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Congenital factor VII deficiency: a case report

Zarina L, Hamidah A, Rohana J, Faraizah AK, Noryati AA, Jamal R, et al.

Malays J Pathol, 2004 Jun;26(1):65-7.
PMID: 16190109

Factor VII deficiency is a rare congenital blood disorder. Its clinical features are rather variable and ranges from epistaxis to massive intracranial haemorrhage. Treatment involves replacement therapy, which constitutes use of fresh frozen plasma, prothrombin complex concentrates or recombinant activated factor VII. Although it is a rare entity, one still needs to consider it as a probable diagnosis in a newborn with coagulopathy. We report here a case of Factor VII deficiency in a newborn who presented with subdural haemorrhage at day 4 of life.

Matched MeSH terms: Plasma
Heavy metals contamination in lipsticks and their associated health risks to lipstick consumers

Zakaria A, Ho YB

Regul Toxicol Pharmacol, 2015 Oct;73(1):191-5.
PMID: 26190304 DOI: 10.1016/j.yrtph.2015.07.005

This study aimed to determine the heavy metals (lead, cadmium, and chromium) concentration in lipsticks of different price categories sold in the Malaysian market and evaluate the potential health risks due to daily ingestion of heavy metals in lipsticks. A total of 374 questionnaires were distributed to the female staff in a public university in Malaysia in order to obtain information such as brand and price of the lipsticks, body weight, and frequency and duration of wearing lipstick. This information was important for the calculation of hazard quotient (HQ) in health risk assessment. The samples were extracted using a microwave digester and analyzed using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The concentrations of lead, cadmium, and chromium in lipsticks ranged from 0.77 to 15.44 mg kg(-1), 0.06-0.33 mg kg(-1), and 0.48-2.50 mg kg(-1), respectively. There was a significant difference of lead content in the lipsticks of different price categories. There was no significant non-carcinogenic health risk due to the exposure of these heavy metals through lipstick consumption for the prolonged exposure of 35 years (HQ < 1).

Matched MeSH terms: Plasma
Abuse potential and adverse cognitive effects of mitragynine (kratom)

Yusoff NH, Suhaimi FW, Vadivelu RK, Hassan Z, Rümler A, Rotter A, et al.

Addict Biol, 2016 Jan;21(1):98-110.
PMID: 25262913 DOI: 10.1111/adb.12185

Mitragynine is the major psychoactive alkaloid of the plant kratom/ketum. Kratom is widely used in Southeast Asia as a recreational drug, and increasingly appears as a pure compound or a component of 'herbal high' preparations in the Western world. While mitragynine/kratom may have analgesic, muscle relaxant and anti-inflammatory effects, its addictive properties and effects on cognitive performance are unknown. We isolated mitragynine from the plant and performed a thorough investigation of its behavioural effects in rats and mice. Here we describe an addictive profile and cognitive impairments of acute and chronic mitragynine administration, which closely resembles that of morphine. Acute mitragynine has complex effects on locomotor activity. Repeated administration induces locomotor sensitization, anxiolysis and conditioned place preference, enhances expression of dopamine transporter- and dopamine receptor-regulating factor mRNA in the mesencephalon. While there was no increase in spontaneous locomotor activity during withdrawal, animals showed hypersensitivity towards small challenging doses for up to 14 days. Severe somatic withdrawal signs developed after 12 hours, and increased level of anxiety became evident after 24 hours of withdrawal. Acute mitragynine independently impaired passive avoidance learning, memory consolidation and retrieval, possibly mediated by a disruption of cortical oscillatory activity, including the suppression of low-frequency rhythms (delta and theta) in the electrocorticogram. Chronic mitragynine administration led to impaired passive avoidance and object recognition learning. Altogether, these findings provide evidence for an addiction potential with cognitive impairments for mitragynine, which suggest its classification as a harmful drug.

Matched MeSH terms: Dopamine Plasma Membrane Transport Proteins/drug effects; Dopamine Plasma Membrane Transport Proteins/genetics
Bilateral plasma cell granuloma (inflammatory pseudotumour) of the breast

Yip CH, Wong KT, Samuel D

Aust N Z J Surg, 1997 May;67(5):300-2.
PMID: 9152166

Plasma cell granuloma of the breast is an extremely rare condition. Only one other case has been reported in the literature. We report here the second case of plasma cell granuloma of the breast. After the initial excision, the lesion recurred in both breasts after 5 months.

Matched MeSH terms: Granuloma, Plasma Cell/pathology*
Fulltext Response to intradermal autologous platelet rich plasma injection in refractory dermal melasma: report of two cases

Yew, C.H., Ramasamy, T.S., Amini, F.

JUMMEC, 2015;18(2):1-6.
MyJurnal

Refractory dermal melasma is resistant to conventional treatment. Platelet rich plasma (PRP) may help to reduce the pigmentation of melasma. We present a case report on the clinical outcome of 2 patients with melasma, given PRP, as an adjunct therapy. PRP was administered at a monthly interval for 2 sessions in combination with a monthly Q-switched Nd Yag laser treatment and topical alpha arbutin application. A modified melasma area and severity index (MASI) was evaluated by two dermatologists who were blinded. At the follow up on the 3rd months, the MASI score was reduced by mean 33.5% for case 1 and 20% for case 2. There were no clinical complications for case 1. However recurrence of melasma was noted in case 2 by a worsening of the MASI score mean to 53% at the sixth months follow up. In conclusion, intradermal PRP injection as an adjunct to the conventional treatment of melasma presented with differing results in two cases.

Matched MeSH terms: Platelet-Rich Plasma
Fulltext Why metabonomics?

Yap, Ivan K.S.

International e-Journal of Science, Medicine & Education, 2011;5(1):17-26.
MyJurnal

Metabonomics can be used to quantitatively measure dynamic biochemical responses of living organisms to physiological or pathological stimuli. A range of analytical tools such as high-resolution nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS) combined with multivariate statistical analysis can be employed to create comprehensive metabolic signatures of biological samples including urine, plasma, faecal water and tissue extracts. These metabolic signatures can reflect the physiological or pathological condition of the organism and indicate imbalances in the homeostatic regulation of tissues and extracellular fluids. This technology has been employed in a diverse range of application areas including investigation of disease mechanisms, diagnosis/prognosis of pathologies, nutritional interventions and drug toxicity. Metabolic profiling is becoming increasingly important in identifying biomarkers of disease progression and drug intervention, and can provide additional information to support or aid the interpretation of genomic and proteomic data. With the new generation of postgenomic technologies, the paradigm in many biological fields has shifted to either top down systems biology approaches, aiming to achieve a general understanding of the global and integrated response of an organism or to bottom up modelling of specific pathways and networks using a priori knowledge based on mining large bodies of literature. Whilst metabolic profiling lends itself to either approach, using it in an exploratory and hypothesis generating capacity clearly allows new mechanisms to be uncovered.

Matched MeSH terms: Plasma
Fulltext Catalpol Ameliorates Insulin Sensitivity and Mitochondrial Respiration in Skeletal Muscle of Type-2 Diabetic Mice Through Insulin Signaling Pathway and AMPK/SIRT1/PGC-1α/PPAR-γ Activation

Yap KH, Yee GS, Candasamy M, Tan SC, Md S, Abdul Majeed AB, et al.

Biomolecules, 2020 09 24;10(10).
PMID: 32987623 DOI: 10.3390/biom10101360

Catalpol was tested for various disorders including diabetes mellitus. Numerous molecular mechanisms have emerged supporting its biological effects but with little information towards its insulin sensitizing effect. In this study, we have investigated its effect on skeletal muscle mitochondrial respiration and insulin signaling pathway. Type-2 diabetes (T2DM) was induced in male C57BL/6 by a high fat diet (60% Kcal) and streptozotocin (50 mg/kg, i.p.). Diabetic mice were orally administered with catalpol (100 and 200 mg/kg), metformin (200 mg/kg), and saline for four weeks. Fasting blood glucose (FBG), HbA1c, plasma insulin, oral glucose tolerance test (OGTT), insulin tolerance test (ITT), oxygen consumption rate, gene (IRS-1, Akt, PI3k, AMPK, GLUT4, and PGC-1α) and protein (AMPK, GLUT4, and PPAR-γ) expression in muscle were measured. Catalpol (200 mg/kg) significantly (p < 0.05) reduced the FBG, HbA1C, HOMA_IR index, and AUC of OGTT whereas, improved the ITT slope. Gene (IRS-1, Akt, PI3k, GLUT4, AMPK, and PGC-1α) and protein (AMPK, p-AMPK, PPAR-γ and GLUT4) expressions, as well as augmented state-3 respiration, oxygen consumption rate, and citrate synthase activity in muscle was observed in catalpol treated mice. The antidiabetic activity of catalpol is credited with a marked improvement in insulin sensitivity and mitochondrial respiration through the insulin signaling pathway and AMPK/SIRT1/PGC-1α/PPAR-γ activation in the skeletal muscle of T2DM mice.

Matched MeSH terms: Plasma
ASSESSMENT OF HEAVY METAL CONCENTRATION IN MARINE SEDIMENTS IN TERENGGANU WATERS

YIP TAIM HING, TAN EVONNE, POONG JUN HAN, TEE LIAN SHENG, MUHAMMAD HASBI RAMLI, ONG MENG CHUAN, et al.

UMT Journal of Undergraduate Research, 2020;3(2):1-12.
MyJurnal

The distribution of heavy metals (Cu, Zn, Cd, Pb) in surface sediments was examined in waters off the coast of Marang, Terengganu. A total of 20 samples were collected using Ponar grab and analysed by inductively coupled plasma-mass spectrometer after closed digestion with acid. The sediments were filtered using a dry sieving method to determine their particle size. The spatial distribution maps on the concentration of selected metals were drawn using the ArcGIS software. Results showed that the average concentration of Cu, Zn, Cd, and Pb were 2.33±0.38 µg/g dry weight, 28.4±3.78 µg/g dry weight, 0.09±0.01 µg/g dry weight and 8.35±1.48 µg/g dry weight, respectively. The level of pollution was also evaluated using the Index of Geoaccumulation (Igeo) and Pollution Load Index (PLI). All Igeo and PLI values obtained were low, which indicated low or no pollution. Meanwhile, the sediment mean size ranged between -0.77Ø and 3.18Ø, which characterised a sandy type of sediment. Correlation analysis showed a positive correlation between the heavy metals and sediment size. The results indicated that there was a common source of heavy metal pollution in the study area, possibly from shipping activities. Overall, there was no significant heavy metal pollution in the waters off Marang. This finding is important as the data could be used to evaluate the risk of metal contamination and the impact of anthropogenic activities on the marine environment.

Matched MeSH terms: Plasma
Concentration-dependent effect of platelet-rich plasma on keratinocyte and fibroblast wound healing

Xian LJ, Chowdhury SR, Bin Saim A, Idrus RB

Cytotherapy, 2015 Mar;17(3):293-300.
PMID: 25456581 DOI: 10.1016/j.jcyt.2014.10.005

Platelet-rich plasma (PRP) has been found to contain a high concentration of growth factors that are present during the process of healing. Studies conducted found that application of PRP accelerates wound healing. In this study, we characterized the skin cell suspension harvested using the co-isolation technique and evaluated the effects of PRP (10% and 20%, v/v) on co-cultured keratinocytes and fibroblasts in terms of wound healing.

Matched MeSH terms: Platelet-Rich Plasma/metabolism*
CD3-positive plasmablastic lymphoma reported in two cases: A potential diagnostic caveat

Wong YP, Masir N, Chew MX

Indian J Pathol Microbiol, 2021 8 4;64(3):579-583.
PMID: 34341278 DOI: 10.4103/IJPM.IJPM_616_20

Plasmablastic lymphoma (PBL) is a rare aggressive subtype of mature large B cell lymphoma involving almost exclusively the extranodal regions particularly the oral cavity, frequently described in immunocompromised patients. PBL is characterized histologically by diffuse proliferation of large neoplastic cells resembling B immunoblasts or plasmablasts. The diagnosis of PBL can be difficult due to its ambiguous histopathological features mimicking most large cell lymphomas and lacking a distinctive immunophenotypic pattern. They typically lack expression of CD20 and CD79a but may express plasma cell marker, CD138. Aberrant immunoexpression of CD3, a T-cell marker in PBL in the absence of other B-cell markers is exceptionally rare, may potentially lead to incorrect interpretation. Herein, we report a case series of CD3-positive PBL of oral cavity in two individuals, which were initially misdiagnosed as high-grade T-cell lymphomas including extranodal NK/T-cell lymphoma, nasal type. Useful distinguishing clinical settings, histomorphological features, immunohistochemistry and molecular expression profiles of PBL are discussed.

Matched MeSH terms: Plasma Cells/pathology
Fulltext A case of recurrent respiratory papillomatosis successfully removed via endoscopic argon plasma coagulation (APC) with no evidence of recurrence

Wong JL, Tie ST, Lee J, Kannan SK, Rashid Ali MR, Ibrahim A, et al.

Med J Malaysia, 2014 Aug;69(4):195-6.
PMID: 25500852 MyJurnal

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by the human papilloma virus (HPV), characterized by the formation of recurrent, epithelial neoplastic lesions in the airways. While benign, they can cause significant airway obstruction in some cases. Difficulties in treatment arise from the recurrent nature of the lesions despite repeated procedures. Other known procedures that result in deep tissue damage also cause unacceptable collateral damage to the underlying airway mucosa. We describe a case of recurrent papillomatosis that was successfully treated with argon plasma coagulation ( APC) when laser and electrocautery ablation had failed in the past. After the papillomatasis was treated with APC, there is no recurrence on repeat scope at 4 months and 9 months after the initial procedure. The procedure was done as a day case and there is no complication from the procedure. The property of the APC that allows it to cause only superficial thermal damage to the tissue makes it a suitable adjunct therapy to the treatment of papillomas, which are usually superficial lesions.

Matched MeSH terms: Argon Plasma Coagulation
A case of co-infection: First reported case of severe plasmodium knowlesi malaria and dengue co-infection in Sabah, Malaysia

Wong CK, Md Fuzi NH, Baherin MF, Lee HG

Med J Malaysia, 2020 03;75(2):171-172.
PMID: 32281602

We report a rare case of severe Plasmodium knowlesi malaria and dengue co-infection in a 36-year-old lady with hyperparasitaemia, metabolic acidosis, haemolysis and acute kidney injury. She was in shock requiring inotropic support and elective intubation. She had pericardial tamponade which necessitate pericardiocentesis to allow for haemodynamic stability during haemodialysis. She underwent haemodialysis, was ventilated for six days and stayed in hospital for 29 days. She was discharged home well with almost complete renal recovery. Physicians must have a high degree of suspicion for dengue co-infection in malaria patients with plasma leakage such as pericardial effusion to allow for prompt management.

Matched MeSH terms: Plasma
Fulltext Heat acclimation attenuates the increased sensations of fatigue reported during acute exercise-heat stress

Willmott AGB, Hayes M, James CA, Gibson OR, Maxwell NS

Temperature (Austin), 2019 Sep 19;7(2):178-190.
PMID: 33015245 DOI: 10.1080/23328940.2019.1664370

Athletes exercising in heat stress experience increased perceived fatigue acutely, however it is unknown whether heat acclimation (HA) reduces the magnitude of this perceptual response and whether different HA protocols influence the response. This study investigated sensations of fatigue following; acute exercise-heat stress; short- (5-sessions) and medium-term (10-sessions) HA; and between once- (ODHA) and twice-daily HA (TDHA) protocols. Twenty male participants (peak oxygen uptake: 3.75 ± 0.47 L·min-1) completed 10 sessions (60-min cycling at ~2 W·kg-1, 45°C/20% relative humidity) of ODHA (n = 10) or non-consecutive TDHA (n = 10). Sensations of fatigue (General, Physical, Emotional, Mental, Vigor and Total Fatigue) were assessed using the multi-dimensional fatigue scale inventory-short form pre and post session 1, 5 and 10. Heat adaptation was induced following ODHA and TDHA, with reductions in resting rectal temperature and heart rate, and increased plasma volume and sweat rate (P Plasma volume; RH: Relative humidity; RPE: Rating of perceived exertion; SD: Standard deviation; SE: Standard error of the slope coefficient or intercept; SEE : Standard error of the estimate for the regression equation; STHA: Short-term heat acclimation; TDHA: Twice daily heat acclimation; TC: Thermal Comfort; Tre: Rectal temperature; TSS: Thermal sensation; V̇O2peak: Peak oxygen uptake; WBSL: whole-body sweat loss.

Matched MeSH terms: Plasma Volume
Fulltext Once- and twice-daily heat acclimation confer similar heat adaptations, inflammatory responses and exercise tolerance improvements

Willmott AGB, Hayes M, James CA, Dekerle J, Gibson OR, Maxwell NS

Physiol Rep, 2018 Dec;6(24):e13936.
PMID: 30575321 DOI: 10.14814/phy2.13936

This experiment aimed to investigate the efficacy of twice-daily, nonconsecutive heat acclimation (TDHA) in comparison to once-daily heat acclimation (ODHA) and work matched once- or twice-daily temperate exercise (ODTEMP, TDTEMP) for inducing heat adaptations, improved exercise tolerance, and cytokine (immune) responses. Forty males, matched biophysically and for aerobic capacity, were assigned to ODHA, TDHA, ODTEMP, or TDTEMP. Participants completed a cycling-graded exercise test, heat acclimation state test, and a time to task failure (TTTF) at 80% peak power output in temperate (TTTFTEMP : 22°C/40% RH) and hot conditions (TTTFHOT : 38°C/20% RH), before and after 10-sessions (60 min of cycling at ~2 W·kg-1 ) in 45°C/20% RH (ODHA and TDHA) or 22°C/40% RH (ODTEMP or TDTEMP). Plasma IL-6, TNF-α, and cortisol were measured pre- and postsessions 1, 5, and 10. ODHA and TDHA induced equivalent heat adaptations (P plasma volume expansion [+10.1 ± 5.6, +8.5 ± 3.1%]) and improved heat acclimation state (sweat set point [-0.22 ± 0.18, -0.22 ± 0.14°C] and gain [+0.14 ± 0.10, +0.15 ± 0.07 g·sec-1 ·°C-1 ]). TTTFHOT increased (P 0.05) following ODHA (+14 ± 4%), TDHA (14 ± 8%), ODTEMP (9 ± 10%) or TDTEMP (8 ± 13%). Acute (P 0.05) increases were observed in IL-6, TNF-α, or cortisol during ODHA and TDHA, or ODTEMP and TDTEMP. Once- and twice-daily heat acclimation conferred similar magnitudes of heat adaptation and exercise tolerance improvements, without differentially altering immune function, thus nonconsecutive TDHA provides an effective, logistically flexible method of HA, benefitting individuals preparing for exercise-heat stress.

Matched MeSH terms: Plasma Volume
Fulltext Treatment of MOG antibody associated disorders: results of an international survey

Whittam DH, Karthikeayan V, Gibbons E, Kneen R, Chandratre S, Ciccarelli O, et al.

J Neurol, 2020 Dec;267(12):3565-3577.
PMID: 32623595 DOI: 10.1007/s00415-020-10026-y

INTRODUCTION: While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed.
OBJECTIVE: To survey the current global clinical practice of clinicians treating MOGAD.
METHOD: Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February-April 2019).
RESULTS: Fifty-two responses were received (response rate 60.5%) from 86 invited experts, comprising adult (78.8%, 41/52) and paediatric (21.2%, 11/52) neurologists in 22 countries. All treat acute attacks with high dose corticosteroids. If recovery is incomplete, 71.2% (37/52) proceed next to plasma exchange (PE). 45.5% (5/11) of paediatric neurologists use IV immunoglobulin (IVIg) in preference to PE. Following an acute attack, 55.8% (29/52) of respondents typically continue corticosteroids for ≥ 3 months; though less commonly when treating children. After an index event, 60% (31/51) usually start steroid-sparing maintenance therapy (MT); after ≥ 2 attacks 92.3% (48/52) would start MT. Repeat MOG antibody status is used by 52.9% (27/51) to help decide on MT initiation. Commonly used first line MTs in adults are azathioprine (30.8%, 16/52), mycophenolate mofetil (25.0%, 13/52) and rituximab (17.3%, 9/52). In children, IVIg is the preferred first line MT (54.5%; 6/11). Treatment response is monitored by MRI (53.8%; 28/52), optical coherence tomography (23.1%; 12/52) and MOG antibody titres (36.5%; 19/52). Regardless of monitoring results, 25.0% (13/52) would not stop MT.
CONCLUSION: Current treatment of MOGAD is highly variable, indicating a need for consensus-based treatment guidelines, while awaiting definitive clinical trials.

Matched MeSH terms: Plasma Exchange
Alteration of plasma alanine, glutamate, and glycine Level: A potentiate manic episode of bipolar disorder

Wan Nasru WN, Ab Razak A, Yaacob NM, Wan Azman WN

Malays J Pathol, 2021 Apr;43(1):25-32.
PMID: 33903302

INTRODUCTION: The amino acids that function as co-agonists at the N-methyl-D-aspartate (NMDA) receptor have been investigated in bipolar disorder (BD). However, studies comparing amino acid levels in the plasma of BD patients with healthy controls have yielded inconsistent results. We, therefore, conducted a study in Hospital Universiti Sains Malaysia to determine the plasma levels of glutamate, glycine, and alanine in BD patients and compared them with the healthy controls.
MATERIALS AND METHODS: An overnight fast of 10-hour plasma levels of glutamate, glycine, alanine, and tryptophan were measured in 83 bipolar patients, and were compared to a group of 82 healthy controls.
RESULTS: The mean (SD) age of bipolar patients was 40.9 (12.1), while the mean (SD) age for control groups was 35.6 (7.7) years. The median (25th, 75th percentile) of glutamate and alanine levels in bipolar patients was 111.0 (65.0,176.0) and 530.0 (446.0,629.0), respectively, while the mean (SD) of glycine level in bipolar patients was 304.0 (98.1). Significant higher glutamate, glycine, and alanine levels were found in bipolar disorder patients in the manic episode as compared to the healthy controls.
CONCLUSION: Although the exact relationship between peripheral NMDA receptor co-agonist levels in the pathogenesis of BD is not well understood, these findings should be explored and may enlighten some new paths for BD therapy which could reward the patients also clinicians.

Matched MeSH terms: Plasma
Fulltext Efficiency of different sampling tools for aquatic macroinvertebrate collections in Malaysian streams

Wan Mohd Hafezul Wan Abdul Ghani, Che Salmah Md Rawi, Suhaila Abd. Hamid, Al-Shami, Salman Abdo

Trop Life Sci Res, 2016;27(1):115-133.
MyJurnal

This study analyses the sampling performance of three benthic sampling tools
commonly used to collect freshwater macroinvertebrates. Efficiency of qualitative D-frame
and square aquatic nets were compared to a quantitative Surber sampler in tropical
Malaysian streams. The abundance and diversity of macroinvertebrates collected using
each tool evaluated along with their relative variations (RVs). Each tool was used to
sample macroinvertebrates from three streams draining different areas: a vegetable farm,
a tea plantation and a forest reserve. High macroinvertebrate diversities were recorded using the square net and Surber sampler at the forested stream site; however, very low
species abundance was recorded by the Surber sampler. Relatively large variations in the
Surber sampler collections (RVs of 36% and 28%) were observed for the vegetable farm
and tea plantation streams, respectively. Of the three sampling methods, the square net
was the most efficient, collecting a greater diversity of macroinvertebrate taxa and a
greater number of specimens (i.e., abundance) overall, particularly from the vegetable
farm and the tea plantation streams (RV

Matched MeSH terms: Norepinephrine Plasma Membrane Transport Proteins
Second regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders, Kuala Lumpur, Malaysia, 9th December 2017

Viswanathan S, Hung SKY, Goyal V, Apiwattanakul M, Thirugnanam UN, Abdullah S, et al.

J Clin Apher, 2018 Oct;33(5):559-568.
PMID: 29626354 DOI: 10.1002/jca.21630

In December 2017, 79 delegates attended the 2nd regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders in Kuala Lumpur, Malaysia. This meeting featured 6 plenary lectures, interactive sessions dedicated for experience sharing, case presentations, and a practical session for paramedics. Clinical experts and researchers from 7 SEA countries and India shared experience and challenges in treating autoimmune neurological disorders. While the spectrum of diseases and neurology practice remained largely similar, there was great disparities in accessibility of therapeutic plasma exchange (TPE) within SEA countries and between urban or rural settings. Costs, human resources, and healthcare policies are common challenges in providing sustainable TPE services. Novel techniques and innovative ideas in performing TPE were explored. A working consortium comprising of key opinion leaders was proposed to improve standards of TPE and enhance future research.

Matched MeSH terms: Plasma Exchange/methods*
The establishment of in-house neurology driven therapeutic plasma exchange infrastructure in a resource-limited public hospital in Malaysia: Adopting and integrating evidenced-based health care technology through time

Viswanathan S, Hiew FL

J Clin Apher, 2019 Aug;34(4):434-444.
PMID: 30829434 DOI: 10.1002/jca.21696

There has been an increase in the use of therapeutic plasma exchange (TPE) in immune-mediated neurological disorders in recent years. However, accessibility and availability of TPE remains low and costly, especially for a country with limited healthcare funding like Malaysia. With expanding clinical indications in neurological disorders, and increasingly expensive conventional immunomodulatory treatment such as intravenous immunoglobulin and monoclonal antibodies, TPE remains an effective part of first or second-line treatment. In this article, we detailed the historical aspects of the use of TPE in neurological disorders in Malaysia over the last four decades and discussed the challenges behind the establishment of the first in-house neurology-driven TPE service in the country. Local TPE database from a national neurology centre in Kuala Lumpur over the past 20 years was analyzed. We observed a remarkable three folds increase in the use of TPE at our center over the past 10 years (total 131 TPE treatments) compared to a decade prior, with expanding clinical indications predominantly for central nervous system demyelinating disorders. Besides using membrane filtration method, centrifugal technique was adopted, providing new opportunities for other clinical beneficiaries such as a neurologist driven "in-house TPE unit". However, there were real world challenges, especially having to provide services with limited funding, human resources, and space. In addition, much has to be done to improve accessibility, availability, and sustainability of TPE services at our center and nationwide. Nevertheless, even with limited resources and support, it is possible with concerted efforts to work within the confines of these limitations to establish a safe, successful, and sustainable TPE service.

Matched MeSH terms: Plasma Exchange/economics; Plasma Exchange/methods*; Plasma Exchange/trends
Proceedings of the Inaugural Strategy Meeting for the Establishment of a Southeast Asia Regional Therapeutic Plasma Exchange Consortium for Neurological Disorders

Viswanathan S, Appiwatanakul M, Nayak A, Islam B, Khatri B, Pangeran D, et al.

Ther Apher Dial, 2019 Jun;23(3):289-297.
PMID: 30927331 DOI: 10.1111/1744-9987.12806

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre-meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs.

Matched MeSH terms: Plasma Exchange/methods*

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