MyMedR

Chye JK, Lim CT, Ng KB, Lim JM, George R, Lam SK

Clin Infect Dis, 1997 Dec;25(6):1374-7.

Dengue, an important mosquito-borne flavivirus infection, is endemic in Southeast Asia. We describe two mothers who had acute dengue 4 and 8 days before the births of their infants. One mother had worsening of her proteinuric pregnancy-induced hypertension, liver dysfunction, and coagulopathy and required multiple transfusions of whole blood, platelets, and fresh frozen plasma. Her male infant was ill at birth, developed respiratory distress and a large uncontrollable left intracerebral hemorrhage, and died of multiorgan failure on day 6 of life. Dengue virus type 2 was isolated from the infant's blood, and IgM antibody specific to dengue virus was detected in the mother's blood. The second mother had a milder clinical course; she gave birth to a female infant who was thrombocytopenic at birth and had an uneventful hospitalization. Dengue virus type 2 was recovered from the mother's blood, and IgM antibody specific to dengue virus was detected in the infant's blood. This report highlights not only the apparently rare occurrence of vertical transmission of dengue virus in humans but also the potential risk of death for infected neonates.

Unusual clinical manifestations of dengue virus infection

George R, Liam CK, Chua CT, Lam SK, Pang T, Geethan R, et al.

Southeast Asian J. Trop. Med. Public Health, 1988 Dec;19(4):585-90.

PMID: 3238469

Four recent cases of dengue fever with severe, unusual clinical manifestations are described. Two of these cases had features of fulminant hepatitis and encephalopathy; one of these cases was fatal. The two remaining cases showed hepatitis with renal impairment. The significance and importance of these unusual manifestations of dengue disease are discussed.

Fulltext The impact of chimerism in DNA-based forensic sex determination analysis

George R, Donald PM, Nagraj SK, Idiculla JJ, Hj Ismail R

Malays J Med Sci, 2013 Jan;20(1):76-80.

PMID: 23785258 MyJurnal

Sex determination is the most important step in personal identification in forensic investigations. DNA-based sex determination analysis is comparatively more reliable than the other conventional methods of sex determination analysis. Advanced technology like real-time polymerase chain reaction (PCR) offers accurate and reproducible results and is at the level of legal acceptance. But still there are situations like chimerism where an individual possess both male and female specific factors together in their body. Sex determination analysis in such cases can give erroneous results. This paper discusses the phenomenon of chimerism and its impact on sex determination analysis in forensic investigations.

Fulltext The effects of temperature on extracted teeth of different age groups: A pilot study

George R, Tan WJ, Shih Yi AL, Donald PM

J Forensic Dent Sci, 2018 4 17;9(3):165-174.

PMID: 29657495 DOI: 10.4103/jfo.jfds_25_16

Context: Type of dentition and age related changes may affect the behavior of dental hard tissues under thermal stress.

Aim: This study was conducted to analyze the effects of varying temperatures on extracted teeth of different age groups in a simulated laboratory set up.

Settings and Design: Experimental pilot study.

Methods and Material: Extracted teeth from three age groups (deciduous, young permanent and adult permanent) were collected and were exposed to three different temperatures (400°C, 700°C and 1000°C) in a laboratory set up. Post-test changes were analyzed visually and radiographically.

Results: (1) The colour changes of the teeth may serve as an indicator for the temperature to which they were exposed. (2) Deciduous teeth tolerated thermal stress with lesser morphological changes compared to young and adult permanent teeth. (3) Coronal dentin of elderly permanent teeth appeared to be more resistant to thermal stress compared to that of young permanent teeth. (4) The root portion of the teeth showed better tolerance to temperature while crown was fragmented easily under thermal stress.

Conclusion: The age factor and type of the dentition may influence the heat induced changes in teeth. These variables should be taken into consideration while applying comparative dental identification methods where dental hard tissues are exposed to extreme temperatures.

Fulltext Spectrum of beta-thalassaemia mutations in transfusion dependent thalassaemia patients: practical implications in prenatal diagnosis

George E, George R, Ariffin WA, Mokhtar AB, Azman ZA, Sivagengei K

Med J Malaysia, 1993 Sep;48(3):325-9.

PMID: 8183146

The study concerned the identification of the beta-thalassaemia mutations that were present in 24 patients with beta-thalassaemia major who were transfusion dependent. The application of a modified polymerase chain reaction, the amplification refractory system (ARMS) was found to be an effective and rapid method for the identification of the beta-thalassaemia mutations. Six different mutations were detected. Seventy five percent of the patients were Chinese-Malaysians and showed the commonly occurring anomalies: 1. frameshift codon 41 and 42 (-TCTT); 2. the C to T substitution at position 654 of intron 2 (IVS-2); 3. the mutation at position -28(A to G); and the nonsense mutation A to T at codon 17. In the Malays, the common mutations seen were: 1. the G to C mutation at position 5 of IVS-1; 2. the G to T mutation at position 1 of intron 1 (IVS-1); and the A to T at codon 17. The delineation of the specific mutations present will enable effective prenatal diagnosis for beta-thalassaemia to be instituted.

Severe protein-energy malnutrition in Kuala Lumpur

George R, Foo LC, Chong YH, Abraham SC

J Trop Pediatr, 1981 10;27(5):259-62.

PMID: 6798223 DOI: 10.1093/tropej/27.5.259

Fulltext Serum ferritin concentrations in transfusion dependent beta-thalassaemia

George E, Wong HB, George R, Ariffin WA

Singapore Med J, 1994 Feb;35(1):62-4.

PMID: 8009283

Patients on a moderate red cell transfusion programme have iron overload where the concentrations of the serum ferritin were inappropriate to increases in the transfusion load as a result of limitations of apoferritin synthesis and conversion of ferritin into haemosiderin. This study confirms the limitations for the use of estimations of the serum ferritin to evaluate the iron status in patients with expected high overload as would be seen in patients on many years of maintenance red cell transfusions in the absence of iron chelation therapy. Poor compliance, inadequate dosage of Desferal (deferoxamine), and the late initiation of iron chelation therapy were factors that were considered in the patients with failure of response to iron chelation.

Reye and Reye-like syndromes: results of a pilot study in Peninsular Malaya, 1986

Sinniah D, Sinniah R, Yap YF, Singh M, George R, Lim NL, et al.

Acta Paediatr Jpn, 1990 Aug;32(4):385-90.

PMID: 2288220

A pilot epidemiologic study of all cases of Reye and Reye-like syndromes was undertaken at 8 representative major hospitals in Peninsular Malaya from January 1st to December 31st 1986. The cases were classified as definitive Reye's syndrome, clinical Reye's syndrome and encephalo-hepatopathies. Less than 50% of cases reviewed fulfilled the National Center for Disease Control criteria for clinical Reye's syndrome. Causes of Reye-like syndromes/encephalo-hepatopathies included fulminant hepatitis, Japanese B encephalitis, dengue, septicaemia, and complex febrile fits. It was not possible to differentiate clinical Reye's syndrome from the other encephalo-hepatopathies by either the clinical features (except for jaundice) or biochemical parameters. Liver biopsy is necessary for a definitive diagnosis of Reye's syndrome in Malaysia, because of the high prevalence of Reye-like diseases. The mortality rate in the 2 groups of patients is similar. Ingestion of salicylates was not found to be significantly associated with Reye and Reye-like syndromes in this study.

Fulltext Resurrection of Bronchocela burmana Blanford, 1878 for the Green Crested Lizard (Squamata, Agamidae) of southern Myanmar

Zug GR, Mulcahy DG, Vindum JV

Zookeys, 2017.

PMID: 28331413 DOI: 10.3897/zookeys.657.11600

Recent fieldwork in southern Tanintharyi revealed the presence of a small Green Crested Lizard in the wet evergreen forest. We generated mtDNA sequence data (ND2) that demonstrates that this population's nearest relative is Bronchocela rayaensis Grismer et al., 2015 of Pulau Langkawi, northwestern Peninsular Malaysia and Phuket Island. Morphologically the Burmese Bronchocela shares many features with Bronchocela rayaensis, which potentially would make this recently described Thai-Malay species a synonym of Bronchocela burmana Blanford, 1878; however, we interpret the genetic and morphological differences to reflect evolutionary divergence and recommend the recognition of both species.

Problems in diagnosis and classification of dengue virus infection

George R

Malays J Pathol, 1993 Jun;15(1):25-7.

PMID: 8277785

Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement

Mastacouris N, Tannenbaum R, Strunk A, Koptyev J, Aarts P, Alhusayen R, et al.

JAMA Dermatol, 2023 Nov 01;159(11):1258-1266.

PMID: 37755725 DOI: 10.1001/jamadermatol.2023.3282

IMPORTANCE: Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines.

OBJECTIVE: To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied.

EVIDENCE REVIEW: Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice.

FINDINGS: Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]).

CONCLUSIONS AND RELEVANCE: An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.

Mosquito-borne haemorrhagic fever

George R, Kassim MS, Wah LT

Med J Malaysia, 1974 Sep;29(1):11-6.

PMID: 4282623

Interaction of haemoglobin E with alpha-thalassaemia and haemoglobin Constant Spring

Ganesan J, Lie-Injo LE, Ng TS, George R

Acta Haematol., 1977;57(2):109-15.

PMID: 402765 DOI: 10.1159/000207867

The combination of Hb E,alpha-thalassaemia and Hb CoSp was found in a 20-year-old female Malay who presented with a moderately severe haemolytic anaemia. The findings in the patient and her family from which this diagnosis was arrived at are discussed. Although this is the first report of this condition in this country it is pointed out that one may see more such cases in the future if one is aware of this condition since Hb E, alpha-thalassaemia and Hb CoSp all occur at significant frequencies in this country.

Inheritance pattern of lip prints among Malay population: A pilot study

George R, Nora Afandi NS, Zainal Abidin SN, Binti Ishak NI, Soe HH, Ismail AR

J Forensic Leg Med, 2016 Apr;39:156-60.

PMID: 26896666 DOI: 10.1016/j.jflm.2016.01.021

We assessed the resemblance of lip print patterns between parents and biological offspring in families of 31 Malay students as well as the distribution of different types of lip print in the study group. Only a few studies have successfully established the inheritance pattern of lip prints. Such studies can be population specific and need to be conducted in various populations. No such study have been conducted in Malay population in Malaysia, according to our knowledge. Present study was carried out to ascertain whether there is any inherence pattern in lip prints and thereby to investigate the potential role of lip prints in personal identification. We found 58.06% resemblance of lip print patterns between the parents and their biological offspring in our study. The influence of heredity in lip print pattern is still a new concept and there is lack of concrete evidence. The data from our study shows that there is potential influence of inheritance in the lip print patterns among the family members. Further researches involving larger samples size are suggested to derive more reliable and accurate results. The most common lip print pattern among the study group is type I (29.84%) followed by type II (23.12%), type III (22.45%), type I' (13.44%), type IV (9.54%) and type V (1.61%). Racial variations in lip print patterns and their prevalence may serve as an aid in forensic identification and crime scene investigation. The results of this pilot study will help in establishing guidelines for future researches on lip print analysis in Malaysia.

Fulltext Hormonal changes in exfoliated normal buccal mucosal cells

Donald PM, George R, Sriram G, Kavitha B, Sivapathasundharam B

J Cytol, 2013 Oct;30(4):252-6.

PMID: 24648669 DOI: 10.4103/0970-9371.126655

The present study was undertaken as a baseline study to evaluate the nuclear diameter (ND), cell diameter (CD) and nuclear-cytoplasmic ratio (N:C) and their variation with age in normal buccal smears of female subjects.

Fulltext Hepatitis B infection in multitransfused thalassaemics

George E, Ilina I, Yasmin AM, George R, Duraisamy G

Med J Malaysia, 1988 Dec;43(4):284-7.

PMID: 3241594

Fulltext Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1

Klionsky DJ, Abdel-Aziz AK, Abdelfatah S, Abdellatif M, Abdoli A, Abel S, et al.

Autophagy, 2021 Jan;17(1):1-382.

PMID: 33634751 DOI: 10.1080/15548627.2020.1797280

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.

Fulltext Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

Klionsky DJ, Abdelmohsen K, Abe A, Abedin MJ, Abeliovich H, Acevedo Arozena A, et al.

Autophagy, 2016;12(1):1-222.

PMID: 26799652 DOI: 10.1080/15548627.2015.1100356

Fulltext Group A streptococcal skin infection in childhood

Jamal F, Minhaj AA, Kasim MS, Zainal Z, George R

Family Practitioner, 1985;8(2):53-56.

Bacterial skin infection was studied in 239 children between the ages of 1 and 12 years in an urban squatter area in Kuala Lumpur over a period of three months (January - March 1983). 62 children presented with dermatological problems, 33 of which were clinically diagnosed as pyoderma. Microbiological examination of swabs from the lesions yielded mixed growth from 54.5% (18/33) specimens. Beta-haemolytic streptococci were isolated from 63.6% (21/33) and Staphylococcus aureus from 54.5% (18/33) specimens. All streptococcal isolates were grouped with a commercial kit, the Streptex (Wellcome). 81% (17/21) belonged to Lancefield's group A, 90% of which were not M or T typable by the standard international set of antisera. Urine analysis, pharyngeal swab culture and determination of anti-streptococcal antibody titre were also performed for children with positive skin cultures for group A streptococcus. 6% (2/33) of children with impetigo developed acute glomerulonephritis, requiring hospitalization.
Study site: Growth and nutrition clinic, squatter area, Kuala Lumpur, Malaysia

Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology

Thompson GR, Le T, Chindamporn A, Kauffman CA, Alastruey-Izquierdo A, Ampel NM, et al.

Lancet Infect Dis, 2021 12;21(12):e364-e374.

PMID: 34364529 DOI: 10.1016/S1473-3099(21)00191-2

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.

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