Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin.
The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells
homing towards tumor site.
Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+
and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the
peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.
Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to
the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers
and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were
quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson
correlation were used for the data analysis.
Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to
adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive
correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue
(Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells
in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson
correlation, r = 0.42, p = 0.049).
Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells
homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.
Background: Most postpartum women are prescribed at least one medication; so the safety of the medication
is a major concern. In 2017, 11% of 815 questions received by the Pharmacy Drug Information Services at seven
clinics in Dungun is related to medication use in breastfeeding. Thus, this study was carried out to evaluate
the attitudes of healthcare providers (HCPs) and to investigate the effect of knowledge about medication use
in breastfeeding among HCPs; pre- and post-educational intervention.
Methods: An interventional study was carried out among medical officers, assistant medical officers,
pharmacists and pharmacist assistants from seven clinics in the district of Dungun, Malaysia. The questionnaires
were distributed during pre- and post-intervention period. The interventions in this study included continuous
medical education (CME) and the use of a booklet regarding medication use for breastfeeding women. The
data collected were analyzed using Statistical Package for Social Studies (SPSS) and presented as frequencies,
means, and standard deviations.
Results: Fifty HCPs were enrolled in this study and over 20% of them advised mothers to discontinue
breastfeeding whenever they are prescribed any medication. The knowledge of HCPs about medication use in
breastfeeding women was significantly improved (Z= -5.917, p
Background: Despite regularly participating in international and national level multisport events, there is still
limited data on the pattern of injuries and illnesses and factors associated with injuries and illnesses in Malaysia.
Such information is crucial to instil preventive measures because sustaining injuries during competition could
hamper the athlete’s performance.
Methods: This cross-sectional study investigated the incidence, patterns and risk factors of injuries and illnesses
among athletes throughout SUKIPT 2018, from the 2nd to the 10th of February 2018. All injuries and illnesses
treated by tournament medical personnel were reported using a standardised online injury reporting form.
This form was adapted from the injury surveillance form used by the International Olympic Committee.
Results: A total of 6071 athletes from 80 contingents took part in SUKIPT 2018. During the nine days of
competition 323 injuries and 48 illnesses were reported, resulting in an incidence of 5.3 injuries and 0.8 illness
per 100 athletes. Approximately 6% of the athletes sustained at least one injury or illness.
Conclusion: In summary, the incidence of injuries and illnesses among athletes during SUKIPT was 5.3 and
0.8 per 100 athletes, respectively. Muscle strain/rupture/tear was the most common pattern of injury while
collision with another athlete was the most frequent mechanism of injury. Meanwhile, the respiratory system
was the most commonly affected by illness and infection was the most prevalent cause of illness.
Cryptococcus neoformans is an encapsulated fungal pathogen that causes severe disease primarily in
immunocompromised patients. Adherence and internalisation of microbial pathogens into host cells often
begin with engagement of microbes to the surface receptors of host. However, the mechanisms involved
remain poorly understood. In this study, we investigated the association of cell surface determinants of C.
neoformans with mammalian cells. Our results showed that treatment with trypsin, but not paraformaldehyde
or heat killing, could reduce host-cryptococci interaction, suggesting the involvement of cell surface proteins
(CSPs) of C. neoformans in the interaction. We extended our investigations to determine the roles of CSPs
during cryptococci-host cells interaction by extracting and conjugating CSPs of C. neoformans to latex beads.
Conjugation of CSPs with both encapsulated and acapsular C. neoformans increased the association of latex
beads with mammalian alveolar epithelial cells, alveolar macrophages and monocyte-derived macrophages.
Further examination on the actin organisation of the host cells implied the involvement of actin-dependent
phagocytosis in the internalisation of C. neoformans in CSP-conjugated latex beads. We hypothesised that
CSPs present on the cell wall of C. neoformans mediate the adherence and actin-dependent phagocytosis
of cryptococci by mammalian cells. Our results warrant further studies on the exact role of CSPs in the
pathogenesis of cryptococcosis.
Long-distance running has gathered some momentum among health-conscious participants. However, some
studies have revealed association between long-distance running and development of acute kidney injury.
Although the impact usually lasts only for a few days after the event, some participants have been admitted for
severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the
injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS.
Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function.
Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were
asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported.
Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone
have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of
the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment
of both conditions.
Purpose: The object of this study was to identify patients with diagnosed dengue infection, who were positive
for both dengue-specific NS1 antigen and IgM antibody.
Method: From January 2013 to December 2016, in Central Kolkata in West Bengal in India, patients with
symptoms of dengue infection, were sent to the laboratory by the physicians for confirmatory diagnosis of
dengue infection. A total of 4762 patients were seen, and serum samples tested and distributed into seven
panels, according to the investigations requested. 1436 patients were tested positive.
Results: 1053 cases were tested for both NS1 and Ig M antibody, 835 for dengue-specific NS1 antigen, IgM and
IgG antibodies and 218 for NS1 dengue-specific antigen and IgM antibody. Of these, dengue was confirmed in
34.3 %, with 16.6% positive for both NS1 antigen and IgM antibody. Eleven were diagnosed, with late dengue
infection, thirty-nine with late primary infections and ten with late secondary dengue infection.
Conclusions: Many of the patients were reactive for both NS1 antigen and IgM antibody, and they required
proper attention and strict vigilance with effective monitoring and treatment, not of early dengue infection,
but of late dengue infection. Unless the serological tests for Ig M and IgG antibodies, and the dengue specific
viral antigen NS1 are performed simultaneously, these types of cases would not all be detected.
congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very
promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study,
we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest
Borneo. A better understanding of the barriers will provide us with the information to formulate effective
programmes for clubfoot treatment in this region.
Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted
a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda
in the year 2006.
Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with
16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment
in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).
Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study
are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers
having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its
treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic
constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to
increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot
program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country.
We report a case of a 59-year-old gentleman with complete left brachial plexus injury. He presented with
chronic pain over the dorsum of his left hand since the injury eight years ago. Medical treatment had been
optimised but the pain still persist. End-to-side nerve transfer was done involving superficial sensory radial
nerve and median nerve to alleviate the pain. The surgery was considered successful as the patient claimed
that the pain score had reduced a few weeks postoperatively. However, there was no sensory recovery and
functionally no improvement was observed.
Objective: The study was designed to determine the risk perception of the public population in Kota Kinabalu towards childhood immunisation.
Methodology: This was a cross-sectional study where self-administered questionnaires were distributed to the public in Kota Kinabalu. The respondents who consented were 18 years old and older. The illiterate persons and the foreigners were excluded. The calculated sample size was 400. Only 313 samples collected were suitable for analysis using SPSS v21.0.
Results: Fever, pain swelling and allergic reaction were correctly identified as risks of immunisation. Autism, mental retardation and even death could also result from vaccination. Of the total respondents, 76.7% agreed with the practice of childhood vaccination, 70.0% thought that childhood vaccinations were safe and effective and 58.1% felt that its benefit outweighed the risk. Other than that, 32.0% refused childhood vaccination from fear of its risks, and this fear was the main reason for the refusal of childhood vaccination. Age, marital status, race and income were the factors which influenced parental willingness to vaccinate their children (p<0.05).
Conclusions: Most participants understood the risks of childhood vaccination, but few agreed to the practice of childhood immunisation for herd immunity. Public health campaigns are needed, to increase the understanding and acceptance of childhood vaccination especially in the rural community.
Keywords: Childhood Immunisation, Parental Risk, Perception, Public Acceptance
Graft-versus-host Disease (GVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic
stem cell transplantation (alloHSCT). In spite of immune-suppressive prophylaxis, most survivors suffer from
acute and chronic GVHD (aGVHD and cGVHD). The outcome of alloHSCT may be affected by the presence of
single nucleotide polymorphism (SNP) in non-HLA genes including those involved in innate immune responses.
This study aimed to evaluate the impact of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and caspase recruitment
domain 15 (NOD2/CARD15) gene polymorphisms on the incidence and severity of aGVHD and cGVHD following
alloHSCT. A structured literature review was carried out using various keywords and MESH terms such as
stem cell transplantation, allogenic haematopoietic stem cell transplantation, GVHD, and non-HLA gene
polymorphism, in PubMed, Google Scholar and Cochrane Database. A total of 8 studies that met inclusion
criteria (English publications from 2006 to 2017) were included. Ten SNPs in CTLA-4 gene and three SNPs in
NOD2/CARD15 gene were tested in patients with underlying haematological malignancies. Four studies tested
the SNPs of CTLA-4 gene and two were found to have an association with CTLA-4 SNPs (rs3087243, rs231775)
and increased incidence of aGVHD. The other four studies tested the SNPs of NOD2/CARD15 gene and one
found an association between SNP13 and increased incidence of aGVHD. None of these eight studies found
any effect on severity of GVHD. In conclusion, two SNPs in CTLA-4 and one SNP in NOD2/CARD15 increased
the incidence of aGVHD but not its severity. The higher incidence of aGVHD in studies with larger sample size
could support the impact of SNPs in the outcome of alloHSCT. However, due to the heterogeneity of studies in
regard to the age of patients and donor, and conditioning regimen, it is difficult to draw a definite conclusion.
Locked pubic symphysis is a rare form of pelvic injury that usually occurs after a lateral compression injury to
the pelvis, where the intact pubis is trapped behind the contralateral pubis. To the best of our knowledge, there
were 25 similar cases reported in the English literature since it was first described in 1952. We present a case
of locked pubic symphysis with a left iliac wing fracture and a left femur shaft fracture requiring open reduction
and internal fixation. We also reviewed previous reported cases of locked pubic symphysis and analysed the
pattern of presentation and guide to management of such injuries. We propose a classification system for
grading overlapping pubic symphysis that will provide a better guide to the management of such injuries.
Objectives: The objectives of our study were to determine the mean age of onset of thelarche and menarche,
to determine the ages of each stage of puberty and to investigate if there are any ethnic differences in these
ages amongst female adolescents in Kuala Lumpur, Malaysia.
Methods: This was a cross-sectional study involving three secondary schools in Cheras, Kuala Lumpur. A total of
730 students were recruited via stratified random sampling. Self-administered survey forms on menstruation
and puberty were used.
Results: Out of 730 recruited respondents, 385 (52.74%) completed the survey and informed consents were
obtained from their parents/legal guardians. Our respondents’ ages ranged between 13 to 17 years old with
the median (IQR) age of 14.00(2.00) years. With regards to ethnicity, 329 (85.50%) were Malay, 46 (11.90%)
were Chinese, 9 (2.30%) were Indian and 1(0.30%) was a Bajau. The mean age for breast development
(thelarche) and menarche were 11.72 ±1.10 and 11.97±1.11 years respectively. The majority, 363 (94.30%),
out of 385 respondents had attained menarche. There appeared to be a later onset of puberty amongst
Malays comparatively.
Conclusion: The mean ages of pubertal onset and menarche amongst female adolescents in the Cheras area
are similar to those reported worldwide.
The objective of this study was to determine the factorial validity of the Chinese version of the General Family
Functioning subscale (GF-12) and to assess parents’ perceived family functioning of children with or without
chronic respiratory disease in Malaysia. Thirty two parents of children with chronic respiratory disease and
30 parents of healthy children were recruited. The GF-12 was administered at baseline and 2 weeks later.
Confirmatory factor analysis showed that our instrument was a 1-factor model assessing general family
functioning. Cronbach’s α value was 0.950. Test-retest reliability coefficient ranged from 0.490-0.790. The overall
mean (standard deviation) score was not significantly different between parent’s perceived family functioning
of children with or without respiratory disease [1.83(0.63) versus 1.65(0.46), p=0.385]. The Chinese version
of the GF-12 was found to be a valid and reliable instrument to assess family functioning in Malaysia. Parents
in the present study showed healthy perceived family functioning (total score >2.00).
Phenytoin is commonly prescribed for the prophylaxis of seizures in neurosurgical patients. A phenytoininduced
serious adverse effect of thrombocytopenia has been reported in the literature. The concurrent
use of dexamethasone, another commonly prescribed drug in neurosurgical patients, has been reported to
aggravate this adverse haematological effect. We present a report of phenytoin-induced thrombocytopenia
in a patient concurrently prescribed with dexamethasone, after an intracerebral haemorrhage secondary to
a rupture of an arteriovenous malformation. The thrombocytopenia was noted after two weeks of phenytoin
medication. Phenytoin was immediately withheld, and seven units of random donor platelets were transfused.
A gradual resolution of thrombocytopenia was observed within a week.
There had been increased and strong public interests in rare diseases and orphan drugs as well as the issue of
compulsory licencing for expensive medications in Malaysia in the mass-media and social media. We reviewed
the issues of orphan drugs and the challenges faced in many countries in developing appropriate health financial
modelling as well as getting accurate data on rare diseases. We also reviewed the old off-patent medications
and the developments on how policy-makers can intervene to make expensive treatment affordable and
sustainable for patients and the country.
A review of all colonic biopsies received by the Department of Pathology during a 8-year period revealed 41 cases of ulcerative colitis (UC). The diagnosis was based on histological and clinical features. The age range of patients was between 14 - 76 years with a median age of 35.4 years. The disease was more prevalent among Indians. The common presenting sysmptoms were diarrhoea (100%) and haematochezia (83%). The extent of colonic involvement varied. Twelve patients (29.2%) had pancolitis and 8 (19.5%) had proctitis.Extraintestinal manifestations were rare and only one patient had pyoderma gangrenosum. One patient developed multifocal colorectal cancer 10 years after the inial diagnosis of UC and died 2 years later due to metastases. Histology plays an important role in the diagnosis and management of patients with UC. We noted a good correlation between clinical and pathological features. The most recent colonic biopsy showed features of chronic UC with activity in 34 cases and features of remission in 4 cases.
The conventional use of aminoglycoside antibiotics has several disadvantages including the need for regular pre- and post-dose assaying and the risks of toxicity. Achieving a therapeutic and non-toxic serum concentration may be difficult in many patients especially those with severe sepsis. Correct timing of doses and assays is essential, but this is often difficult to achieve. Many of these difficulties may be remedied by the use of once daily dosing. This dosing schedule appears to be equally effective as the conventional method and i s also less toxic. There are many other advantages including the need for less assays and venepuncture resulting in reduced costs. KEYWORDS: Aminoglycosides, antibiotic therapy, toxicity, therapeutic monitoring
Compression of the common bile duct by a stone impacted in the cystic duct is an uncommon cause of obstructive jaundice. We present a case study and review of the literature pertaining to the presentation, diagnosis, and surgical treatment of Mirizzi syndrome.
Preliminary work was carried out f o r the development of a rapid method for the detection and enumeration of enterococcal phages in natural water. Eight enterococcal phages were isolated after amplification from water obtained from 2 local ponds. These were plaque-purified and used to test the phage susceptibility of 34 strains of enterococci isolated from pristine and polluted waters. Eight strains with the widest phage susceptibility were used as hosts in a double agar layer (DAL) and a single agar layer (SAL) assay for phage enumeration without pre-assay amplification. N o phages were obtained with the DAL method with all 8 hosts. Usingthe SALmethod, 2 phages were obtained with 1 of the 2 hosts used. Phage isolation was not improved by incubation at 44.5°C. For rapid quantitative testing, the sensitivity of the assays has to be increased to enable phage isolation without the need for prior amplification. KEYWORDS: Enterococci, phage, enumeration