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  1. Innate Immune and Neuronal Genetic Markers Are Highly Predictive of Postoperative Pain and Morphine Patient-Controlled Analgesia Requirements in Indian but Not Chinese or Malay Hysterectomy Patients
    Barratt DT, Sia AT, Tan EC, Somogyi AA
    Pain Med, 2021 Nov 26;22(11):2648-2660.
    PMID: 34015137 DOI: 10.1093/pm/pnab172
    OBJECTIVE: Pain severity and opioid requirements in the postoperative period show substantial and clinically significant inter-patient variation due mainly to factors such as age, surgery type, and duration. Genetic factors have not been adequately assessed except for the neuronal OPRM1 rs1799971 and COMT rs4680, whereas the contribution of innate immune signaling pathway genetics has seldom been investigated.

    SETTING: Hospital surgical ward.

    SUBJECTS: Women (107 Indian, 184 Malay, and 750 Han Chinese) undergoing total hysterectomy surgery.

    METHODS: Morphine consumption, preoperative pain, and postoperative pain were evaluated in relation to genetic variability comprising 19 single-nucleotide polymorphisms (SNPs) in 14 genes involved in glial activation, inflammatory signaling, and neuronal regulation, plus OPRM1 (1 SNP) and COMT (3 SNPs).

    RESULTS: Pre- and postoperative pain and age were associated with increased and decreased morphine consumption, respectively. In Chinese patients, only 8% of the variability in consumption could be explained by these nongenetic and genetic (BDNF, IL1B, IL6R, CRP, OPRM1, COMT, MYD88) factors. However, in Indian patients, 41% of morphine consumption variability could be explained by age (explaining <3%) and variants in OPRM1 rs1799971, CRP rs2794521, TLR4 rs4986790, IL2 rs2069762, COMT rs4818, TGFB1 rs1800469, and IL6R rs8192284 without controlling for postoperative pain.

    CONCLUSIONS: This is the highest known value reported for genetic contributions (38%) to morphine use in the acute postoperative pain setting. Our findings highlight the need to incorporate both genetic and nongenetic factors and consider ethnicity-dependent and nonadditive genotypic models in the assessment of factors that contribute to variability in opioid use.

  2. First record of the genus Discorhabdella (Porifera, Demospongiae, Poecilosclerida, Crambeidae) from Sagami Bay, Japan with description of two new species
    Ise Y, Vacelet J, Izumi T, Woo SP, Tan SH
    Zookeys, 2021;1076:67-81.
    PMID: 34992490 DOI: 10.3897/zookeys.1076.37278
    Two new species of Discorhabdella are described from Sagami Bay, Japan. Discorhabdella has been suggested to have an ancient Tethyan origin according to discovery of their unique pseudoastrose acanthostyles from late Eocene to Oligocene deposits. This is the first record of the genus from the northwest Pacific and first record of the family Crambeidae from Japan. Discorhabdellahispida sp. nov. is distinctive within the genus by possession of special sigmoid microscleres and C-shaped isochelae with short alae. Discorhabdellamisakiensis sp. nov. is characterized by short choanosomal subtylostyles, and their length overlapped with that of the ectosomal subtylostyles. Only one other species, Discorhabdellatuberosocapitata (Topsent, 1890), has the same spicule composition. However, all spicule types are larger in D.tuberosocapitata than those of D.misakiensis sp. nov., and the shape of the isochelae is different: the alae are more widely opened in D.tuberosocapitata. An identification key to species of the genus Discorhabdella is also provided. The discovery of two new species from warm temperate northwest Pacific extends the geographical distribution of the genus Discorhabdella.
  3. Fulltext Psychometric Evaluation of the Malay Version of the Family Adaptability and Cohesion Evaluation Scale III for Malaysian Adolescents
    Cong CW, Tan CS, Noew HS, Wu SL
    Int J Environ Res Public Health, 2021 Dec 24;19(1).
    PMID: 35010416 DOI: 10.3390/ijerph19010156
    The Family Adaptability and Cohesion Scale III (FACES-III) has been widely used to measure an individual's family functioning in terms of cohesion and adaptability. In Malaysia, the FACES-III has been translated into the Malay language for the community, but its psychometric properties in this context remain unknown. Thus, the purpose of this research is to examine the psychometric properties of the Malay version of the FACES-III in 852 adolescents attending secondary schools in Kuala Lumpur, Malaysia. Data were randomly split into two halves: the exploration sample and the validation sample. Exploratory factor analysis was conducted on the exploration sample and a two-factor model was discovered after removing nine items that showed low factor loading. Then, confirmatory factor analysis was conducted on the validation sample to compare the one-factor models, two-factor models, and three-factor models. Results showed that the 11-item two-factor model (FACES-III-M-SF) was superior to the other competing models. Both the exploratory and confirmatory factor analyses replicated the two-factor structure of the original version of FACES-III. The reliability of the overall scale was consistently good, but the subscale results were mixed. This suggests that researchers should use the overall score, but not the subscale scores, in analyses.
  4. Fulltext Biocompatible graphene-zirconia nanocomposite as a cyto-safe immunosensor for the rapid detection of carcinoembryonic antigen
    Lin LP, Tham SY, Loh HS, Tan MTT
    Sci Rep, 2021 11 18;11(1):22536.
    PMID: 34795382 DOI: 10.1038/s41598-021-99498-0
    Graphene-based materials have gained remarkable attention in numerous disciplines owing to their unique electrochemical properties. Out of various hybridized nanocomposites, graphene-zirconia nanocomposite (GZ) was distinctive due to its biocompatibility. Zirconia nanoparticles serve as spacers that reduce the stacking of graphene and improve the electrochemical performance of the material. Considering that lungs and skin suffer the greatest exposure to nanoparticles, this study aimed to evaluate the cytotoxicity of the as-synthesized GZ nanocomposites on MRC5 (lung cells) and HaCaT (skin cells) via morphological observation and cell viability assay using 3-(4,5 dimethylthiazol-2-yl)-(2,5-diphenyltetrazolium bromide) tetrazolium (MTT). GZ-treated cells showed a comparable proliferation rate and morphology with untreated cells under microscopic evaluation. Based on MTT results, the IC50 values of GZ were > 500 µg/ml for MRC5 and HaCaT cells. The excellent biocompatibility was the supremacy of GZ over other nanocomposites applied as electrode materials in biosensors. GZ was functionalized with biolinker for the detection of carcinoembryonic antigen (CEA). The proposed immunosensor exhibited good responses towards CEA detection, with a 4.25 pg/ml LOD and correlation coefficient of R2 = 0.99 within a linear working range from 0.01 to 10 ng/ml. The performance of the immunosensor to detect CEA present in human serum was also evaluated. Good recovery of CEA was found, suggesting that the proposed immunosensor possess a high affinity to CEA even in a complex biological matrix, rendering it a promising sensing platform for real sample analysis and open a new way for the detection of cancer-associated proteins.
  5. Infantile intracardiac thrombus in severe encephalo-myocarditis
    Woodhull S, Choo KK, Terumalay SD, Liew PS, Tan ZY
    Med J Malaysia, 2021 Nov;76(6):956-959.
    PMID: 34806696
    Myocarditis is an uncommon disease in childhood and has a wide range of clinical presentations, from subtle to devastating and thus requires a high index of suspicion. Intracardiac thrombus formation following myocarditis is rare and thus its management remains challenging and not well defined. We report a child whom presented with a viral prodrome, rapidly deteriorated into multi organ failure and developed fulminant viral myocarditis with encephalitis that was complicated with an intracardiac thrombus formation. We describe the challenges faced, the successful medical treatment offered and propose factors that can help guide appropriate treatment.
  6. Lithium neurotoxicity with electroencephalogram changes
    Tan HJ, Lim KY, Rajah R, Ng CF
    BMJ Case Rep, 2021 Nov 17;14(11).
    PMID: 34789530 DOI: 10.1136/bcr-2021-246499
    Lithium is a medication with a variety of medical usage for various diseases including bipolar mood disorder. As the therapeutic window of lithium is narrow, its usage is commonly associated with toxicity. Lithium toxicity affects multiple systems especially the central nervous system, leading to neuropsychiatric complications. Haemodialysis is an effective method for lithium removal especially in severe lithium toxicity such as neurotoxicity with electroencephalogram changes. We describe a case of lithium neurotoxicity with electroencephalographic abnormalities which was reversed following haemodialysis.
  7. Baby boy blue … and mommy too! A rare case of methaemoglobinaemia presenting simultaneously in a mother-neonate pair
    Foong SC, Hwang YC, Foong WC, Tan ML
    Med J Malaysia, 2021 Nov;76(6):924-926.
    PMID: 34806687
    Methaemoglobinaemia occurs when there is >1% methaemoglobin in erythrocytes. In an infant, they can present either congenitally or in an acquired form. We present a rare case of methaemoglobinaemia presenting simultaneously in a mother and infant pair. The mother and infant were discharged well on Day-4 post-delivery with both mother and baby recording oxygen saturation levels of 100%. On Day-7, during a routine clinic visit, they were incidentally found to be centrally cyanosed. There were no other abnormalities. On investigation, the methaemoglobin levels were elevated in the infant (23.9%) and mother (14.3%). Treatment with ascorbic acid normalised mother's methaemoglobin levels; but baby's levels remained high until the administration of oral methylene blue. Both baby and mother remained well and pink at last follow-up at 2 years 8 months of age. This case illustrates difficulties in ascertaining the cause of methaemoglobinaemia. Postdelivery, the mother-neonate pair were pink, and their haemoglobin electrophoresis were normal, hence it was unlikely to be congenital methaemoglobinaemia. The team could not identify any triggering factors for acquired methaemoglobinaemia. There was also the uncertainty of the necessity to treat the baby. This is because treatment is not without harmful effects and despite the high methaemoglobin levels, the infant was otherwise well. Only a single published paper recommended that high methaemoglobin levels must be treated, and the recommendation was not supported by evidence. Lessons learnt from our case are that neonates with methaemoglobinaemia can be safely treated with oral methylene blue, but more research is needed on the benefitrisk profile of treatment.
  8. Surgical subspecialty training outside Malaysia during COVID-19 Pandemic: Perspectives and experiences of Trainees
    Tan YL, Ng EHB, Diong NC
    Med J Malaysia, 2021 11;76(6):906-908.
    PMID: 34806681
    Subspecialty surgical training is an integral part of continuous professional development. It represents a unique opportunity for surgeons to enhance and develop specific advanced skills in their sub-disciplines. Hence, hands-on training in an international training centre abroad allows one to bring home new technical and management skills in the expansion of Malaysian surgical services to raise to be on par with the international standards. The unexpected onset of the COVID-19 pandemic brought in previously unknown hindrances to the training both locally and abroad but our success in engagement with international centres despite the pandemic restrictions serves as a valuable experience towards maintaining international networking for future collaborations.
  9. Fulltext Uncovering drug repurposing candidates for head and neck cancers: insights from systematic pharmacogenomics data analysis
    Chai AWY, Tan AC, Cheong SC
    Sci Rep, 2021 12 14;11(1):23933.
    PMID: 34907286 DOI: 10.1038/s41598-021-03418-1
    Effective treatment options for head and neck squamous cell carcinoma (HNSCC) are currently lacking. We exploited the drug response and genomic data of the 28 HNSCC cell lines, screened with 4,518 compounds, from the PRISM repurposing dataset to uncover repurposing drug candidates for HNSCC. A total of 886 active compounds, comprising of 418 targeted cancer, 404 non-oncology, and 64 chemotherapy compounds were identified for HNSCC. Top classes of mechanism of action amongst targeted cancer compounds included PI3K/AKT/MTOR, EGFR, and HDAC inhibitors. We have shortlisted 36 compounds with enriched killing activities for repurposing in HNSCC. The integrative analysis confirmed that the average expression of EGFR ligands (AREG, EREG, HBEGF, TGFA, and EPGN) is associated with osimertinib sensitivity. Novel putative biomarkers of response including those involved in immune signalling and cell cycle were found to be associated with sensitivity and resistance to MEK inhibitors respectively. We have also developed an RShiny webpage facilitating interactive visualization to fuel further hypothesis generation for drug repurposing in HNSCC. Our study provides a rich reference database of HNSCC drug sensitivity profiles, affording an opportunity to explore potential biomarkers of response in prioritized drug candidates. Our approach could also reveal insights for drug repurposing in other cancers.
  10. Silver nanoparticle in biosensor and bioimaging: Clinical perspectives
    Tan P, Li H, Wang J, Gopinath SCB
    Biotechnol Appl Biochem, 2021 Dec;68(6):1236-1242.
    PMID: 33043496 DOI: 10.1002/bab.2045
    Recent developments in nanotechnology promoted the production of nanomaterials with various shapes and sizes by utilizing interdisciplinary researches of biology, chemistry, and material science toward the clinical perspectives. In particular, gold and silver (Ag) are noble metals that exhibit tunable and unique plasmonic properties for the downstream applications. Ag exhibits higher thermal and electrical conductivities, and more efficient in the electron transfer than gold with sharper extinction bands. In addition, modified Ag nanoparticle is more stable in water and air. With all these above features, Ag is an attractive tool in various fields, including diagnosis, drug delivery, environmental, electronics, and as antimicrobial agent. In particular, applications of Ag nanoparticle in the fields of biosensor and imaging are prominent in recent days. Enhancing the specific detection of clinical markers with Ag nanoparticle has been proved by several studies. This review discussed the constructive application of Ag nanoparticle in biosensor and bioimaging for the detection of small molecule to larger whole cell in the perspectives of diagnosing diseases.
  11. Fulltext Case Series of Osmotic Demyelination Syndrome Treated With Plasmapheresis: Experience From Two Tertiary Hospitals
    Lim KY, Chia YK, Khoo CS, Tan HJ
    J Clin Neurol, 2022 Jan;18(1):117-119.
    PMID: 35021290 DOI: 10.3988/jcn.2022.18.1.117
  12. Evaluation of commercial serological assays in Malaysia for detection of anti-Zika virus antibodies
    Khoo HY, Lee HY, Khor CS, Tan KK, AbuBakar S
    Trop Biomed, 2021 Dec 01;38(4):613-621.
    PMID: 35001928 DOI: 10.47665/tb.38.4.105
    The recommended test guidelines for Zika virus (ZIKV) include using both molecular and serological tools. While the molecular tools are useful for detecting acute infection, the serological tools are useful for the detection of previous infections. Nevertheless, detection of ZIKV-specific antibodies remains a challenge due to the high cross-reactivity between ZIKV and other flaviviruses such as dengue virus (DENV) and Japanese encephalitis virus (JEV). The objective of this study is to evaluate the commercially available enzyme-linked immunosorbent assay (ELISA) for the detection of ZIKV IgG. In this study, we evaluated 6 commercially available anti-ZIKV IgG ELISA kits. Pre-characterized serum panels consisting of 70 sera were selected for the evaluation. The diagnostic accuracy of each ELISA kits was determined and compared to the gold standard, Foci Reduction Neutralization Test (FRNT). The present study established that the performance of the NS1-based anti-ZIKV IgG ELISA kit was superior to that which uses of the E protein as antigen. Overall, commercial ZIKV IgG ELISA showed varying test performances, with some achieving moderate to high test sensitivities and specificities. When compared against the FRNT, the test sensitivities ranged from 7.1% to 78.6%, whereas, the test specificities ranged from 40.0% to 100%. Limitation to the study includes the cross reactivity between flavivirus and specificity of the kit in addressing the cross reactivity.
  13. Fulltext Comparative Study of Digital Breast Tomosynthesis (DBT) with and without Ultrasound versus Breast Magnetic Resonance Imaging (MRI) in Detecting Breast Lesion
    Goh JHL, Tan TL, Aziz S, Rizuana IH
    Int J Environ Res Public Health, 2022 Jan 11;19(2).
    PMID: 35055581 DOI: 10.3390/ijerph19020759
    Digital breast tomosynthesis (DBT) is a fairly recent breast imaging technique invented to overcome the challenges of overlapping breast tissue. Ultrasonography (USG) was used as a complementary tool to DBT for the purpose of this study. Nonetheless, breast magnetic resonance imaging (MRI) remains the most sensitive tool to detect breast lesion. The purpose of this study was to evaluate diagnostic performance of DBT, with and without USG, versus breast MRI in correlation to histopathological examination (HPE). This was a retrospective study in a university hospital over a duration of 24 months. Findings were acquired from a formal report and were correlated with HPE. The sensitivity of DBT with or without USG was lower than MRI. However, the accuracy, specificity and PPV were raised with the aid of USG to equivalent or better than MRI. These three modalities showed statistically significant in correlation with HPE (p < 0.005, chi-squared). Generally, DBT alone has lower sensitivity as compared to MRI. However, it is reassuring that DBT + USG could significantly improve diagnostic performance to that comparable to MRI. In conclusion, results of this study are vital to centers which do not have MRI, as complementary ultrasound can accentuate diagnostic performance of DBT.
  14. Hypohydration but not Menstrual Phase Influences Pain Perception in Healthy Women
    Tan B, Philipp MC, Che Muhamed AM, Mundel T
    J Appl Physiol (1985), 2022 Jan 27.
    PMID: 35085028 DOI: 10.1152/japplphysiol.00402.2021
    Chronic pain is a pervasive health problem and is associated with tremendous socioeconomic costs. However, current pain treatments are often ineffective due, in part, to the multi-factorial nature of pain. Mild hypohydration was shown to increase experimental pain sensitivity in men, but whether this also occurs in women has not been examined. Fluctuations in ovarian hormones (i.e., 17ß-oestradiol and progesterone) throughout the menstrual cycle may influence a woman's pain sensitivity, as well as hydration levels, suggesting possible interactions between hypohydration and menstrual phase on pain. We investigated the effects of mild hypohydration (HYPO, 24 hr of fluid restriction) on ischaemic pain sensitivity in 14 eumenorrheic women during the early follicular (EF) and mid-luteal (ML) phases of their menstrual cycle. We also examined whether acute water ingestion could reverse the negative effects of hypohydration. Elevated serum osmolality, plasma copeptin, and urine specific gravity indicated mild hypohydration. Compared to euhydration, HYPO reduced pain tolerance (by 34 ± 46 s; P = 0.02, ηp2 = 0.37) and increased ratings of pain intensity (by 0.7 ± 0.7 cm; P = 0.004; ηp2 = 0.55) and unpleasantness (by 0.7 ± 0.9 cm; P = 0.02; ηp2 = 0.40); these results were not influenced by menstrual phase. Water ingestion reduced thirst perception (Visual Analogue Scale, by 2.3 ± 0.9 cm; P < 0.001, ηp2 = 0.88) but did not reduce pain sensitivity. Therefore, hypohydration increases pain sensitivity in women with no influence of menstrual phase.
  15. Crystal network structure and stability of beeswax-based oleogels with different polyunsaturated fatty acid oils
    Han W, Chai X, Liu Y, Xu Y, Tan CP
    Food Chem, 2021 Dec 04;381:131745.
    PMID: 35124493 DOI: 10.1016/j.foodchem.2021.131745
    The effect of different types of oils including camellia oil (CLO), sunflower oil (SFO), corn oil (CO) and linseed oil (LO) on the formation, crystal network structure and mechanical properties of 4%wt beeswax (BW) in oleogel was investigated. BW oleogels containing oils with higher contents of polyunsaturated fatty acids gelled first (1%wt), especially LO with higher contents of linolenic acid rather than CLO with higher contents of monounsaturated fatty acids. In comparison, oils with higher polyunsaturated fatty acid contents exhibited higher Db with more extensive microstructure at different cooling rates, which was related to shorter nucleation induction time of crystal and higher crystallinity. Stronger van der Waals forces were observed in oleogels with higher polyunsaturated fatty acid contents especially for LO oleogel. Rheology also showed that LO oleogel with higher content of linolenic acid had higher crystallinity and lower crystal melting interfacial tension, resulting in the formation of a more stable network structure.
  16. A South East Asian perspective of neuropsychiatric startle syndromes of latah
    Lim TT, Tan K, Eow GB, Bhidayasiri R
    Parkinsonism Relat Disord, 2022 Jan 26.
    PMID: 35120841 DOI: 10.1016/j.parkreldis.2022.01.013
    Latah is a culture-specific syndrome characterized by exaggerated startle response, echolalia, palilalia, echopraxia, coprolalia, forced obedience and involuntary vocalization in response to startle. Latah is stimulus-induced and is associated with behavior and psychiatric features. The aim of this review is to provide a comprehensive description on latah from a regional perspective based on previous literature and clinical experiences and highlight the clinical characteristics of latah from a movement disorders perspective. The pathophysiology of latah is complex and poorly understood although psychological stressors have been implicated. In view of the distressing psychosocial impact of latah, this neuropsychiatric startle syndrome warrants further studies to understand the pathophysiology and identify the appropriate treatments.
  17. A Systemic Review for Ethnopharmacological Studies on Isatis indigotica Fortune: Bioactive Compounds and their Therapeutic Insights
    Wong LW, Goh CBS, Tan JBL
    Am J Chin Med, 2022 Feb 09.
    PMID: 35139772 DOI: 10.1142/S0192415X22500069
    Isatis indigotica Fortune is a biennial Chinese woad of the Cruciferae family. It is primarily cultivated in China, where it was a staple in indigo dye manufacture till the end of the 17th century. Today, I. indigotica is used primarily as a therapeutic herb in traditional Chinese medicine (TCM). The medicinal use of the plant is separated into its leaves (Da-Qing-Ye) and roots (Ban-Lan-Gen), whereas its aerial components can be processed into a dried bluish-spruce powder (Qing-Dai), following dehydration for long-term preservation. Over the past several decades, I. indigotica has been generally utilized for its heat-clearing effects and bodily detoxification in TCM, attributed to the presence of several classes of bioactive compounds, including organic acids, alkaloids, terpenoids, and flavonoids, as well as lignans, anthraquinones, glucosides, glucosinolates, sphingolipids, tetrapyrroles, and polysaccharides. This paper aims to delineate I. indigotica from its closely-related species (Isatis tinctoria and Isatis glauca) while highlighting the ethnomedicinal uses of I. indigotica from the perspectives of modern and traditional medicine. A systematic search of PubMed, Embase, PMC, Web of Science, and Google Scholar databases was done for articles on all aspects of the plant, emphasizing those analyzing the bioactivity of constituents of the plant. The various key bioactive compounds of I. indigotica that have been found to exhibit anti-inflammatory, antimicrobial, anticancer, and anti-allergic properties, along with the protective effects against neuronal injury and bone fracture, will be discussed. Collectively, the review hopes to draw attention to the therapeutic potential of I. indigotica not only as a TCM, but also as a potential source of bioactive compounds for disease management and treatment.
  18. Fulltext Automated knowledge-assisted mitosis cells detection framework in breast histopathology images
    Tan XJ, Mustafa N, Mashor MY, Rahman KSA
    Math Biosci Eng, 2022 Jan;19(2):1721-1745.
    PMID: 35135226 DOI: 10.3934/mbe.2022081
    Based on the Nottingham Histopathology Grading (NHG) system, mitosis cells detection is one of the important criteria to determine the grade of breast carcinoma. Mitosis cells detection is a challenging task due to the heterogeneous microenvironment of breast histopathology images. Recognition of complex and inconsistent objects in the medical images could be achieved by incorporating domain knowledge in the field of interest. In this study, the strategies of the histopathologist and domain knowledge approach were used to guide the development of the image processing framework for automated mitosis cells detection in breast histopathology images. The detection framework starts with color normalization and hyperchromatic nucleus segmentation. Then, a knowledge-assisted false positive reduction method is proposed to eliminate the false positive (i.e., non-mitosis cells). This stage aims to minimize the percentage of false positive and thus increase the F1-score. Next, features extraction was performed. The mitosis candidates were classified using a Support Vector Machine (SVM) classifier. For evaluation purposes, the knowledge-assisted detection framework was tested using two datasets: a custom dataset and a publicly available dataset (i.e., MITOS dataset). The proposed knowledge-assisted false positive reduction method was found promising by eliminating at least 87.1% of false positive in both the dataset producing promising results in the F1-score. Experimental results demonstrate that the knowledge-assisted detection framework can achieve promising results in F1-score (custom dataset: 89.1%; MITOS dataset: 88.9%) and outperforms the recent works.
  19. Hemophagocytosis in dengue: comprehensive report of six cases
    Tan LH, Lum LC, Omar SF, Kan FK
    J Clin Virol, 2012 Sep;55(1):79-82.
    PMID: 22789140 DOI: 10.1016/j.jcv.2012.06.005
    Hemophagocytic syndrome is a potentially fatal disorder. It is being increasingly reported but remained under-recognized in dengue. Most reported cases were in association with plasma leakage and shock but multi-organ impairment was also observed. We describe the time-lines of 6 cases of confirmed dengue with varying severities of hemophagocytosis. All had persistent fever, cytopenia and elevated transaminases with markedly elevated ferritin levels during and beyond the plasma leakage phase. Acute renal failure and central nervous system manifestation were observed in two patients. Morphological hemophagocytosis was demonstrated in three patients. All survivors showed clinical and biochemical resolution of hemophagocytosis indicating its transient nature. Persistence of fever and cytopenia together with multi-organ dysfunction, out of proportion to and beyond the plasma leakage phase should prompt clinicians to consider this phenomenon.
  20. Fulltext Human telomerase reverse transcriptase expression in ovarian tumors
    Maraei AA, Hatta AZ, Shiran MS, Tan GC
    Indian J Pathol Microbiol, 2012 Apr-Jun;55(2):187-91.
    PMID: 22771641 DOI: 10.4103/0377-4929.97865
    Ovarian cancer is the 6 th most common cancer among women. In ovarian tumors, the borderline category is not well defined due to the difficulty in assessing stromal invasion. The World Health Organization (WHO) defined it as tumor that lacks obvious invasion of the stroma with mitotic activity and nuclear abnormalities intermediate between clearly benign and unquestionably malignant. Telomerase is expressed in many human cancers and is hence a potential biomarker for cancer. Immunohistochemical study of anti-human telomerase enzyme reverse transcriptase (hTERT) antibody allows direct visualization of its expression. The aim of this study was to determine the expression of hTERT and serum CA-125 level in ovarian epithelial tumors, and their ability to distinguish borderline tumor from malignancy.
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