the perceived risk of death of Malaysians from selected causes of death. The highest perceived risks of death were, in order of ranking, motor vehicle accidents, cancer and diabetes mellitus whereas according to the certified causes of death in Malaysia the highest risks of death among the selected items were cardiovascular disease, cancer and stroke. The difference in perception and mortality data needs be addressed.
Functionality among stroke survivors with upper limb impairment attending community-based rehabilitation

Omar NH, Mohd Nordin NA, Chai SC, Abdul Aziz AF

Med J Malaysia, 2020 03;75(2):146-151.
PMID: 32281596

INTRODUCTION: There is scarcity of research information on upper limb (UL) functionality among Malaysian post-stroke population despite the increasing number of stroke survivors. This study intends to evaluate functionality among stroke survivors residing in the community, with a specific focus on the UL.
METHODS: This cross-sectional study involved 65 stroke survivors with UL dysfunction (mean (SD) age = 64.83 (8.05) years, mean (SD) post-stroke duration 41.62 (35.24) months) who attended community-based rehabilitation program. Upper limb functionality was assessed using the UL items of Stroke Specific Quality of Life Scale (SSQOL), the Lawton Instrumental Activities of Daily Living (IADL) Scale and the Jebsen-Taylor Hand Function Test (JTHFT). The stroke survivors' performance in completing JTHFT using their affected dominant hand was compared with standard norms.
RESULTS: The three most affected UL daily living tasks were writing (64.7%, n=42), opening a jar (63.1%, n=41) and putting on socks (58.5%, n=38). As for IADL, the mean (SD) score of Lawton scale was 3.26 (2.41), with more than 50% unable to handle finance, do the laundry and prepare meals for themselves. Performances of stroke survivors were much slower than normal population in all tasks of JTHFT (p<0.05), with largest speed difference demonstrated for 'stacking objects' task (mean difference 43.24 secs (p=0.003) and 24.57 (p<0.001) in males and females, respectively.
CONCLUSION: UL functions are significantly impaired among stroke survivors despite undergoing rehabilitation. Rehabilitation professionals should prioritize highly problematic tasks when retraining UL for greater post-stroke functionality.
Anti-diabetic medication burden amongst older persons with diabetes and associated quality of life

Shalihin SE, Fauzi A, Zulkifli NA, Aziz AA

Med J Malaysia, 2020 09;75(5):525-530.
PMID: 32918421

BACKGROUND: Older persons with diabetes are the major demographic of diabetic patients followed up in primary health clinics. Despite their increasing age and morbidities, they are still being managed strictly towards good sugar control in order to achieve the ideal HbA1c level without taking their quality of life into consideration. This study aimed to determine the prevalence in the use of antidiabetic drugs among older persons with diabetes and its association with their quality of life.
METHODOLOGY: A cross-sectional study was conducted among 269 older persons with diabetes in all government health clinics in Kuantan using Diabetes Quality of Life questionnaire. SPSS version 23 was used for the statistical analysis.
RESULTS: Majority of the respondents were females (61%), Malays (84.8%), pensioners (54.3%) with education up to primary school (52%) and are staying with family members (93.7%). Most of the patients were on two antidiabetic agents (48%) followed by a single antidiabetic agent (32%). Despite the risk of hypoglycaemia, 0.4% of them are on glibenclamide. The use of insulin is still common among 21% of them that are on intermediate-acting insulin, 15.6% on premixed insulin and 7.8% on short-acting insulin. Those taking a higher number of antidiabetic agents were found to be associated with poorer quality of life (p=0.001) compared to those taking one or two antidiabetic medications. Those on insulin also have significantly poorer quality of life score (p=0.012).
CONCLUSION: Despite aiming for controlled diabetes, older persons suffer poor quality of life with further intensification of their antidiabetic medications according to the guidelines. This includes the complexity of insulin usage and polypharmacy, which contribute to the low quality of life score.
A challenging road to diagnosing transthyretin cardiac amyloidosis and using technetium-99m pyrophosphate bone scintigraphy in nuclear cardiology - A case report

Kavita A, Abdul Onny MA, Suppiah S, Abdul Aziz AF, Hashim H, Raja Shariff RE, et al.

Med J Malaysia, 2021 Sep;76(5):762-767.
PMID: 34508392

Cardiac amyloidosis (CA) is a rare form of protein deposition disease, leading to restrictive cardiomyopathy that often presents with signs and symptoms of unexplained heart failure with preserved ejection fraction (HFpEF). There are two main subtypes of CA, namely light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), which are conventionally confirmed by endomyocardial biopsy (EMB). The prognosis and treatment of the subtypes differ extensively, making it crucial to distinguish between the two. Although echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) are useful to aid in the diagnosis, they are unable to differentiate between the subtypes. Advantageously, the transthyretin cardiac amyloidosis (ATTR-CA) subtype can be diagnosed based on nuclear medicine bone scintigraphy imaging using Technetiumlabelled bone-seeking radiotracers. We report a case of a previously well, elderly gentleman who presented with acute heart failure symptoms, whereby ECHO findings were suspicious for CA. Technetium-99m pyrophosphate (99mTc- PYP) bone scintigraphy performed with complementary single photon emission computed tomography/computed tomography (SPECT/CT) at three hours post-injection revealed radiotracer uptake in the myocardium that was higher than the skeletal bone uptake. This corresponded to Perugini score of 3 along with an increased heart to contralateral lung ratio (H:CL) of 1.69. The bone scintigraphy findings together with his symptoms, ECHO, CMR, and laboratory results enabled the diagnosis of ATTR-CA to be made. In summary, bone scintigraphy offers a reliable and non-invasive method for the diagnosis of ATTR-CA. We also highlight the diagnostic pitfalls and recommendations in reporting bone scintigraphy for the indication of typing cardiac amyloidosis.
18F-FDG PET/CT for the pre-surgical localization of epileptogenic focus among paediatric patients with drug resistant epilepsy in Malaysia: perspective of a nuclear medicine physician

Abdul Aziz AF, Mohamed AR, Murugesu S, Siti Zarina AH, Lee BN

Med J Malaysia, 2021 07;76(4):502-509.
PMID: 34305111

BACKGROUND: Scalp video electroencephalography monitoring (VEM) and brain MRI sometime fail to identify the epileptogenic focus (EF) in patients with drug resistant epilepsy (DRE). 18F-FDG PET/CT has been shown to improve the detection of EF in patients but is not widely used in Malaysia. Thus, the objective of this study was to identify whether 18F-FDG PET/CT conferred an added benefit in the pre-surgical evaluation of DRE.
METHODS: Retrospective review of 119 consecutive paediatric patients referred for 18F-FDG-PET/CT at the Department of Nuclear Medicine of the National Cancer Institute, Putrajaya. All had DRE and underwent evaluation at the Paediatric Institute, Hospital Kuala Lumpur. Visually detected areas of 18F-FDG-PET/CT hypometabolism were correlated with clinical, MRI and VEM findings.
RESULTS: Hypometabolism was detected in 102/119 (86%) 18FFDG- PET/CT scans. The pattern of hypometabolism in 73 patients with normal MRI was focal unilobar in 16/73 (22%), multilobar unilateral in 8/73 (11%), bilateral in 27/73 (37%) and global in 5/73 (7%) of patients; whilst 17/73 (23%) showed normal metabolism. In 46 patients with lesions on MRI, 18F-FDG-PET/CT showed concordant localisation and lateralization of the EF in 30/46 (65%) patients, and bilateral or widespread hypometabolism in the rest. Addition of 18FFDG PET/CT impacted decision making in 66/119 (55%) of patients; 24/73 with non-lesional and 30/46 patients with lesional epilepsies were recommended for surgery or further surgical work up, whilst surgery was not recommended in 11/46 patients with lesional epilepsy due to bilateral or widespread hypometabolism. 25 patients subsequently underwent epilepsy surgery, with 16/25 becoming seizure free following surgery.
CONCLUSION: 18F-FDG-PET/CT has an added benefit for the localization and lateralization of EF, particularly in patients with normal or inconclusive MRI.

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