Displaying publications 1 - 20 of 92 in total

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  1. Nadia Yaacob, Adil Hussein, Maizan Yaakob, Zuraidah Mustari
    MyJurnal
    The presence of retinal vasculitis in patients with pulmonary tuberculosis is not uncommon. However, asymptomatic presentations are quite rare. Here, we present a case of 25-year-old Malay gentleman with pulmonary tuberculosis, who was referred for an eye assessment following initiation of anti-tuberculosis drugs. His vision was good; he had no other symptoms despite having retinal neovascularization, pre-retinal haemorrhages and healed choroiditis at the fundus of the left eye. Fundus fluorescein angiography showed multiple areas of capillary fallouts at the superotemporal quadrant of the left eye with leakage from the retinal neovascularization. He was treated with laser retinal photocoagulation and oral steroids for 6 weeks, while the anti-tuberculosis drugs were continued for 9 months. Subsequent follow-ups showed regression of the neovascularization. He has remained asymptomatic since his initial visit to the eye clinic.
  2. Azhan, A., Mutasim, H., Abdul-Hadi, R., Khairul-Anwar, I., Zunaina, E.
    MyJurnal
    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.
  3. Yuslina Mat Yusoff, Syahzuwan Hassan, Nizmah Mahani Mokhri, Nur Aisyah Aziz, Faidatul Syazlin Abdul Hamid, Ezalia Esa, et al.
    MyJurnal
    Mutations in the δ globin gene are not pathologically significant [1]. However, coinheritance of β and δ thalassaemia can mask the diagnosis of β thalassaemia trait as it causes HbA2 level to be lowered [2,3]. Here, we reported 5 unrelated cases of compound heterozygous β0 Filipino ~ 45 kb deletion and codon 67 (GTG>ATG) HbA2 Deventer in Sabahan population.

    Cases of β°-thalassemia traits with unusual low HbA2 were reviewed. These cases were initially referred to our laboratory for definitive diagnosis of β-thalassemia trait. Haematological parameters and Hb analysis were carried out at the referral hospital. Genomic DNA was extracted from the peripheral blood. Multiplex ARMS and Gap PCR were done to detect common point mutations and deletions for both alpha and beta globin genes. Sanger sequencing was performed to detect mutations in delta globin gene.

    Patients’ consist of 4 males and 1 female aged between 25-38 years old. All of them are indigenous Sabahan (2 Kadazans, 1 Murut, 1 Dusun and 1 Sungai). Their haemoglobin level ranges between 10.8 – 12.8g/dl. Hb analysis findings of HbA2 and HbF level ranges between 2.9 – 4.0 and 2.2 – 9.4g/dl respectively. Molecular findings revealed heterozygous state of (β)º-thal, Filipino ~45Kb deletion, NG_000007.3:g.[66258_184734del];[66258_184734=] and heterozygous state of Codon 67 [GTG>ATG] Hb A2-Deventer mutation, NG_000007.3:g.[63512G>A];[63512G=] (Figure 1 and 2).

    Detection of 5 unrelated cases of HbA2 Deventer may suggest that this delta variant is common among indigenous Sabahan. Since beta thalassaemia is also common in the population, more attention should be paid during diagnosis. Identification of delta variant in beta thalassaemia carrier is important because coinheritance of beta and delta thalassaemia results in a less elevated HbA2 level. Therefore, molecular testing of thalassemia carrier state in the case of borderline HbA2 is warranted to avoid misdiagnosis of beta thalassaemia carriers.
  4. Mot, Yee Yik, Siti Fatimah Ramli, Nazlina Mohamad Isa, Ruzzieatul Akma Razali, Abdul Rahman Azhari, Abdul Razak Abdul Khalid, et al.
    MyJurnal
    Chromosomal abnormalities (CA) can affect numerical or structural compositions of chromosomosal DNA leading to a diversity of clinical phenotypic presentations. Awareness of prenatal diagnosis and genetic counselling have improved with advancing medical research but CA remain prevalent as its aetiology is unknown. The objective of this study is to determine the frequencies of various CA in the principle region of north-western Malaysia and compare this data to previous reports to ascertain if statistical differences exist. Karyotype analyses performed at the Genetics Laboratory, Advanced Diagnostic Laboratory (ADL) during the first 5-years of cytogenetic services, totalling 1461 cases, were assessed in this report. Cases suspected of CA were initially diagnosed by clinicians and detailed clinical and family histories were recorded. Peripheral blood lymphocytes of patients were collected and cultured in vitro for acquisition of karyotype by standardized G-banding technique. Fluorescence in situ hybridization (FISH) was conducted in cases suspected of to be DiGeorge, Prader-Willi, Angelman and Williams syndrome. Of the total samples (1805) received and cultured, 1669 (92.46%) successfully yielded results. Abnormal outcomes were observed in 495 cases (29.66%) whereby pronounced majority of cases 299 (68.42%) were Down syndrome. This is followed by Edward, Turner and Patau syndrome, in order of frequency. Numerical CA appears to be prevalent accounting for 85.86% of cases. Structural CA accounted for 14.14% of total positive cases whereby the most common was deletions (34.29%) followed by translocations (20%), ring chromosomes (5.71%), Fragile X syndrome (4.29%), duplications (5.71%) and marker chromosomes (7.14%). The remainder of cases (22.86%) consisted of derivative chromosomes and other complex aberrations. The number of polymorphic variant cases were 27 (1.62%). The number of peripheral blood samples received has significantly increased from 14.3 per month in 2006 to 32.17 per month in 2011. Comparative analysis of our study to previous reports reveal statistical differences in the occurrence of several CA including Edward, Patau, Klinefelter and Fragile-X syndrome. Our experience with peripheral blood samples for cytogenetic analysis demonstrated a success rate of 92.46%. This showed an increase in clinicians validating patients’ diagnoses with karyotyping which is essential in confirming genetic anomalies with the goal to substantiate genetic counselling.
  5. Durar Aqilah Zamri, Lailatul Hadziyah Mohd Pauzy, Ezalia Esa, Yuslina Mat Yusoff, Nur Aisyah Aziz, Syahzuwan Hassan, et al.
    MyJurnal
    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.
  6. Khor, Sok Fang, Ezalia Esa, Nur Aisyah Aziz, Faidatul Syazlin Abdul Hamid, Yuslina Mat Yusoff, Zubaidah Zakaria
    MyJurnal
    The aims of this study are to identify and characterize the Haemoglobin G Makassar. Haemoglobin G Makassar was identified in Makassar, Sulawesi (Celebes), Indonesia in 1969 and has been reported in a family of Thai origin in 2002. Haemoglobin G Makassar was found to share identical properties with haemoglobin S in routine haemoglobin separation by cation-exchange HPLC. It is therefore, patients with Haemoglobin G Makassar and Haemoglobin S may sometimes be mistakenly identified for each other.

    There were four cases identified from year 2015 to 2016 in Peninsular Malaysia by Molecular Genetics Laboratory, Institute for Medical Research. All patients were asymptomatic with mild hypochromic microcytic anaemia. All patients were analysis with Haemoglobin S trait. Analysis by Capillary Electrophoresis showed that these patients had 39.9 to 44.0% of haemoglobin variant in zone S. Alpha and Beta globin gene analysis were performed on these samples.

    DNA sequence analysis, revealed a single nucleotide substitution GAG to GCG at codon 6 of the beta-globin gene (Glu>Ala), indicating of Haemoglobin G Makassar for all the patients (Fig. 1). All patients were positive with Haemoglobin S trait. Multiple Amplification Refractory Mutation System (MARMS) PCR for Haemoglobin S was negative in all cases. However alpha-globin gene analysis showed that two of them had single alpha deletion (α3.7). The mean reading for HGB is 11.95 g/dL, for MCV is 72.1 fL and for MCH is 23.65 pg which all are lower than normal peoples.

    The screening method may mistakenly identify Haemoglobin G Makassar as Haemoglobin S. Therefore identification and characterization of Haemoglobin G Makassar by several molecular methods such as polymerase chain reaction (PCR) and sequence analysis are necessary for confirmation of the diagnosis.
  7. Haiyuni, M.Y., Aziee S., Heba A., Rosline H., Abdullah W.Z., Johan M.F., et al.
    MyJurnal
    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.
  8. Muhamad-Amin, R., Nur Hasnida Gani, Liza-Sharmini, A.T., Zamli, A.H.
    MyJurnal
    Acute lymphoblastic leukemia (ALL) is the most common
    childhood leukaemia. It is a malignant neoplasm caused by the proliferation of
    poorly differentiated precursors of the lymphoid cells. It is relatively
    uncommon in adult. In adult ALL, central nervous system (CNS) involvement
    is associated with poor prognosis. The incidence of CNS involvement has
    been reported between 7% and 15 %. We report a case of optic nerve
    infiltration in ALL in a 49 years old gentleman. He was diagnosed with
    precursor-B ALL. He was treated with chemotherapy and CNS prophylactic
    regime. He presented with sudden left eye loss of vision for one-day duration
    with history of right eye inferior visual field loss for the past three months. His
    visual acuity was no perception to light on the left eye and 6/9 on the right
    eye. There was marked left relative afferent pupillary defect. The right eye
    showed decreased in optic nerve function with inferior visual field defect.
    Anterior segment examination was unremarkable in both eyes. Left optic disc
    appeared normal but the right optic disc was pale. Blood investigation
    showed no sign of infection or haemoconcentration. Cerebral spinal fluids
    examination revealed abundant of white cells and blast cells. Magnetic
    resonant imaging showed bilateral optic nerve enhancement suggesting of
    bilateral optic nerves infiltration. He was started on a new regime of
    chemotherapy followed by cranial radiotherapy. Unfortunately, he succumbed
    to death due to septicaemia. There are variations in clinical presentation of
    optic nerve infiltration in leukaemic patients. Normal appearance of optic disc
    may not exclude the possibility of infiltration by malignancy. Assessment of
    the optic nerve function and imaging is helpful for the detection of leukaemic
    infiltration. Early detection of optic nerve infiltration is important for initiation or
    change of therapy to prevent mortality.
  9. Mohd. Ridah L.J., Ismail A., A. Talib N., Muhammad N., Hussain F.A., Zainuddin N.
    MyJurnal
    Introduction: Methylation of promoter region of p16 leading to gene silencing has been implicated ina wide range of malignancies including lymphomas. In diffuse large B cell lymphoma (DLBCL) particularly, a varying percentage of epigenetic inactivation of p16 promoter region was observed ranging from 16 -54%. However, quantitative analysis of p16 promoter methylation in DLBCL has not been extensively studied in Malaysia. Objective: This study aims to quantitatively analyse p16 methylation in DLBCL samples using pyrosequencing technique. Methods: Genomic DNA was extracted from 16 formalin-fixed paraffin-embedded lymphoma tissue blocks from patients diagnosed with DLBCL. Samples were retrieved from Hospital Tengku Ampuan Afzan, Pahang and Hospital Universiti Sains Malaysia, Kelantan. Primers were designed to amplify bisulfite-treated DNA targeting p16 promoter region. Methylation status of 7 CpG sites was determined by pyrosequencing. Results: All the 16 samples studied showed promoter methylation of p16. The range of mean methylation percentage was between 18 to 81%. Conclusion: The present study has successfully measured the level of methylation of p16 in all 7 CpG sites despite the limitation in sample size. Since p16 methylation is a common event in our series of DLBCL cases, it is worth including a larger sample size in future studies to increase the chance of finding a significant correlation with clinical parameters.
  10. Wan Taib W.R., Tengku M.A., Aryati A., Yusoff N.A.M.
    MyJurnal
    Immunization has been introduced for decades to eradicate fatal infectious diseases by inoculating attenuated, killed or toxoid of microorganisms such as bacteria and virus. The triggering action to the immune system would not harm the host; despite can boost the immune responses to any infection. However, several cases of the eradicated infectious disease have re-emerged due to the existence of vaccine hesitancy group. Vaccine hesitancy has been observed emerging worldwide due to rejection in receiving vaccine. The main obstacle in vaccination program was identified according to the misconception that they received from internet or any mass media without boundaries. Various actions from the government have met the needs to enforce and educate the public especially the hesitant group towards better disease prevention with vaccination. The strategy would cover any interaction activities or programs with the public in transferring the information about the vaccination and its benefit to the health of herd community.
  11. Latahir, Ahmad Zaeri, Kardia, Egi, Yahaya, Badrul Hisham
    MyJurnal
    The repair process of airway epithelium involves cell migration, spreading, proliferation and re-differentiation. Objective: Cellular and molecular responses to tracheal brush induced injury were investigated using a rabbit model. Methods: Eighteen New Zealand white rabbits were divided into uninjured and injured groups. After tracheal brushing, the animals were maintained in the laboratory before being sacrificed at given time points (1, 12 hours, 3, 7, and 21 days). The trachea of each rabbit was retrieved and preserved before being subjected to haematoxylin and eosin staining and real time PCR. Results: After injury, the remained epithelial cells underwent an instant response by proliferating and migrating into the damaged site. This finding was in accordance with the proliferative and migration activity-related gene expression results (MMP-9, TIMP1, vimentin, and ß-integrin). The increased activity of these genes was crucial at the early time points, as it encouraged the remaining cells to repopulate the damaged area. Conclusions: Continuous regulation of MMP-9, vimentin and ß-integrin plays important roles in promoting cellular homing especially the cells bordering the lesion to migrate and repair of the damaged ECM. Thus, this activation enhanced regeneration and repair of the damaged tracheal epithelium as early as 1 h and complete at 21 d following injury.
  12. Fitreena A.A., Shahidah C.A., Mohd. Nizam M.H., Wan Zainira W.Z., Wong, M.P.K.
    MyJurnal
    Hernia is a common surgical problem. However, worldwide
    incidence of obturator hernia is
  13. Lai, Kuan Teh, Koh, Sam Yu, Shi, Min Chua, George, Elizabeth, Mei, I Lai, Wong, Lily
    MyJurnal
    In Malaysia, Sabah population constitutes the most number of β-thalassaemia cases ranging from asymptomatic to transfusion dependent. Filipino β°-deletion has been reported as the predominant mutation in Sabah [1]. Despite having the same primary mutation, co-inheritance of genetic variants at HbF quantitative trait loci of HBS1L-MYB intergenic region may cause variability in clinical features by affecting the haemoglobin (Hb) subtypes level, especially HbF. Study suggested that MYB would activate γ-globin repressor gene directly and subsequently initiate the molecular HbF repression mechanisms. Polymorphisms within HBS1L-MYB intergenic region would inhibit binding of transcription factor on MYB and leading to elevation of HbF levels [2]. This can act as an ameliorating factor in the clinical presentation of β-thalassaemia patients [3]. This study aimed to elucidate the association of Hb subtypes levels with three HBS1L-MYB variants among 134 Filipino β°-deletion carriers. PCR-RFLP analysis was done for HBSIL-MYB rs4895441 (A→G) while tetra-primers ARMS PCR analysis was done for HBSIL-MYB rs9399137 (T→C) and rs11759553 (A→T) (Fig.1).
  14. Shavani, Abirami, Adil Hussein, Wan-Hazabbah W.H.
    MyJurnal
    To report a rare case of an elderly gentleman who presented with herpes zoster ophthalmicus, complicated with persistent hyphema and orbital apex syndrome. A 75-year-old Malay gentleman presented with left herpes zoster ophthalmicus that was complicated with complete ophthalmoplegia and ptosis. He developed total hyphema in the affected eye with a secondary elevated intraocular pressure after a week. He was treated with oral acyclovir and topical corticosteroids. However, the total hyphema persisted that required an anterior chamber washout surgery. Herpes Zoster Ophthalmicus complicated with persistent hyphema and orbital apex syndrome is rare and very challenging to manage. Radiological imaging is important to exclude other causes of OAS. It is recommended to treat HZO with systemic acyclovir for a longer duration in view of ocular and neurological involvement.
  15. Rufa’i AA, Yen SH, Wan Muda WAM
    MyJurnal
    Shift in the dispersion of breast cancer population continues to be a major health concern for women in the developing countries. However, prevalence and associated factors of physical activity among this population have not been explored in Malaysia. This study determined the profile and factors associated with physical activity in the breast cancer women. A multi-center cross-sectional survey was conducted among 399 breast cancer women. Socio-demographic questionnaire was used to generate socio-demographic and clinical data. Physical activity was assessed using the international physical activity questionnaire (IPAQ-SF). Sociodemographic variables were summarized by descriptive statistics. Factors associated with physical activity were identified using Logistic regression analyses. Majority of the participants were married (83.9%), had surgery (92.4%) and menopause (74.1%). The overall physical activity prevalence was 39.4%. Non formal education (Adjusted Odds Ratio [AOR] 5.80; 95%CI: 1.65, 52.15;p=0.017), having had surgery (AOR 0.18; 95%CI: 0.04, 0.79; p=0.023),
  16. Hwang Zhen Shan, Juhara Haron, Maya Mazwin Yahya, Tengku Ahmad Damitri Al-Astani Tengku Din, Wan Faiziah Wan Abdul Rahman
    MyJurnal
    Breast cancer in young pregnancy is a breast cancer diagnosed in a young lady at the age of less than 30 years old during pregnancy. Diagnosis and treatment of breast cancer during pregnancy are challenging as both maternal and fetal outcome must be considered in terms of their short and long-term effects. It requires multidisciplinary treatment. Instead, pregnancy should be preserved whenever possible, while treating the underlying breast cancer. It is important not to compromise the treatment of breast cancer because of the pregnancy. The overall therapeutic concept basically depends on timing of delivery, staging of the underlying disease, treatment mode and the impacts of treatment recommended as well as foetal outcome in relation to treatment that administered to the mother during pregnancy. We present a case of young pregnant lady at the age of 23 with breast cancer as it is a rare event and the challenges encountered in managing her and to highlight the treatment options for the patient and the baby.
  17. Royan, Jeyarine, Teo, Khairy Shamel Sonny, Vengadasalam, Selva Raja
    MyJurnal
    To report on a rare case of an intralenticular foreign body which
    demonstrates that use of a spring-powered airsoft gun can result in a severe
    ocular injury. A 2-year-old male presented following a trauma to the left eye.
    The trauma was caused by a wooden matchstick from a spring-powered airsoft
    gun being shot into his eye. On examination, there was a shallow anterior
    chamber with a full thickness corneal laceration, with fragmented matchstick
    pieces embedded in the cornea and in the lens. The corneal foreign bodies
    were removed, corneal laceration wound sutured and lensectomy done. There
    were no post-operative complications, and the cornea wound healed with a
    scar. A few months later, he underwent a successful secondary intraocular lens
    implantation surgery with an iris claw lens. Airsoft guns are easily available to
    children who are unaware of its dangers. It can cause significant ocular
    morbidity despite successful surgical treatment of the injury.
  18. Moze T., Abdul Karim F., Hami R., Tuan Din SA
    MyJurnal
    Blood donation in Malaysia is practised as voluntary non-remunerated. However, recruiting and retaining blood donors remain a challenge in the transfusion service. The main aim of this study was to understand the factors affecting the return of first-time blood donors. This was a retrospective study involving 480 first-time temporarily deferred whole blood donors from National Blood Centre (NBC), Kuala Lumpur. Data of donors who were deferred from 2010 to 2014 were extracted from the Blood Bank Information System. Deferred blood donors were categorised into two main groups, namely, a group of donors who returned for blood donation and a group that did not return for the donation. Each blood donor was contacted personally via telephone. Donors who returned were younger (p < 0.001), with females in a higher proportion (61.3%) compared to males (38.8%) (p < 0.001). Singles (68.3%) were more likely to return for donation compared to married donors (31.7%) (p < 0.001). Donors who lived in urban areas were more likely to return for donation compared to donors who lived in rural areas (34.6%) (p < 0.005). The most common factor that had motivated these donors to return was self-satisfaction (29.9%), while the most common factor that hindered them from returning for donation was the lack of time (28.50%). As a conclusion, more awareness and education regarding regular blood donation should be considered to donors from a rural areas. Additionally, mobile blood donation drives should be made easier for blood donors who have a busy lifestyle.
  19. Nafiu Aminu, Chan, Siok-Yee, Toh, Seok-Ming
    MyJurnal
    The aim of this study was to design and systematically optimize
    triclosan loaded nanoparticles (TCS-loaded NPs) formulation for the treatment
    of periodontal disease. Triclosan (TCS) is a broad spectrum antimicrobial
    agent that has been used in the treatment of the disease. The free drug has
    poor aqueous solubility and therefore may encounter permeability problems
    when applied to the oral cavity. Resolution IV model of Design-Expert®
    software (version 10) was used for the design of experiment and optimization
    of TCS-loaded NPs. The nanoparticles (NPs) were prepared using the solvent
    displacement method. Effect of factors that were investigated include drugpolymer ratio, surfactant concentration, stirring speed, stirring duration, and
    drug-polymer injection rate. Particle size, zeta potential, polydispersity index
    (PDI) and entrapment efficiency (EE) were the critical quality attributes
    selected for the study. Desirability function determined by the software for
    optimized TCS-loaded NPs was 0.704. The observed particle size, PDI, zeta
    potential and EE of the optimized TCS-loaded NPs was found to be 135 ± 2.3
    nm, 0.1 ± 0.012, -30 ± -4 mV and 75 ± 6%, respectively. It was found that
    particle size increases by elevating the concentration of polymer and
    decreases with an increase in surfactant concentration and stirring speed.
    Zeta potential was found to increase when surfactant concentration was
    reduced. Both surfactant concentration and drug to polymer ratio were found
    to negatively affect PDI while % EE was positively influenced by the increase
    in polymer concentration and decrease in surfactant concentration. The use of
    Design-Expert®
    software helped in identifying suitable levels of critical quality
    parameters for preparing improved NPs formulation for delivery of TCS into
    the periodontal pocket.
  20. Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.
    MyJurnal
    44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.
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