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Fulltext Efficacy and safety of intralymphatic immunotherapy in allergic rhinitis: A systematic review and meta-analysis

Aini NR, Mohd Noor N, Md Daud MK, Wise SK, Abdullah B

Clin Transl Allergy, 2021 Aug;11(6):e12055.
PMID: 34429875 DOI: 10.1002/clt2.12055

Background: Intralymphatic immunotherapy (ILIT) is a potential treatment option for allergic rhinitis (AR). We aimed to determine the efficacy (primary outcomes) and safety (secondary outcomes) of ILIT in treating patients with AR.
Methods: An electronic literature search was performed using MEDLINE and Cochrane Central Register of Controlled Trials CENTRAL (from their inception to December 2020). A random-effects model was used to estimate the pooled prevalence with 95% confidence intervals. This study is registered with PROSPERO (CRD42019126271).
Results: We retrieved a total of 285 articles, of which 11 satisfied our inclusion criteria. There were 452 participants with age ranged from 15 to 58 years old. Intralymphatic immunotherapy was given in three doses with intervals of four weeks between doses in 10 trials. One trial gave three and six doses with an interval of two weeks. Both primary and secondary outcomes showed no difference between ILIT and placebo for all trials. There was no difference in the combined symptoms and medication score (SMD -0.51, 95% CI -1.31 to 0.28), symptoms score (SMD -0.27, 95% CI -0.91 to 0.38), medication score (SMD -6.56, 95% CI -21.48 to 8.37), rescue medication (RR 12.32, 95% CI 0.72-211.79) and the overall improvement score (MD -0.07, 95% CI -2.28 to 2.14) between ILIT and placebo. No major adverse events noted.
Conclusions: Intralymphatic immunotherapy possibly has a role in the treatment of AR patients. This review found it is safe but not effective, which could be contributed by the high variation amongst the trials. Future trials should involve larger numbers of participants and report standardized administration of ILIT and outcome measures.
Fulltext Genetic Variation between Triploid and Diploid Clarias gariepinus (Burchell, 1822) Using RAPD Markers

Normala J, Okomoda VT, Mohd AA, Nur AA, Abol-Munafi AB, Md Sheriff S

Vet Sci, 2021 May 04;8(5).
PMID: 34064306 DOI: 10.3390/vetsci8050075

This study was designed to examine the use of RAPD markers in discriminating triploid and diploid African catfish Clarias gariepinus (Burchell, 1822). Following a routine technique, triploidy was induced by cold shock and confirm by erythrocyte measurement in C. gariepinus. Thereafter, 80 RAPD markers were screened; out of which, three showed the highest percentage of polymorphism (i.e., OPB 16 = 71.43%; OPC 14 = 61.9%; OPD 12 = 75%). The results obtained showed genotype differences between triploid and diploid without overlapping. However, the development of a Sequence Characterized Amplified Region (SCAR) marker was not achievable because progenies of triploid and diploid C. gariepinus could not be differentiated based on a specific fragment. Consequently, the genetic distance showed high similarities for both treatments and the UPGMA-generated dendrogram could not separate the treatments into two distinct clusters. It was concluded that RAPD makers cannot be used to separate the ploidy status of fishes.
Does facial appearance of dentofacial deformity influence the need for orthognathic surgery: The Malaysian perception

Abdul Halim Chong FH, Md Salleh SN, Abu Bakar N, Ismail IN

Singapore Dent J, 2019 12;39(1):41-52.
PMID: 32910746 DOI: 10.1142/S2214607519500044

Aim: This study evaluates perception toward facial appearance in dentofacial deformity and the need for orthognathic surgery among the public with and without dental backgrounds. Materials and Methods: A questionnaire consisting of 12 facial photographs of cases with dentofacial deformity or malocclusion in varying severity was used. A hundred individuals were selected to answer the questionnaire. The perception of facial appearance (FAS), treatment need score (TNS), and knowledge regarding dentofacial deformity were used for the evaluation. Results: Significant differences were found between dental and non-dental when the respondents' knowledge in all the questionnaire items ([Formula: see text].05) was assessed. However, no significant difference was found in the mean of FAS and TNS in all the presented cases (normal, borderline, severe). Pearson correlation between perceived FAS and TNS was statistically negative for severe and normal cases, whereby a decrease in FAS for severe cases showed an increase in TNS, and an increase in FAS for normal cases showed a decrease in TNS. Conclusion: Respondents with dental background had sound knowledge of dentofacial deformity. A poorly attractive respondent with dentofacial deformity showed a greater need for orthognathic surgery.
Palbociclib and beyond for the treatment of HR + HER2- metastatic breast cancer: an Asian-Pacific perspective and practical management guide on the use of CDK4/6 inhibitors

Dawood S, Chiu JW, Huang CS, Nag S, Sookprasert A, Yap YS, et al.

Curr Med Res Opin, 2020 08;36(8):1363-1373.
PMID: 32544344 DOI: 10.1080/03007995.2020.1783646

Breast cancer is the most frequent cancer amongst women worldwide including in Asia where the incidence rate is rapidly increasing. Even with treatment, around 30% of patients with early breast cancer progress to metastatic disease, with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) breast cancer the most common phenotype. First-line endocrine therapy targeting the estrogen receptor signaling pathway provides a median progression-free survival or time to progression of 6-15 months in HR + HER2- metastatic breast cancer. Recently, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, combined with endocrine therapy, have achieved more than two years median progression-free survival in HR + HER2- metastatic breast cancer. However, the characteristics of the Asian breast cancer population differ from those of Western populations and need to be considered when selecting a suitable treatment. Breast cancer is diagnosed at a younger age in Asian populations and late stage at presentation is generally more common in low-/middle-income countries than high-income countries. Consequently, the proportion of premenopausal women with metastatic breast cancer is higher in Asian compared with Western populations. While CDK4/6 inhibitors have been approved in the USA (FDA) since 2015, experience with them in Asia is more limited. We review the experience with the CDK4/6 inhibitor palbociclib in Asian patients with HR + HER2- metastatic breast cancer and provide guidance on the use of palbociclib in these patients.
Influence of serum concentration in retinoic acid and phorbol ester induced differentiation of SH-SY5Y human neuroblastoma cell line

Magalingam KB, Radhakrishnan AK, Somanath SD, Md S, Haleagrahara N

Mol Biol Rep, 2020 Nov;47(11):8775-8788.
PMID: 33098048 DOI: 10.1007/s11033-020-05925-2

Numerous protocols to establish dopaminergic phenotype in SH-SY5Y cells have been reported. In most of these protocols there are variations in concentration of serum used. In this paper, we compared the effects of high (10%), low (3%) and descending (2.5%/1%) serum concentration in differentiation medium containing different proportion of retinoic acid (RA) and 12-O-Tetradecanoylphorbol-13-acetate (TPA) or RA-only on the undifferentiated SH-SY5Y cells with regards to cell morphology, biochemical and gene expression alterations. Cells differentiated in culture medium containing low and descending serum concentrations showed increased number of neurite projections and reduced proliferation rates when compared to undifferentiated cells. The SH-SY5Y cells differentiated in culture medium containing 3% RA and low serum or descending (2.5%/1% RA/TPA) were found to be more susceptible to 6-hydroxydopamine (6-OHDA) induced cytotoxicity. Cells differentiated with RA/TPA or RA differentiated showed increased production of the α-synuclein (SNCA) neuroprotein and dopamine neurotransmitter compared to undifferentiated cells, regardless serum concentrations used. There was no significant difference in the expression of tyrosine hydroxylase (TH) gene between undifferentiated and differentiated SH-SY5Y cells. However, the expression of dopamine receptor D2 (DRD2) gene was markedly increased (p<0.05) in differentiated cells with 3% serum and RA only when compared to undifferentiated cells. In conclusion, to terminally differentiate SH-SY5Y cells to be used as a cell-based model to study Parkinson's disease (PD) to investigate molecular mechanisms and drug discovery, the optimal differentiation medium should contain 3% serum in RA-only.
Microplastics in seawater and zooplankton: A case study from Terengganu estuary and offshore waters, Malaysia

Taha ZD, Md Amin R, Anuar ST, Nasser AAA, Sohaimi ES

Sci Total Environ, 2021 Sep 10;786:147466.
PMID: 33984707 DOI: 10.1016/j.scitotenv.2021.147466

Widespread accumulation and distribution of microplastics at the sea surface raise concerns as the habitat is a feeding ground for zooplankton. As primary consumers, these organisms are closely connected to microplastic input in the marine food chain. Little comparative information currently exists about this problem in estuary and offshore systems. This study investigates microplastic distribution in the surface water and the potential ingestion of microplastics in selected taxonomic groups of zooplankton from the Terengganu Estuary to offshore waters, Malaysia. In the surface water, three types of microplastics were found (fibres, fragments and pellets). Fibres made up the highest percentage, comprising 80.8% and 73.8% of microplastics in offshore waters and estuaries, respectively. The highest total density of microplastics was found in the Terengganu Estuary (545.8 particles m-3). Microplastics sampled from the offshore waters were identified as polyamide, polyethylene, and polypropylene, which possibly originated from secondary microplastic sources. Two types of microplastics were detected in zooplankton: fibres and fragments. Fibres were the most commonly ingested microplastic type in zooplankton collected from offshore waters (94%) and estuaries (77.7%). The average sizes of ingested fibres and fragments were 361.7 ± 226.8 μm and 96.8 ± 28.1 μm, respectively, with a wider range of sizes ingested observed in offshore waters than in estuaries. The concentration of microplastics in seven zooplankton groups varied from 0.01 ± 0.002 particles ind.-1 (Harpacticoida) to 0.2 ± 0.14 particles ind.-1 (Aphragmophora). Notwithstanding the conformity of our results (increased anthropogenic activities led to greater plastic pollution within the estuary), no significant correlation was observed between the levels of microplastic ingestion and microplastic concentration in the surface water within both areas. Our results provide an important baseline reference on microplastic pollution from estuary to offshore waters, as well as proving that zooplankton act as a repository for microplastic in the marine ecosystem.
Fulltext The external realities of people with type 2 diabetes-Understanding disease perspective and self-management behaviour via Grounded Theory Approach

Swarna Nantha Y, Chelliah AAP, Haque S, Yen GK, Md Zain AZ

PLoS One, 2021;16(1):e0245041.
PMID: 33444368 DOI: 10.1371/journal.pone.0245041

BACKGROUND: Qualitative strategies can uncover the relationship between the external realities of people living with type 2 diabetes (T2D) and the barriers that are associated with disease self-management. Information from in-depth interviews (IDI) and focus group discussions (FGD) can be used to devise psychological models that could potentially facilitate behaviour changes in people with T2D. We aim to identify salient factors that govern the external realities of people with T2D in relation to disease management.
METHODS: A qualitative study was conducted at a regional primary care clinic in Malaysia using a Grounded Theory Approach. People with T2D were recruited through purposeful sampling to determine their living experiences with the disease. A total of 34 IDIs with 24 people with T2D and 10 health care professionals, followed by two FGDs with people with T2D, were conducted.
RESULTS: Three major processes that arbitrate self-management practices include- 1) external reality, 2) internal reality, 3) mediators of behaviour. Within the context of external reality, three important sub-themes were identified-intrinsic background status, personal experience, and worldview. Lifestyle habits of persons with T2D play a central role in their disease management. Another common recurring concern is the issue of a low-quality food environment in the country. More importantly, individuals with T2D have a high degree of expectations for a more person-centered approach to their illness.
CONCLUSIONS: We identified modifiable and non-modifiable behavioural factors that influence the daily living environment of people with T2D. This information can be used to customize the management of T2D through targeted behavioural interventions.
Fulltext The Internal Realities of Individuals With Type 2 Diabetes: Mediators Influencing Self-Management Beliefs via Grounded Theory Approach

Swarna Nantha Y, Haque S, Paul Chelliah AA, Md Zain AZ, Kim Yen G

J Prim Care Community Health, 2020 2 6;11:2150132719900710.
PMID: 32009509 DOI: 10.1177/2150132719900710

Background: There has been an unabated rise in the prevalence of type 2 diabetes (T2D) worldwide. Although T2D is highly preventable, these trends suggest that a paradigm change is much needed in the way both clinicians and policy makers view what effective T2D strategies conventionally entail. Hence, it is becoming increasingly clear that T2D patients require more than just a pharmacological approach to their disease. Evidence indicate that culturally specific mediators can help foster better self-management practices. We intend to discover psychosocial mediators that influence and support self-management beliefs in T2D patients. Methods: We adopted the grounded theory approach to guide in-depth interviews with T2D patients and health care professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling method to examine the inner psychological narratives about how they perceive and what they believe beliefs about the disease. Two focus group discussions were also were conducted for data triangulation. Results: A functional framework for the psychosocial mediators influencing self-management beliefs in T2D patients was designed and characterized by 4 major processes: (1) health promotion, (2) personal expectations, (3) person-centered care, and (4) psychosocial support. The fulfillment of patients' personal expectations is central to better self-management beliefs. Conclusions: Positive emotional states are important in providing a positive environment to nurture self-management practices. A person-centered consultation that focuses on empathy and cultural sensitivities has the potential to foster behavioral change required to sustain self-care practices.
Older age and duration of exposure to type 2 diabetes in selective screening of asymptomatic carotid artery stenosis for primary stroke prevention-A single institution experience

Safri LS, Lip HTC, Saripan MI, Huei TJ, Krishna K, Md Idris MA, et al.

Prim Care Diabetes, 2020 08;14(4):364-369.
PMID: 31744790 DOI: 10.1016/j.pcd.2019.10.001

AIMS: To evaluate the incidence and risk factors for carotid artery stenosis amongst asymptomatic type 2 diabetes from a single Malaysian tertiary institution.
METHODS: This is a prospective cross-sectional study of asymptomatic type 2 diabetics selected from the outpatient ophthalmology and endocrine clinics for carotid duplex ultrasound scanning performed by a single radiologist. The duplex ultrasound criteria were based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification of carotid artery stenosis. Univariate and multivariate analysis was performed to identify possible risk factors of carotid artery stenosis.
RESULTS: Amongst the 200 patients, the majority were males (56%) and Malay predominance (58.5%). There were 12/200 patients (6%) with mean age of 69.2 years identified to have carotid artery stenosis. Univariate analysis of patients with asymptomatic carotid artery stenosis identified older age of 69.2 years (p=0.027) and duration of exposure to diabetes of 17.9 years (p=0.024) as significant risk factors.
CONCLUSION: Patients with longer exposure of diabetes and older age were risk factors of carotid artery stenosis in asymptomatic type 2 diabetics. These patients should be considered for selective screening of carotid artery stenosis during primary care visit for early identification and closer surveillance for stroke prevention.
Fulltext The Research on Organizational Justice in Scopus Indexed Journals: A Bibliometric Analysis of Seven Decades

Sheeraz MI, Ungku Ahmad UN, Ishaq MI, Sarfraz M, Md Nor K

Front Psychol, 2021;12:647845.
PMID: 34177702 DOI: 10.3389/fpsyg.2021.647845

The organizational justice terminology has had a long journey to become one of the significant contributors to organizational success. Recently, an intense global upsurge in the use of organizational justice terms in publications has forced us for this bibliometric analysis in order to look at the overall publications on organizational justice. The objective of the current research is to advance knowledge about organizational justice research trends using Scopus database and bibliometric analysis research. The analysis was performed to see the publication trends between the years 1941 and 2018; it used authors, journals, countries, academic discipline, research institutes/universities, and various keywords related to organizational justice as search words. After careful consideration and using multiple checkpoints for eliminating irrelevant studies, 5,650 research articles were analyzed. In the realm of organizational justice, procedural justice was the most frequently occurred among other dimensions. Moreover, variables such as organizational trust, job satisfaction, organizational commitment, citizenship behavior, ethics, and turnover are major concepts that occurred within organizational justice research. Some variables with infrequent occurrences, along with future recommendations and study limitations, are also discussed.
Fulltext COVID-19 Deep Learning Prediction Model Using Publicly Available Radiologist-Adjudicated Chest X-Ray Images as Training Data: Preliminary Findings

Che Azemin MZ, Hassan R, Mohd Tamrin MI, Md Ali MA

Int J Biomed Imaging, 2020;2020:8828855.
PMID: 32849861 DOI: 10.1155/2020/8828855

The key component in deep learning research is the availability of training data sets. With a limited number of publicly available COVID-19 chest X-ray images, the generalization and robustness of deep learning models to detect COVID-19 cases developed based on these images are questionable. We aimed to use thousands of readily available chest radiograph images with clinical findings associated with COVID-19 as a training data set, mutually exclusive from the images with confirmed COVID-19 cases, which will be used as the testing data set. We used a deep learning model based on the ResNet-101 convolutional neural network architecture, which was pretrained to recognize objects from a million of images and then retrained to detect abnormality in chest X-ray images. The performance of the model in terms of area under the receiver operating curve, sensitivity, specificity, and accuracy was 0.82, 77.3%, 71.8%, and 71.9%, respectively. The strength of this study lies in the use of labels that have a strong clinical association with COVID-19 cases and the use of mutually exclusive publicly available data for training, validation, and testing.
Parotid gland oncocytic carcinoma: A rare entity in head and neck region

Wan Ahmad Kammal WS, Azman M, Salleh AA, Md Pauzi SH, Abd Shukor N

Malays J Pathol, 2020 Aug;42(2):283-286.
PMID: 32860383

Oncocytic carcinoma of the salivary gland is an uncommon tumour in the head and neck region. Owing to its rarity, identifying the histopathological features of a malignant tumour can be difficult and challenging. We report a case of a 70-year-old man who presented with a left facial weakness for six months in a background history of left parotid swelling over the past 10 years. Clinical examination revealed a 3x3cm left parotid mass and grade 4 facial nerve palsy. Fine needle aspiration of the mass showed scattered cohesive, monolayered sheets of uniform oncocytic cells. Subsequently, a left total parotidectomy and selective neck dissection were performed. Histological examination showed sheets of small oncocytes with minimal nuclear atypia. Evidence of nerve entrapment, capsular invasion and perivascular permeation were identified in focal areas. Thus, a final diagnosis of oncocytic carcinoma was rendered.
Characterization of multidrug-resistant and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strains from Malaysian hospitals

Lim KT, Yeo CC, Md Yasin R, Balan G, Thong KL

J Med Microbiol, 2009 Nov;58(Pt 11):1463-1469.
PMID: 19589908 DOI: 10.1099/jmm.0.011114-0

The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae poses a serious antibiotic management problem as resistance genes are easily transferred from one organism to another. Fifty-one strains of K. pneumoniae isolated from sporadic cases in various hospitals throughout Malaysia were analysed by antimicrobial susceptibility testing, PCR detection of ESBL-encoding genes and DNA fingerprinting. Although 27 of the 51 K. pneumoniae strains were MDR (i.e. resistant to three or more classes of antibiotics), the majority of the strains (98 %) were sensitive to imipenem. PCR detection using ESBL gene-specific primers showed that 46 of the K. pneumoniae strains harboured bla(SHV), 19 harboured bla(CTX-M), 5 harboured bla(OXA-1) and 4 harboured bla(TEM-1). Class 1 integron-encoded intI1 integrase was detected in 21 of the 51 K. pneumoniae strains and amplification of the integron 5'CS region showed the presence of several known antibiotic resistance gene cassettes of various sizes. Results of conjugation and transformation experiments indicated that some of the ESBL-encoding genes (i.e. bla(SHV), bla(CTX-M) and bla(TEM-1)) were transmissible and were likely plasmid-encoded. DNA fingerprinting using PFGE and PCR-based methods indicated that the 51 K. pneumoniae strains were genetically diverse and heterogeneous.
Impact of Ar Flow Rates on Micro-Structural Properties of WS2 Thin Film by RF Magnetron Sputtering

Akhtaruzzaman M, Shahiduzzaman M, Amin N, Muhammad G, Islam MA, Rafiq KSB, et al.

Nanomaterials (Basel), 2021 Jun 22;11(7).
PMID: 34206518 DOI: 10.3390/nano11071635

Tungsten disulfide (WS2) thin films were deposited on soda-lime glass (SLG) substrates using radio frequency (RF) magnetron sputtering at different Ar flow rates (3 to 7 sccm). The effect of Ar flow rates on the structural, morphology, and electrical properties of the WS2 thin films was investigated thoroughly. Structural analysis exhibited that all the as-grown films showed the highest peak at (101) plane corresponds to rhombohedral phase. The crystalline size of the film ranged from 11.2 to 35.6 nm, while dislocation density ranged from 7.8 × 1014 to 26.29 × 1015 lines/m2. All these findings indicate that as-grown WS2 films are induced with various degrees of defects, which were visible in the FESEM images. FESEM images also identified the distorted crystallographic structure for all the films except the film deposited at 5 sccm of Ar gas flow rate. EDX analysis found that all the films were having a sulfur deficit and suggested that WS2 thin film bears edge defects in its structure. Further, electrical analysis confirms that tailoring of structural defects in WS2 thin film can be possible by the varying Ar gas flow rates. All these findings articulate that Ar gas flow rate is one of the important process parameters in RF magnetron sputtering that could affect the morphology, electrical properties, and structural properties of WS2 thin film. Finally, the simulation study validates the experimental results and encourages the use of WS2 as a buffer layer of CdTe-based solar cells.
Fulltext Piper sarmentosum Roxb. Attenuates Vascular Endothelial Dysfunction in Nicotine-Induced Rats

Md Salleh MFRR, Aminuddin A, Hamid AA, Salamt N, Japar Sidik FZ, Ugusman A

Front Pharmacol, 2021;12:667102.
PMID: 34194328 DOI: 10.3389/fphar.2021.667102

Exposure to cigarette smoke is an important risk factor for cardiovascular diseases. Nicotine is an addictive compound in cigarette smoke that triggers oxidative stress, which leads to vascular dysfunction. Piper sarmentosum Roxb. is a herb with antioxidant and vascular protective effects. This study evaluated the potential protective effect of the aqueous extract of P. sarmentosum leaf (AEPS) on vascular dysfunction in rats induced with prolonged nicotine administration. A total of 22 male Sprague-Dawley rats were divided into control (normal saline, oral gavage [p.o.]), nicotine (0.8 mg/kg/day nicotine, intraperitoneally [i.p.]), and nicotine + AEPS groups (250 mg/kg/day AEPS, p.o. + 0.8 mg/kg/day nicotine, i.p.). Treatment was given for 21 days. Thoracic aortae were harvested from the rats for the measurement of vasorelaxation, vascular nitric oxide (NO) level, and antioxidant level and the assessment of vascular remodeling. Rats treated with AEPS had improved vasorelaxation to endothelium-dependent vasodilator, acetylcholine (ACh), compared with the nicotine-induced rats (p < 0.05). The presence of endothelium increased the maximum relaxation of aortic rings in response to ACh. Compared with the nicotine group, AEPS enhanced vascular NO level (p < 0.001) and increased antioxidant levels as measured by superoxide dismutase activity (p < 0.05), catalase activity (p < 0.01), and reduced glutathione level (p < 0.05). No remarkable changes in aortic histomorphometry were detected. In conclusion, P. sarmentosum attenuates vascular endothelial dysfunction in nicotine-induced rats by improving vasorelaxation and enhancing vascular NO and antioxidant levels.
Severe central airway stenosis and tracheomalacia in hunter syndrome

Tan HL, Abd Rahman R, Md Tarekh NA, Kassim M, Sathiamurthy N, Nik Mohamad Kamil A, et al.

Med J Malaysia, 2021 05;76(3):441-445.
PMID: 34031351

Hunter Syndrome is a genetic disease characterized by deficiency of Iduronate-2-Sulfatase enzyme activity, resulting in accumulation of glycoaminoglycans in various organs including the central airways. We report a case of severe tracheomalacia and airway stenosis at Hospital Sultanah Aminah, Johor Bahru, Malaysia requiring mechanical ventilation in a middle aged gentleman who was previously undiagnosed of mucopolysaccharidosis. The patient underwent emergency tracheostomy for failed intubation, when he presented with shortness of breath and acute respiratory failure. A contrast-enhanced computed tomography of the neck and thorax revealed that the trachea distal to the tracheostomy tube had collapsed with narrowed right and left main bronchus. These findings were confirmed via direct visualization of the airway through a flexible bronchoscopy. Eventually, a tracheal stenting were performed to maintain the airway patency and assist in weaning off from mechanical ventilation. Further investigations to identify the aetiology of the central airway stenosis revealed elevated urinary glycoaminoglycans and the absence of iduronate-2-Sulfatase activity tested on dried blood spots, thus confirming the diagnosis of Hunter Syndrome. Managing mucopolysacharidosis with central airway obstruction requires multidisciplinary team effort in handling the difficult airway, anaesthesiology risk, potential comorbidities and providing genetic counselling.
Fulltext Incidental finding of congenital pericardial defect during vats bullectomy. Tips and tricks to avoid blunder

Loo GH, Ismail H, Ismail MI, Md Ali NAB, Abdul Rahman MRB, Haron H

Ann Med Surg (Lond), 2021 Sep;69:102806.
PMID: 34527238 DOI: 10.1016/j.amsu.2021.102806

The absence of a small portion of the pericardium is termed pericardial defect. This rare entity can be either acquired or congenital. The prevalence of congenital pericardial defect is exceedingly rare, which is approximately 0.002-0.004% of surgical and pathologic series. The most common type is the absence of the entire left side of pericardium, seen in 67% of all patients with a congenital pericardial defect. Other varieties are incredibly uncommon. Congenital pericardial defect has a male preponderance with a male to female ratio of 3:1, and familial occurrence is uncommon. We report a case of left partial congenital pericardial defect detected incidentally in a 22-year-old man who presented with recurrent left spontaneous pneumothorax. He underwent video-assisted thoracoscopic bullectomy and intraoperatively, we discovered a left partial pericardial defect which exposed the left atrial appendage. Although generally asymptomatic, patients may present with non-specific cardiac symptoms such as atypical chest pain. Partial pericardial defects have an increased risk of herniation of the whole left atrium, the left atrial appendage or the ventricles. If this occurs, cardiac strangulation may occur, leading to necrosis and sudden death. Cardiac MRI is a sensitive tool and will demonstrate the absence of preaortic pericardial recess. In conclusion, no surgical intervention is required in cases of congenital pericardial defect, unless the patient is symptomatic due to complications. If detected incidentally during cardiac or thoracic surgery, the best may be to leave it alone.
Fulltext Ficus deltoidea promotes bone formation in streptozotocin-induced diabetic rats

Samsulrizal N, Goh YM, Ahmad H, Md Dom S, Azmi NS, NoorMohamad Zin NS, et al.

Pharm Biol, 2021 Dec;59(1):66-73.
PMID: 33399485 DOI: 10.1080/13880209.2020.1865411

CONTEXT: Diabetes mellitus increases the risk of bone diseases including osteoporosis and osteoarthritis. We have previously demonstrated that Ficus deltoidea Jack (Moraceae) is capable of reducing hyperglycaemia. However, whether F. deltoidea could protect against diabetic osteoporosis remains to be determined.
OBJECTIVE: The study examines the effect of F. deltoidea on bone histomorphometric parameters, oxidative stress, and turnover markers in diabetic rats.
MATERIALS AND METHODS: Streptozotocin (STZ)-induced diabetic Sprague-Dawley rats (n = 6 animals per group) received one of the following treatments via gavage for 8 weeks: saline (diabetic control), metformin (1000 mg/kg bwt), and methanol leaves extract of F. deltoidea (1000 mg/kg bwt). A group of healthy rats served as normal control. The femoral bones were excised and scanned ex vivo using micro-computed tomography (micro-CT) for histomorphometric analysis. The serum levels of insulin, oxidative stress, and bone turnover markers were determined by ELISA assays.
RESULTS: Treatment of diabetic rats with F. deltoidea could significantly increase bone mineral density (BMD) (from 526.98 ± 11.87 to 637.74 ± 3.90). Higher levels of insulin (2.41 ± 0.08 vs. 1.58 ± 0.16), osteocalcin (155.66 ± 4.11 vs. 14.35 ± 0.97), and total bone n-3 PUFA (2.34 ± 0.47 vs. 1.44 ± 0.18) in parallel with the presence of chondrocyte hypertrophy were also observed following F. deltoidea treatment compared to diabetic control.
CONCLUSIONS: F. deltoidea could prevent diabetic osteoporosis by enhancing osteogenesis and inhibiting bone oxidative stress. These findings support the potential use of F. deltoidea for osteoporosis therapy in diabetes.
Fulltext Relationship between Physical Activity, Sedentary Behavior, and Anthropometric Measurements among Saudi Female Adolescents: A Cross-Sectional Study

Ahmad Bahathig A, Abu Saad H, Md Yusop NB, Mohd Shukri NH, El-Din MME

Int J Environ Res Public Health, 2021 08 10;18(16).
PMID: 34444210 DOI: 10.3390/ijerph18168461

Overweight and obesity are becoming increasingly prevalent among children and adolescents in Saudi Arabia and are an emerging cause of non-communicable diseases (NCDs). Lifestyle factors, such as insufficient levels of physical activity and sedentary behaviors, are responsible for the increased prevalence of NCDs. This study aimed to determine the association between physical activity levels, sedentary behaviors, and anthropometric measurements in Saudi female adolescents. A cross-sectional study was carried out among 399 healthy female adolescent students aged 13-14 years in Arar, Saudi Arabia. The participants were randomly selected from different schools and their anthropometric measurements were determined. The Physical Activity Questionnaire for Older Children (PAQ-C) and the Adolescent Sedentary Activity Questionnaire (ASAQ) were used to assess their physical activity levels and sedentary behaviors, and an analysis was conducted using IBM SPSS software version 25. A multiple linear regression model was used to determine the association between the variables. The majority of the participants had a normal body mass index (BMI; 79.4%) and waist circumference (WC; 62.4%). A total of 74.4% had waist to height ratio (WHtR) < 0.5. About 92.7% of the participants were not meeting PA recommendations of 60 min of moderate to vigorous physical activity daily. The overall mean time spent on sedentary activities was high on both weekdays and weekend days at 357.64 ± 86.29 and 470.51 ± 147.64 min/day, respectively. Moreover, anthropometric measurement (BMI) was positively associated with age and negatively associated with sedentary behavior on weekends, while WHtR was positively associated with age. The multiple linear regression analysis also showed that age and sedentary behavior significantly predicted BMI among the study participants (F (2, 396) = 4.346, p < 0.014) and age was the only significant predictor of WHtR (F (1, 397) = 16.191, p ≤ 0.001). This study revealed that most of the female Saudi adolescents undertook low levels of activity and high levels of sedentary behaviors. Sedentary behaviors were significantly associated with their BMI. Accordingly, an intervention program on healthy lifestyles is important to improve Saudi female adolescents' lifestyles.
Fulltext Evaluation of Refractive Status and Ocular Biometric Parameters in Primary Angle Closure Disease

Loh CC, Kamaruddin H, Bastion MC, Husain R, Mohd Isa H, Md Din N

Ophthalmic Res, 2021;64(2):246-252.
PMID: 32810853 DOI: 10.1159/000510925

INTRODUCTION: The aim of the study was to evaluate the refractive status and ocular biometric parameters in subjects with angle closure in Malaysia.
METHODS: This cross-sectional study was conducted on 171 primary angle closure patients (268 eyes). Visual acuity, refraction, and ocular biometry (central anterior chamber depth [ACD], axial length [AL], and lens thickness) were recorded. Vitreous cavity length (VL) and relative lens position (RLP) were calculated.
RESULTS: A total of 92 Primary Angle Closure Suspect (PACS), 30 Primary Angle Closure (PAC), and 146 Primary Angle Closure Glaucoma (PACG) eyes were included. Chinese ethnicity formed the majority (n = 197, 73.5%), followed by Malay (n = 57, 21.3%) and Indian (n = 14, 5.2%). There was a significant female preponderance with a female to male ratio of 1.85. Mean age was 65.7 ± 7.7 years. Mean spherical equivalent was +0.33 ± 1.29 D. Approximately half (n = 137, 51%) of the eyes were hyperopic (spherical power ≥+0.5), with PACG having the highest percentage of hyperopia (n = 69, 50.4%). Myopia and emmetropia were present in 48 (17.9) and 83 (31%) eyes, respectively. Although AL and VL in myopia patients were significantly longer than emmetropic and hyperopic eyes (p < 0.001), the ACD was not significantly different (p = 0.427). While the RLP is smaller in myopic eyes, lens thickness was increased in hyperopic eyes. PACG was significantly higher in elderly patients compared to PACS and PAC (p = 0.005). A total of 37 (13.8%) eyes were blind (vision worse than 3/60) and 19 of them (51.3%) were female patients.
CONCLUSION: A decrease in RLP is predictive of angle closure disease in myopic eyes, whereas increased lens thickness contributes to angle closure disease in hyperopic eyes.

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