Laryngopharyngeal tuberculosis (TB) is a rare disease and usually associated with pulmonary tuberculosis. Mostly, it occurs in adults without BCG vaccination or in immuno-compromised patients (such as AIDS patients). A 34-year-old gentleman with odynophagia and poor oral intake was referred to us to rule out malignancy. Direct laryngoscopy examination revealed ulcerative lesion involving right tonsillar fossa extending downward till right pyriform sinus. Panendoscopy and biopsy was performed. Laryngopharyngeal TB was diagnosed based on the histopathological examination and Ziehl-Neelsen staining.
Screening for Tuberculosis (TB) using Chest X-Rays (CXR) among high-risk individuals is essential to help reach the End TB Strategy goal in reduction of 90% in TB incidence by 2035. Even though Ministry of Health Malaysia has made screening compulsory, the number of cases detected is not encouraging. Therefore, it is essential to identify factors contributing to positive screening that would improve case detection. High-risk groups are individuals that are compulsory to be screened using chest x-ray, regardless of presence or absence of TB symptoms. A cross sectional study was done in 2016 involving individuals belonging to TB high-risk groups who underwent screening in Kedah, Malaysia. Data was obtained from the TB information system (TBIS) 104 A, an information system used for TB screening monitoring and chest x-ray report of the selected individuals. It involved 1417 individuals who were randomly selected from various health facilities in six districts of Kedah. Among all 1417 study samples, 1036 (73.1%) individuals were asymptomatic. Among the asymptomatic individuals, only 91 (8.8%) had positive CXR findings. Smokers were found to have almost 3 times the odds of having positive CXR findings compared to non-smokers [Adjusted OR (95% CI): 2.71 (1.03, 7.15), p-value
Thalassaemia screening programme was conducted to reduce the burden of the disease [1]. Here, we describe one unexpected discovery in a 33-year-old gentleman and also the importance of DNA analysis in detecting the globin gene mutation.
We describe the first clinical case of contact lens related corneal ulcer caused by Elizabethkingia meningosepticaregistered in Southeast Asia. A 20-year-old female student who wasa regular soft contact lens wearer, presented with pain, photophobia and blurring of vision of the right eye for 3 days. On slit lamp examination, there was a small paracentral anterior stromal infiltrate with an overlying epithelial defect. Microbiological cultures from corneal scrapings, contact lens and its casing were positive for E.meningoseptica. Due to high likelihood of contact lens contamination causing keratitis, topical fortified gentamicin0.9% and ceftazidime 5% were administered empirically. Topical vancomycin 5% was later added tailoring to the culture and sensitivity of the organism. After 8 weeks of treatment, the keratitis subsided and corneal epithelial defect completely healed with residual corneal opacity. Even though uncommon, contact lens related E.meningosepticakeratitis can occur in healthy immunocompetent individuals with no ocular comorbidities.
Macular branch retinal vein occlusion (BRVO), a type of retinal vein occlusion, is rarely recognised as a distinct entity. Macular BRVO has unique clinical features and different natural courses than the major BRVO. We report a case of a young patient with macular BRVO with macular oedema who was successfully treated with intravitreal ranibizumab injection. A 43 year-old Chinese man with no underlying medical illness presented with 2 weeks history of left eye painless reduced central vision which was worsening over time. On examination, his left eye visual acuity was 6/30 and Amsler chart drawing showed a lower central scotoma. Dilated fundus examination found marked flame-shaped retinal hemorrhages with cotton wool spot over the superior macular area bounded superiorly by superior arcade and macular thickening. An optical coherence tomography revealed cystoid macular oedema; and fundus fluorescein angiography showed occlusion of a small venous branch draining a superior part of macula to superior temporal venous arcade. A complete medical investigation found that he has hypertriglyceridemia and he was managed accordingly. His vision had improved to 6/6 after receiving 3 injections of intravitreal ranibizumab with no residual central scotoma and complete resolution of macular oedema.
Complex chromosome rearrangements (CCRs) are structural aberrations or rearrangements involving three or more cytogenetics breakpoints on two or more chromosomes [1]. Balanced and unbalanced are known to have significant risk of mental retardation and phenotypic anomalies. CCRs are also associated with infertility in males and recurrent abortion in females. Here we report one case of apparently balanced CCR involving three chromosomes 3, 5 and 12 in a child with abnormal features. G banding and FISH were performed to clarify the nature of this complex abnormality.
Total immunoglobulin E (IgE) has been an indicator for early diagnosis of allergic diseases due the important role of IgE in the sensitization towards allergens. Although total IgE is a common diagnostic test that screens for possible allergic diseases, reports are still lacking on the profile of total IgE levels of allergic patients from the north-east region of Peninsular Malaysia. Hence, this study aimed to investigate the association of total IgE levels with clinico-demographic parameters and whether increasing total IgE levels were associated with certain allergic manifestations in this study cohort. A local cohort of allergic patients (n=71) diagnosed in between 2009 and 2016 in Hospital Universiti Sains Malaysia (HUSM) were evaluated for the relevance of total IgE levels in allergy diagnosis. Our study did not demonstrate significant association between total IgE with age (p=0.75) or gender (p=0.65). However, we showed that elevated total IgE levels were associated with disease severity. Our data suggests that increasing total IgE levels beyond the conventional cutoff used to define abnormal IgE levels were more commonly associated with patients presenting allergic asthma and skin allergy manifestations. Total IgE level is a useful indicator for diagnosis of allergic diseases. Although total IgE level might not be sufficient to confirm the sensitization status of an individual, it may reflect the severity of the allergic disease suffered and it has a high correlation with positive sIgE values.
The aims of the study were to investigate the anti-cancer effects of 5-
Aza and TSA in two leukemic cell lines (CCRF-CEM and HL-60). Inhibition
concentration of 5-Aza and TSA were measured using trypan blue exclusion
assay. 5-Aza and TSA at IC50 were treated to both CCRF-CEM and HL-60 cell
lines for 4-6 days. To confirm the inhibition effects of these agents, Annexin-V
stained cells were analyzed using flow cytometry to evaluate the apoptotic
induction. The IC50 values of CCRF-CEM were 2.01±0.1µM and 2.65±0.3µM for
5-Aza- and TSA-treated, respectively. Whereas, the IC50 values of HL-60 were
1.98±0.2µM and 2.35±0.2µM for 5-Aza- and TSA-treated, respectively. To
further substantiate the findings, the time-dependent exposure of both drugs was
studied. CCRF-CEM cells were reduced to 49.4%±5.0, 49.4%±2.5 and
41.5%±5.6 by 5-Aza; 56.5%±7.0, 45.3%±4.2 and 40.2%±4.2 by TSA treatment
at first, third and sixth day. HL-60 cells were reduced to 72.0%±4.5, 51.0%±1.5
and 40.6%±2.6 by 5-Aza at first, third and sixth day. Meanwhile, HL-60 cells
reduced to 55.6%±4.5, 45.2%±4.0 and 36.3%±2.9 by TSA at first, second and
fourth day. Both cell lines were significantly inhibited (p
Medicinal plants have healing properties and are able to synthesize various chemical compounds. These chemicals (also known as phytochemical compounds) play vital roles in determining the pharmacological properties existing in certain plants. The phytochemical compounds present in plants are associated with primary and secondary constituents. Most of the time, the secondary constituents exhibit the bioactivities in plants such as antimicrobial, antioxidant, antidiabetic, antibacterial and anti-inflammatory properties. Some common medicinal plants that have been used in curing various diseases by traditional practitioners in Malaysia are Ficus deltoidea Jack, Andrographis paniculata, Curcuma longa, Clinacanthus nutans and Eurycoma longifolia Jack. This review discusses the morphology, phytochemical compounds and phytochemical properties of selected medicinal plants in Malaysia. The plants of focus have been found to possess anti-cancer and anti-diabetic effects. This review, it is hoped will enable Malaysian researchers to explore further on the potential of these plants in investigating new and novel drugs in the future.
The most common inherited monogenic disorders in the world are the haemoglobinopathies and thalassaemia. Thalassaemia is a heterogeneous group of genetic disorders of haemoglobin synthesis, characterised by a reduction in the production of one or more of the subunits of haemoglobin chains [1]. Haemoglobin A2 (HbA2) level is an important parameter in thalassaemia diagnosis. High HbA2 level (≥4.0) detected in Hb analysis, points to the diagnosis of beta thalassaemia and other haemoglobinopathies. However, in some cases, the HbA2 levels are apparently normal or borderline high despite abnormal haematological profile. In these cases, further testing is required to confirm the diagnosis. The aim of this study is to examine any abnormality at molecular level in cases of Hb analysis results with normal or borderline high HbA2 level.
Ki67, a nuclear protein presents in cells that is usually associated
with tumor cell proliferation. Therefore, physical quantification of Ki67 is a direct
measure cell proliferation activity. Immunohistochemical staining is known to be
an effective method of assessing the proportion of tumor cells. Currently, there
are various techniques for counting Ki67 in different types of cancer. This paper
provides an overview of recent scoring methods of Ki67, which includes ‘eyeballing’ estimation, vision counting with a microscope or viewer software,
manual counting of the camera-captured or digital image and automated
counting.
Muscular dystrophy is a group of diseases that result in progressive muscle weakness and atrophy. Duchenne Muscular Dystrophy (DMD) is classified as dystrophinopathy and is an X-linked recessive disease. It is caused by alterations in the dystrophin gene at Xp21.2 encoding 79 exons [1]. It is characterised by progressive muscle wasting that begins at 3 to 5 years, delay in motor development and eventually wheelchair confinement followed by premature death at about 30 years from cardiac or respiratory complications [2]. Genetic etiology of cases of DMD in Malaysia are still scarcely reported. Here, we report the genetic cause in the case of an 11-year-old Kelantanese Malay boy who has progressive muscle weakness since 5 years old. He has difficulty in getting up from sitting and supine position also in climbing up stairs until 1st floor. He has a strong family history of DMD and musculoskeletal problems. His younger brother was diagnosed with DMD by molecular analysis and his maternal uncle died at the age of 16 with musculoskeletal problems but was never investigated. Physical examination revealed no dysmorphic features, positive Gower sign with absent tounge fasciculation. On neurological examination, tendon reflexes and muscle tone for limbs were normal. Muscle power for bilateral upper limbs were normal, however, bilateral lower limbs showed slight reduction in muscle power with calf hypertrophy.
Pre-eclampsia may have an impact on women’s health beyond their
pregnancies and has been associated with increased risks for future hypertension
and cardiovascular disease. We report a case of a patient with history of preeclampsia and emergency caesarean section at 31 weeks of gestation due to
impending eclampsia who defaulted follow up and presented with malignant
hypertension and acute loss of vision 10 years later. A 34-year-old Malay female,
presented with generalized painless reduced vision of 5 days duration which was
preceded by an intermittent headache for 1 months duration. She had a history of
pre-eclampsia during her last childbirth 10 years ago and was not started on any
antihypertensive medication as her blood pressure normalized 2 weeks post-delivery.
Subsequently, she defaulted on her follow up. Visual acuity was counting finger at 1
meter in both eyes with no relative afferent pupillary defect. Funduscopy revealed
bilateral grade IV hypertensive retinopathy with the presence of optic disc swelling
and macular star. Optical coherence tomography showed bilateral sub-retinal fluid at
the macula. Her blood pressure was 255/168 mmHg with other systemic
examinations being normal. Ultrasonography of the kidneys showed the presence of
bilateral renal parenchymal disease with elevation of serum urea and creatinine
levels. Her blood pressure was controlled with triple oral antihypertensive agents. Her
vision improved to 6/36 and 6/6 with a pinhole in both eyes and resolution of
papilloedema and sub-retinal fluid at three months follow-up. Patients with a history
of pre-eclampsia must be closely monitored during the postpartum period. Even
though her blood pressure was normalized, careful monitoring and long-term medical
follow up plan must be clearly explained to the patient as she might develop chronic
or essential hypertension afterward. Our patient most likely had essential
hypertension superimposed with pre-eclampsia during her last pregnancy and
currently presented with malignant hypertension due to undiagnosed chronic
hypertension as she defaulted her medical follow up.
Toxoplasmic optic neuropathy is rare and usually occurs monoocularly. This case report demonstrates a rare presentation of bilateral
juxtapapillary retinochoroiditis (Jensen disease) due to toxoplasma infection in
a young healthy patient. A 20-year-old lady presented with bilateral painless
blurring of central vision for 5 days duration. It was preceded by fever, upper
respiratory tract symptoms and headache. There was no history of contact or
being scratched by a cat. Visual acuity was counting fingers for the right eye
and 6/45 for the left eye. There was presence of relative afferent pupillary
defect in the right eye. Optic nerve functions were impaired bilaterally which
was severe in the right eye. Both eyes showed the presence of mild anterior
segment inflammation and vitritis. Fundus examination revealed juxtapapillary
retinochoroiditis bilaterally with swollen optic disc. Optical coherence
tomography (OCT) showed presence of intra-retinal and sub-retinal fluid at
macular area bilaterally. Serology for anti-toxoplasma Immunoglobulin G (IgG)
was positive with titre of 1450 IU/ml. Computed tomography scan (CT scan) of
brain and orbit was normal. A diagnosis of bilateral juxtapapillary
retinochoroiditis or Jensen disease was made. Oral azithromycin 500 mg daily
and guttae prednisolone 4 hourly for 6 weeks was commenced. Oral
prednisolone 50 mg daily (1 mg/kg/day) was added after completion of 1 week
of antibiotic and was tapered down within 5 weeks. There was improvement of
vision as early as 3 weeks post initiation of the treatment. Upon 6 weeks
completing the treatment, her vision has improved to 6/7.5 on both eyes with
resolution of optic disc swelling and sub-retinal fluid. Early recognition and
initiation of treatment in toxoplasma infection associated with juxtapapillary
retinochoroiditis usually result in good visual prognosis.
Conventional anticoagulant therapy is the mainstay of medical treatment for deep vein thrombosis disorders. However,there are many complications associated with these agents such as bleeding. Hence, the search for novel anticoagulant derived from natural substances such as plants origin is in high demand nowadays. Ocimum sanctum(O.sanctum) also known as Ocimum tenuiform (OT), tulsi or holy basil from the family of Lamiaceae has been widely used for thousands of years in Ayurveda and Unani systems to cure or prevent a number of illnessessuch as headache, malaria, ulcers, bronchitis, cough, flu, sore throat and asthma. The objective is to investigate theeffect ofO. sanctum(Tulsi) aqueous leaf extract on prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in human plasma. Coagulation activity of O. sanctum was measured via PT, APTT and TT assay in citrated plasma collected from thirty-six healthy regular blood donors. The plasma was tested against different concentrations of O. sanctum aqueous extract as follows: 0.1mg/ml, 0.5 mg/ml and 1.0 mg/ml. Result shows the aqueous extract of O. sanctum prolonged the PT and APTT assays (p0.05). The gas chromatography-mass spectrometry (GC-MS) analysis had identified the linolenic acid at 1-10% of ethanol and aqueousconcentration at different retention time which was responsible for the coagulation activities of O. sanctumin human plasma. This study suggests that O. sanctum does affect coagulation activity in human plasma and can be potentially used as naturally derived anticoagulant products in the future.
The quality of pap smear determined by the specimen adequacy of cervical smears. It plays an important role to detect changes in the cervix particularly the transformation zone (TZ). This study aimed to determine factors associated with poor pap smear quality in Barat Daya District, Penang. This is a cross-sectional study of 276 randomly selected specimens of woman who underwent pap smear test in all government health clinics in Barat Daya District, Penang between January until June 2019. Study proforma was based on cytological report issued by Pathology Department, Penang Hospital and staff records in Nursing Unit, Barat Daya District Health Office. 30.1% has poor smear quality. Women who are menopause are twice the risk to have poor smear quality [Adjusted OR (95% CI): 2.34(1.14, 4.84), p
The molecular biology knowledge in β-thalassaemia is limited due to the involvement of various erythropoeitic processes where the genetic information is lack due to nucleus ejection throughout the maturation of red blood cell activities concurrence with the accumulation of haemoglobin. Nucleated red blood cells (NRBCs) are typically found in peripheral blood (PB) of β-thalassaemia transfusion dependent patients and abundant in post splenectomy (Fig. 1A) [1]. The presence of NRBCs will provide further understanding on the molecular aspect of ineffective erythropoiesis in β-thalassaemia patients. Therefore, the objectives of this study were to isolate the NRBCs using CD71 magnetic beads from PB of β-thalassaemia patients and to compare the quantity of NRBCs enriched between non-splenectomised transfusion dependent and post-splenectomised transfusion dependent β-thalassaemia patients.
The large clinical spectrum of Haemoglobin E (HbE)/β-thalassaemia leads to identification of modifiers that cause the complexity1. IGSF4, a member of the immunoglobulin superfamily 4 is known as a thalassaemia-related gene that plays an important role in globin synthesis. Methylation of IGSF4 was reported to interrupt the process of globin synthesis through its interaction with other genes in the regulation network of globin expression2. Specific cells isolation is needed in order to study the methylation profile as the interaction between various haematopoietic cells including nucleated red blood cells (NRBCs) in whole blood could impact the methylation results3. Therefore, the objective of this study was to describe the pattern of DNA methylation at the promoter region of IGSF4 gene that may involve in the alteration of globin synthesis in HbE/β-thalassaemia patients.
Introduction: Isolation of specific cell types is important in providing a better understanding of hematological disorders. The knowledge of molecular biology aspect in β-thalassemia is still limited. This is because hemoglobin disorder involves various erythropoietic processes in which the genetic information is lack due to enucleation of red blood cells occurs in bone marrow. It is invasive to collect samples from bone marrow and cord blood although nucleated red blood cells (NRBCs) are abundant in these sites. NRBCs are precursors of red blood cells and typically found in peripheral blood (PB) of β-thalassemia major patients and abundant post-splenectomy. The utilization of PB NRBCs will provide a further understanding of the molecular aspects of ineffective erythropoiesis in β-thalassemia major patients. Objective: The objective of this study was to isolate the NRBCs using CD71 magnetic beads from PB of β-thalassemia major; non-splenectomy and post-splenectomy patients. Methods: NRBCs were isolated from 6 mL PB of β-thalassemia major patients based on density gradient and magnetic activated cell sorting (MACS) for NRBCs enrichment using a CD71 marker. Cell count was determined by using hemocytometer (Weber Scientific, NJ, USA) and BD FACSCantoTM II flow cytometry (Becton-Dickson, NJ, USA) was performed for method validation. Results: NRBCs were successfully isolated from the PB of both non-splenectomy and post-splenectomy β-thalassemia major patients with >90% specificity by flow cytometric analysis. The median number of enriched NRBCs (x104 ) was 58.5 (283) and 340 (338) respectively using hemocytometer. Conclusion: The MACS method was found to be convenient and efficient in the isolation of the targeted cells for downstream applications.