The National Blood Center, Kuala Lumpur interprets laboratory results for the von Willebrand factor (vWF) profile based on guidelines provided by the U.S. National Heart, Lung, and Blood Institute, which were established based on the Caucasian population [1-2]. The vWF profiles among the Malay population has not yet been established.
The goals of this study were to determine the vWF profiles of the different ABO blood types among Malays and to evaluate their association with demographic characteristics and smoking habits.
One hundred and forty Malay donors participated in this study. Factor VIII (FVIII), vWF antigen, and ristocetin cofactor (RiCof) levels and collagen binding activity (CBA) were measured by coagulometric clot detection, latex agglutination, and enzyme-linked immunosorbent assay.
Charged particle therapy with carbon ions has advantages over conventional radiotherapy using x-ray beams. The application of charged particle therapy has rapidly increased over the last decades. This is due to its characteristic Bragg peak which has relatively low entrance doses and favourable doses distribution. In this research work, Geant4 based Monte Carlo simulation (MC) method has been used to calculate the radiation transportation and dose distributions in tissue-like media. The main objective of the work was to compare the Geant4 simulated depth dose distributions with experimental measurements and verify the capability of the geant4 simulation toolkit. The carbon ion beams for the therapeutic energy of 350 MeV/u and 400 MeV/u respectively were simulated, with the same settings as the experimental work carried out at the treatment room at Heavy Ion Medical Accelerator (HIMAC), National Institute of Radiological Sciences (NIRS), Chiba, Japan. The simulation results were verified with measurements data. The work was to measure the accuracy and quality of the dose distributions by Geant4 MC methods. The results show that the Bragg peak and spread out Bragg peak (SOBP) distributions in simulation has fairly good agreement with measurements.
It is important to study optimism as it is negatively correlated with anxiety and depressive and positively correlated with quality of life in cancer patients. This study translated and investigated the psychometric properties of the Malay version of the Life Orientation Test-Revised (LOT-R) among Malaysian cancer patients. The validated Malay version of the LOT-R will be used for assessing level of optimism among Malaysian cancer patients in future studies and determine factors associated with it in order to design effective psychosocial intervention which will enhance level of optimism in cancer patients. Concurrent translation and back translation of original English version of the LOT-R to Malay was performed and the Malay version was administered to 195 cancer patients of different cancer diagnoses at baseline assessment and repeated 2 months later at follow up. Reliability was assessed with internal consistency (Cronbach’s α) and test-retest reliability (intraclass correlation coefficient), validity was assessed with face, content, convergent, and discriminant validities. Construct validity was examined with exploratory factor analysis. Two third of the participants (n = 129/195; 66%) were of middle age, three forth were females (n = 142/195; 72.8%) and eight tenth were Malays (n = 160/195; 82.1%). The LOT-R (Malay) total score (Cronbach’s α = 0.58; ICC = 0.62) and its domains (Cronbach’s α [Optimism) = 0.60; Cronbach’s α[Pessimism) = 0.42; ICC[Optimism] = 0.61; ICC[Pessimism] = 0.59) demonstrated questionable internal consistencies but acceptable test-retest reliability. Convergent and discriminant validities were achieved by the LOT-R (Malay). Construct validity was also demonstrated by the LOT-R (Malay) as exploratory factor analysis showed that all the items had factor loadings > 0.4.
The LOT-R (Malay) has acceptable psychometric properties and suitable to assess optimism in Malaysian cancer patients. It should be validated for use in other Malaysian populations.
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 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.
The practice of traditional medicine has been deduced based on
available evidences from the Malay, Chinese and Indian communities in
Malaysia. Based on extensive review of previous literature, the study
discovered that there is limited empirical documentation on the types of floras
used as Traditional and Complementary Medicine (TCM) by the rural
communities in Sabah, especially those residing along the Ramsar site. Thus,
this article aims to document the types of floras used in TCM by the rural
communities in the Dagat village at the Lower Kinabatangan-Segama area.
The data for the study were obtained from a series of in-depth interviews and
field observations. The findings revealed that the rural communities in the
Dagat village utilized floras available around the village as TCM in their daily
lives. TCM using floras have helped to save lives in emergency cases,
especially for pregnant women with high risks during pregnancy. This study is
significant as it presents an empirical documentation of floras for TCM
practices among the local community in Sabah, Malaysia.
Gene expression is the most fundamental level at which the
genotype gives rise to phenotype. The development of human salivary
exosomes has become one of the promising researches to improve cell-based
tissue engineering but their functions in human periodontal ligament fibroblast
(HPdLF) cells are not well studied. To study the effect of human salivary
derived exosomes on the gene expression of HPdLF cells. In vitro, HPdLF
cells were cultured for 24 hours with 10 µg/ml of human salivary exosomes.
Determination of gene expression levels of basic fibroblast growth factor
(bFGF) and collagen type I (COL1) in the presence and absence of human
salivary exosomes in HPdLF culture was performed using quantitative reverse
transcriptase polymerase chain reaction (RT-qPCR). Human salivary
exosomes significantly upregulated bFGF gene expression but not COL1
gene in HPdLF cells after 24 hours of culture. Human salivary exosomes are
able to upregulate bFGF gene in HPdLF cells. Thus, they might have potential
to be used as an alternative biomaterial in tissue engineering for periodontal
regeneration.
The aim of this study to assess the efficiency of flushing
method of Dental Unit Waterline (DUWL) system in reducing the
number of microorganism. Water samples were taken before and after
two minutes of flushing from air-water syringes system in ten randomly
selected dental units in a Dental Teaching Centre. These samples
were immediately transferred to the microbiology laboratory in the cool
box within 8 hours for the heterotrophic plate count (HPC) test. Paired
t-test was used to analyse number of microbe before and after flushing.
The numbers of colony forming unit (CFU) ranged from 13,000 to
120,000CFU/ml in unflushed samples, and 3,000 to 15,000CFU/ml in
flushed samples. The mean HPC post-flushing was lower than preflushing [8360.00 (4561.48) vs 63300.00 (44587.12) CFU/ml]. The
mean HPC between pre- and post-flushing was significantly different
(P=0.004, 95% CI 22039.52, 87840.48). The coliform count from the
control was 140 CFU/ml. In conclusion, flushing method of DUWL
system significantly reduces the number of microorganisms in the
dental unit. However, the level of microorganisms still does not meet
the standard guideline by Environmental Protection Agency for safe
drinking water, which should be below 500 CFU/ml. In our opinion, the
duration of flushing should be increased and additional chemical
treatments of the dental units should be implemented to ensure the
safety of patients and dental personnel.
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.
Glaucoma is a chronic disease that could affect the quality of life and is a potential stressor for patients. Visual field assessment is important in monitoring disease progression among glaucoma patients. Stress could influence the performance of patients in visual field test that may affect the reliability of the test. Our objective in this study was to determine the association between stress score using Depression, Anxiety and Stress Scale (DASS) questionnaire and reliability indices of Humphrey visual field analysis (HFA). A total of 155 primary and secondary glaucoma patients were recruited in the study. Face to face interview using stress component of DASS questionnaire was conducted after automated HFA test. Reliability indices; i.e. fixation loss, false positive, and false negative error, were used to determine the accuracy of HFA result. Only 12 patients (7.7%) were found to have elevated stress score. No significant correlation was found between DASS stress score and the reliability indices of HFA. There was 0.2 folds (95% confidence interval (CI) [-2.35, -0.06], p = 0.039) reduction of fixation loss for every number of HFA done. For every one year increase in age, there was 0.2 folds (95% CI [-0.38, -0.07], p = 0.006) reduction in false positive error in HFA.
Minimal stress may not affect the reliability of HFA assessment. Minimising stress among glaucoma patients is important not only for assessment of visual field but also for improvement of quality of life.
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.
Zinc oxide (ZnO) nanoparticles (NPs) has become as promising candidate for antibacterial agents against Escherichia coli (E.coli), commensal hospital- acquired infections (HAIs). This study investigates the antibacterial action of ZnO NPs in three difference shapes; nanorod, nanoflakes and nanospheres against E.coli ATCC 25922. The antibacterial activity of ZnO NPs was determine through two standard protocols known as Clinical Laboratory Standards Institute (CLSI) MO2-A11 under light conditions of 5.70 w/m2 and American standard test method (ASTM) E-2149. Preliminary screening shows ZnO NPs did not inhibit the growth of E.coli. Further analysis using ASTM E-2149 in dynamic conditions revealed antibacterial activity after 3 hours with 100% reduction for ZnO NPs nanoflakes and 6 hours with 94.63% reduction for ZnO nanospheres, respectively. It demonstrated the ZnO NPs in nanoflakes and nanospheres exerted higher antibacterial activity possibly through release of ios, free radicals, ROS generation and electrostatic collision which contribute to bacterial death. Further analysis is needed to investigate biocompatibility of these samples for future biomedical applications.
Hyponatraemia is a common electrolyte imbalance in oncology. Rarely has it been reported as a presentation of nasopharyngeal carcinoma (NPC). A 43-year-old gentleman presented with double vision, headache, weight loss, complex ophthalmoplegia and submandibular lymphadenopathy. Computed tomography (CT) scan and nasopharyngeal biopsy confirmed the diagnosis of NPC. Prior to chemotherapy, he developed severe hyponatraemia. Blood investigations failed to pinpoint a clear diagnosis, and he was not responsive to aggressive supportive treatment. Pituitary gland function tests and MRI subsequently was performed, and found a pituitary extension causing hypocortisolism. Finally, his hyponatraemia was successfully optimised with oral hydrocortisone. This case illustrates that ophthalmoplegia and hyponatraemia are important warning signs of NPC or any other aggressive sellar mass that should not be neglected.
Tunnel vision is a classic sign among patients with advanced glaucoma. However, other conditions such as retinitis pigmentosa, optic neuritis and rod-cone dystrophy may be characterized by similar visual field defects. A 52-year-old lady with a family history of glaucoma presented with bilateral gradual loss of peripheral vision for two years. She claimed to have poor night vision about 20 years prior to this presentation. Her visual acuity was 6/7.5 in both eyes. The anterior chamber depth was moderate bilaterally, with Schaffer grading on gonioscopy of grade I to II. The intraocular pressure was 14 mmHg in both eyes. The optic discs appeared normal. Fundus examination showed scattered hypopigmented changes sparing the fovea. Humphrey visual field test revealed bilateral constricted visual fields. She was diagnosed with retinitis punctata albescens (RPA) based on her symptom of poor night vision, supported by the diffuse hypopigmented changes in her fundi. The management of this condition involves careful counselling regarding the genetic nature of the disease and its progressive course. We discuss this case to illustrate the importance of a thorough history taking and careful fundus examination in the workup of patients presenting with tunnel vision.
Iron deficiency anaemia (IDA) frequently occurs in haemodialysis
(HD) patients undergoing recombinant human erythropoietin (rHuEPO)
therapy and is commonly associated with rHuEPO hypo-responsiveness.
However, the conventional iron indices are inadequate to exhibit the status or
utilisation of iron during erythropoiesis. The aim of this study was to elucidate
the accuracy and usefulness of the reticulocyte haemoglobin (RET-He) test
for diagnosing IDA in HD patients undergoing rHuEPO therapy. Methods: In
this cross-sectional study, fifty-five blood samples of HD patients on rHuEPO
therapy were collected and analysed for haematological and biochemical
parameters. A receiver operating characteristics curve was also plotted for
sensitivity and specificity analysis. IDA detection rates by RET-He, soluble
transferrin receptor (sTfR) and serum ferritin were 63.64%, 3.64% and 0%,
respectively. RET-He level was significantly correlated with sTfR level, mean
cell volume, mean cell haemoglobin level and the transferrin receptor-ferritin
index. The sensitivity and specificity of RET-He in detecting IDA were 78.3%
and 92.0%, respectively, with an area under the curve of 0.864. IDA was more
frequently detected by RET-He than by ferritin or sTfR in HD patients
undergoing rHuEPO therapy. The RET-He level also showed higher sensitivity
and specificity for the iron status in these patients. Therefore, RET-He is a
useful biomarker for the detection of IDA in HD patients undergoing rHuEPO
therapy.
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.
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.
Neurofibromatosis (NF) is a genetic neurological disorder which can lead to abnormal tumour suppression. Neurofibromatosis associated neurological tumour is usually benign in nature, only occasionally can become malignant. Gastrointestinal involvement is reported to be infrequent with only up to 25% of patients with neurofibromatosis showing involvement. Solitary gastrointestinal neurofibroma is very rare, with most cases involving the stomach or small bowel. We report here a case of solitary small intestinal neurofibroma with no other associated systemic signs, causing intussusception and intestinal obstruction.
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),
Methicillin Resistant Staphylococcus aureus (MRSA) causing
surgical site infections is one of the most common nosocomial infections
affecting post-surgery patients. Vancomycin is the recommended treatment
with MRSA-resistance breakpoint for minimum inhibition concentration (MIC)
of 2 ug/mL where the pathogen can be considered as susceptible. Here, we
describe the MIC of vancomycin against our MRSA isolates. Retrospective
data of MRSA positive cultures from post-surgical patients who were admitted
to the Clinical Training Centre Sungai Buloh public section from 2016-2017
with documented MIC to vancomycin were analyzed. The specimens consist
of pus swabs, mediastinal fluid, sternal bone, and tissue. A total of 29 MRSA
were isolated from 11 patients. There were 19, 3, 3 and 4 MRSA with
vancomycin’s MIC (ug/mL) of 0.5, 1, 1.5 and 2 respectively. The MRSA with
MIC of 2 ug/mL were observed from two different patients with one of them
showing MIC of 0.5 ug/mL which grew from wound swabs to 2.0 ug/mL which
grew from sternal bone and mediastinal fluid isolates. Vancomycin reduced
susceptibility MRSA has been observed in our clinical training centre with a
1.1% incidence. Identification of possible risk factors and follow up of
outcomes is required to fully elucidate the importance of this occurrence.