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  1. Fulltext Aqueous extract of Piper sarmentosum decreases atherosclerotic lesions in high cholesterolemic experimental rabbits
    Amran AA, Zakaria Z, Othman F, Das S, Raj S, Nordin NA
    Lipids Health Dis, 2010 Apr 30;9:44.
    PMID: 20433693 DOI: 10.1186/1476-511X-9-44
    BACKGROUND: Piper sarmentosum (P.s) has flavonoid component in its leaves which has antioxidative effect. To date, its effect on atherosclerosis has not been studied histologically.

    AIM: The study aimed to investigate the effect of P.s on atherosclerotic changes in hypercholesterolemic rabbits.

    METHODS: Forty two male New Zealand white rabbits were divided into seven groups. C - control group fed normal rabbit chow, CH - cholesterol diet (1% cholesterol), W1 - 1% cholesterol with water extract of P.s (62.5 mg/kg), W2 - 1% cholesterol with water extract of P.s (125 mg/kg), W3 - 1% cholesterol with water extract of P.s (250 mg/kg), W4 - 1% cholesterol with water extract of P.s (500 mg/kg) and Smv - 1% cholesterol supplemented with simvistatin drug (1.2 mg/kg). All rabbits were treated for 10 weeks. Following 10 weeks of supplementation, the animals were sacrificed and the aortic tissue was taken for histological study.

    RESULTS: Rabbits fed only with high cholesterol diet 1% cholesterol (CH) showed focal fatty streak lesions compared to the C group and 1% cholesterol supplemented with simvistatin drug (Smv) group. Atherosclerotic lesions in the 1% cholesterol group supplemented with P.s (500 mg/kg) i.e. W4 group showed significant reduction (30 + or - 6.0%, p < 0.05) in fatty streak compared to the high cholesterol group (85.6 + or - 4.1%) under Sudan IV stain. The atherosclerotic lesions under transmission electron microscope showed reduction in foam cells in the treatment groups compared to the CH groups.

    CONCLUSION: Administration of P.s extract has protective effect against atheroscleros.

  2. Fulltext Changes in the vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and c-reactive protein following administration of aqueous extract of piper sarmentosum on experimental rabbits fed with cholesterol diet
    Amran AA, Zakaria Z, Othman F, Das S, Al-Mekhlafi HM, Nordin NA
    Lipids Health Dis, 2011 Jan 09;10:2.
    PMID: 21214952 DOI: 10.1186/1476-511X-10-2
    BACKGROUND: Inflammation process plays an important role in the development of atherosclerosis. Hypercholesterolemia is one of the major risk factors for atherosclerosis. The present study aimed to evaluate the effect of aqueous extract of Piper sarmentosum (P.s) on inflammatory markers like vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein (CRP).

    METHODS: Forty two male New Zealand white rabbits were divided equally into seven groups; (i) C- control group fed normal rabbit chow (ii) CH- cholesterol diet (1%cholesterol) (iii) X1- 1% cholesterol with water extract of P.s (62.5 mg/kg) (iv) X2- 1% cholesterol with water extract of P.s (125 mg/kg (v) X3- 1% cholesterol with water extract of P.s (250 mg/kg) (vi) X4- 1% cholesterol with water extract of P.s (500 mg/kg) and (vii) SMV group fed with 1% cholesterol supplemented with simvistatin drug (1.2 mg/kg). All animals were treated for 10 weeks. Blood serum was taken for observing the inflammatory markers at the beginning and end of the experiment.

    RESULTS: Rabbits fed with 1% cholesterol diet (CH) showed significant increase in the level of VCAM-1, ICAM-1 and CRP compared to the C group. The levels of VCAM-1, ICAM-1 and CRP in the 1% cholesterol group and supplemented with P.s (500 mg/kg) were significantly reduced compared to the cholesterol group. Similar results were also reported with simvistatin group.

    CONCLUSION: These results suggest that the supplementation of Piper sarmentosum extract could inhibit inflammatory markers which in turn could prevent atherosclerosis.

  3. Effect of pubertal developmental stages and lower limb kinetics during vertical jump task in Sepak Takraw sport
    Leonard Joseph H, Roslizawati N, Safrusahar MY, Efri NM, Das S, Baharudin O, et al.
    Clin Ter, 2009;160(5):403-7.
    PMID: 19997687
    Sepak Takraw is a sport which actively involves the lower limb. A cross sectional study was performed to investigate the lower limb kinetics (ground reaction force, flight time and contact time) involved during the vertical jumping and landing task between the early pubertal and late pubertal stages in National level Sepak Takraw athletes in Malaysia. Twenty athletes (8 pre pubertal and 12 late pubertal) with no previous history of any physical injuries were taken for the study. The kinetics data of the vertical jump task was calculated using a force platform 3-AMTI Biomechanics Force Platform. The Silicon ProCoach (Chart 5 software) was used to collect the ground reaction force signals, flight time and contact time. The results showed a non-significant decrease in peak ground reaction force in the post pubertal group as compared to the pre pubertal group (t(18)=0.659, p=0.518,CI(95)(-2.54, 4.86). Comparison of flight time between the two age groups showed a significant increase in the post pubertal group with mean and SD (0.7773 + or - 0.03) as compared to the pre pubertal group mean and SD (0.7296 + or - 0.05), which was statistically considered significant (p<0.05) (t(18)=-2.401, p<0.05,CI(95)(-0.089, -0.005). The findings from this study demonstrated that the flight time of the vertical jump task differed between the pre and post pubertal athletes with the post pubertal group having an improved ability in maintaining longer duration of flight phase.
  4. An 11-year-old girl presenting with chronic knee pain: a case report with diagnostic dilemma
    Maj MK, Ar AH, Faisal SA, Ahmad J, Das S
    Acta Medica (Hradec Kralove), 2010;53(4):247-9.
    PMID: 21400986
    Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year-old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice.
  5. Development and evaluation of 'neck pain and functional limitation scale': a validation study in the Asian context
    Leonard JH, Choo CP, Manaf MR, Md Isa Z, Mohd Nordin NA, Das S
    Indian J Med Sci, 2009 Oct;63(10):445-54.
    PMID: 19901483
    BACKGROUND: There is a paucity of literature on validated outcome measurement tools for evaluation of neck pain and related disability in the Asian context.

    AIM: The main aim of the present study was to design a new tool called neck pain functional limitation scale (NPFLS) for measuring disability related to neck pain and observe its reliability, concurrent validity and criterion validity.

    SETTING AND DESIGN: This study was performed at the institutional hospital.

    MATERIALS AND METHODS: A total of 157 subjects (neck pain group) and 25 control subjects (control group) without neck pain were recruited for this study. NPFLS was framed as a new tool for this study, which consisted of 5 domains - pain intensity, activities of daily living, social activities, functional activities and psychological factors. Neck Bournemouth questionnaire (NBQ) was used as a gold standard to measure the concurrent validity and criterion validity of the NPFLS.

    STATISTICAL ANALYSIS: Criterion validity and concurrent validity between the neck Bournemouth questionnaire (NBQ) and NPFLS scores were tested statistically using Mann-Whitney U test and Spearman correlation test. The reliability was tested by examining the internal consistency to calculate the Cronbach's alpha value for each item in NPFLS.

    RESULTS: No significant difference between NPFLS and NBQ was observed using Mann-Whitney U Test, with P value greater than 0.05 (P= 0.557). Besides that, NPFLS had a high concurrent validity (r= 0.916) and good internal consistency with high Cronbach's alpha value of (r= 0.948), which demonstrated strong correlation between the items of NPFLS and NBQ.

    CONCLUSION: NPFLS demonstrated good reliability, high concurrent validity and criterion validity in this study. NPFLS can be used to assess neck pain and disability among patients with neck pain.

  6. Atlanto-occipital fusion: an osteological study with clinical implications
    Kassim NM, Latiff AA, Das S, Ghafar NA, Suhaimi FH, Othman F, et al.
    Bratisl Lek Listy, 2010;111(10):562-5.
    PMID: 21125803
    Atlanto-occipital fusion may be symptomatic or asymptomatic in nature. The anomaly may be incidentally detected at autopsies or during routine cadaveric dissections. The fusion of the atlas with occipital bone may result in the compression of vertebral artery and first cervical nerve.
  7. An unexpected case of primary peritoneal carcinoma
    Nur-Syahrina R, Siti-Aishah MA, Swaminathan M, Ng PH, Ismail S, Syazarina SO, et al.
    Clin Ter, 2010;161(3):261-3.
    PMID: 20589359
    Primary peritoneal carcinoma (PPC) is a rare tumor that is histologically and immunohistochemically indistinguishable from epithelial ovarian carcinoma. The diagnosis is usually made after excluding gross ovarian involvement or the ovarian involvement is only confined to the surface. A 68-year-old lady presented with right iliac fossa pain and increasing CA125. The CT scan showed bilateral pelvic adnexal masses with peritoneal deposits within the right side of abdomen. She was initially diagnosed as carcinomatosis peritonei from the omental cake removed after exploratory surgery. She was managed as advanced ovarian tumor with peritoneal metastasis and was then administered six cycles of chemotherapy. Surgical intervention included debulking surgery consisting of total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy and also with right hemicolectomy. The histopathological findings were of primary peritoneal serous carcinoma with only minimal involvement of the serosal surface of the right ovarian capsule. No microscopic invasion into underlying ovarian cortex and stroma was observed. Multiple tumor deposits were also seen over the right paratubal and paraovarian tissue, both parametrium as well as serosal surface of the terminal ileum and periappendicular tissue. Immunohistochemically, the malignant cells were positive to CA125, focally positive to CK7 and negative to CD20 and Calretinin. PPC is one of important differential diagnosis which needs to be considered in cases of advanced ovarian tumor, although the former can only be ascertained after excluding the ovarian involvement microscopically.
  8. Intake of repeatedly heated palm oil causes elevation in blood pressure with impaired vasorelaxation in rats
    Leong XF, Najib MN, Das S, Mustafa MR, Jaarin K
    Tohoku J Exp Med, 2009 Sep;219(1):71-8.
    PMID: 19713687
    Oxidization of dietary cooking oil increases the risk of cardiovascular diseases such as hypertension by increasing the formation oxidative oxygen radicals. The aim of study was to investigate the effects of repeatedly heated palm oil on blood pressure, plasma nitrites, and vascular reactivity. Nitrites were measured, as an indirect marker for nitric oxide production. Male Sprague-Dawley rats were divided into four groups: control group fed with basal diet and other three groups fortified with 15% weight/weight fresh palm oil (FPO), palm oil heated five times (5HPO) or palm oil heated ten times (10HPO) for 24 weeks. The oil was heated to 180 degrees C for 10 min. Blood pressure was measured at baseline and at intervals of four weeks for 24 weeks using non-invasive tail-cuff method. Following 24 weeks, the rats were sacrificed and thoracic aortas were dissected for measurement of vascular reactivity. Blood pressure was elevated significantly (p < 0.05) in 5HPO and 10HPO groups, with the 10HPO group showing higher values. Aortic rings from animals fed with heated oil showed diminished relaxation in response to acetylcholine or sodium nitroprusside, and greater contraction to phenylephrine. Acetylcholine and sodium nitroprusside cause endothelium-dependent and endothelium-independent relaxation, respectively. Relaxation responses remained unaltered in the FPO group, with the attenuated contractile response to phenylephrine, compared to control group. FPO increased plasma nitrites by 28%, whereas 5HPO and 10HPO reduced them by 25% and 33%, respectively. Intake of repeatedly heated palm oil causes an increase in blood pressure, which may be accounted for by the attenuated endothelium-dependent vasorelaxant response.
  9. Dural metastasis mimicking meningioma: an interesting case
    Hamid HA, Gee KY, Muhammad R, Abd Rahman ZA, Das S
    Acta Medica (Hradec Kralove), 2009;52(1):19-22.
    PMID: 19754003
    Dural metastasis is a rare entity in clinical practice. We report a case of dural metastasis secondary to thyroid carcinoma, which on both preoperative CT and MRI and at surgery had the typical appearance of a meningioma. Histopathological findings confirmed metastatic follicular thyroid carcinoma as a primary site. Although rare, dural metastases can mimic a meningioma. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a meningioma is suspected. We believe that reporting of the case of dural metastasis mimicking a meningioma may help clinicians in future.
  10. The accessory foramen ovale of the skull: an osteological study
    Abd Latiff A, Das S, Sulaiman IM, Hlaing KP, Suhaimi FH, Ghazalli H, et al.
    Clin Ter, 2009;160(4):291-3.
    PMID: 19795082
    The sphenoid bone is known to have several foramina and the foramen ovale is one amongst them. The foramen ovale transmits the mandibular nerve, accessory meningeal artery, lesser petrosal nerve and the emissary veins. There have been past reports on the variations of the different foramina present in the skull but there are no reports on the variations of the skull foramina from any of the South-East Asian countries. The present study aims to highlight the presence of an accessory foramen ovale in the skull in Malaysian population. Both sides of fifteen adult skulls (n = 30) were taken for observation of any variations in the foramen ovale. We observed the presence of accessory foramen ovale on the left side of a single skull (3.33%). The minute accessory foramen ovale was located 0.1 cm medial to the normal foramen ovale. The anomalous accessory foramen ovale was circular in shape and measured 0.1 cm in diameter. Anatomical knowledge of the foramen ovale is important for all neurosurgical procedures involving the trigeminal nerve and administration of anaesthesia in the mandibular nerve. Interestingly, the percutaneous biopsy of the cavernous sinus is also performed through the foramen ovale. Prior knowledge of the presence of an accessory foramen ovale may be important for academic, anthropological, forensic and clinical purpose and the present study aims to highlight such.
  11. The additional tendons of the extensor digitorum muscle of the hand: an anatomical study with a clinical significance
    Das S, Sulaiman IM, Hussan F, Latiff AA, Suhaimi FH, Othman F
    Bratisl Lek Listy, 2008;109(12):584-6.
    PMID: 19348385
    The extensor digitorum (ED) muscle of the hand originates from the lateral condyle of the humerus and splits into four tendons; each for one phalanx except the thumb. Literature reports have described multiple tendons (usually two) to each digit but in the presented study we observed four tendons to the ring finger, what is rare. During a routine dissection of the cadavers, we observed an anomalous arrangement of the ED tendon on the left hand of a 42-year-old male. The anomalous tendons to the ring finger were studied in detail, the surrounding structures were carefully delineated and the specimen was photographed. The ED muscle originated as usual from the lateral condyle of the humerus, continued downwards, passing inferiorly to the extensor retinaculum to split into individual tendons for each of the digits. There was a single tendon to the index, middle and ring finger as usual but the ring finger displayed four tendons. All the tendons attached to the phalanges were as described in anatomy textbooks. The arrangement of the anomalous tendons of ED to each of the digits is not uncommon, but existence of four tendons to the ring finger is extremely rare. The increased number of tendons to the ring finger may increase the extension component of the ring finger. Anatomical knowledge of the tendons of the extensor muscles of the hand may be also beneficial for hand surgeons performing graft operations (Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.
  12. The quality of life among coronary heart disease patients at a teaching hospital
    Ho SE, Ting CK, Das S, Loo CY, Rohayu AB, Khor SY, et al.
    Clin Ter, 2011;162(3):217-22.
    PMID: 21717045
    Quality of life after acute coronary heart disease amongst patients is important outcome factor in deliberations of patient's care. The main aim of the study was to examine the quality of life amongst acute CHD patients.
  13. The ideal measurement of the quality of life in post stroke patients: an urban study
    Samsiah M, Das S, Chee SY, Rashidah R, Siti H, Ruth P, et al.
    Clin Ter, 2011;162(3):209-15.
    PMID: 21717044
    There is paucity of literature on the measurement of the quality of life in post stroke patients in the developing countries. The main objective of this study was to determine the quality of life (QOL) of post stroke patients.
  14. Fatigue experienced by patients receiving maintenance dialysis in hemodialysis units
    Letchmi S, Das S, Halim H, Zakariah FA, Hassan H, Mat S, et al.
    Nurs Health Sci, 2011 Mar;13(1):60-4.
    PMID: 21392194 DOI: 10.1111/j.1442-2018.2011.00579.x
    The fatigue that is observed in patients who are undergoing dialysis is usually associated with an impaired quality of life. The present cross-sectional study was conducted from January to April 2009 in three hemodialysis units in Kuala Lumpur, Malaysia. In this study, the Multidimensional Fatigue Inventory and Depression Anxiety and Stress Score 21 were used to determine the level of fatigue, depression, anxiety, and stress of patients who were undergoing dialysis. The data were obtained from a calculated sample of 116 and a total of 103 respondents participated in the study. A total of 56 (54.4%) and 47 (45.6%) respondents experienced a high level and a low level of fatigue, respectively. There was a significant relationship between the duration of treatment and the level of fatigue. The respondents who had been receiving treatment for > 2 years experienced more fatigue, compared to the respondents who had been undergoing hemodialysis for > 2 years. There was a significant difference in relation to the age of the participants regarding the level of fatigue. No significant relationship between the sex of the participants, anemia, depression, anxiety, stress, and the level of fatigue was observed. Special attention needs to be paid to both the younger and older adults who are receiving treatment. In addition, proper planning is needed for the patients regarding their daily activities in order to reduce fatigue. Nurses who work in hemodialysis units are recommended to provide exercise classes or group therapy in order to boost the energy levels among patients who are undergoing dialysis. Health professionals should provide appropriate treatment for patients who are experiencing fatigue in order to prevent any other complications that could arise.
  15. Tocotrienol rich fraction (TRF) supplementation protects against oxidative DNA damage and improves cognitive functions in Wistar rats
    Taridi NM, Yahaya MF, Teoh SL, Latiff AA, Ngah WZ, Das S, et al.
    Clin Ter, 2011;162(2):93-8.
    PMID: 21533313
    Oxidative stress is caused by imbalance between the productions of reactive oxygen species (ROS) and antioxidant defense mechanisms. Palm oil antioxidants such as tocotrienol rich fraction (TRF) is known to have neuroprotective effects on neurones by acting against free radical induced neuronal cell death. This study was undertaken to elucidate the effect of TRF on oxidative DNA damage and cognitive functions in experimental rats.
  16. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study
    Estai MA, Suhaimi FH, Das S, Fadzilah FM, Alhabshi SM, Shuid AN, et al.
    Clinics (Sao Paulo), 2011;66(5):865-72.
    PMID: 21789393
    INTRODUCTION: Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties.

    OBJECTIVES: To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state.

    METHODS: A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 μg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment.

    RESULTS: The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2 ± 11.74 mm³) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4 ± 4.05, 22.4 ± 4.14 and 17.5 ± 3.68 mm³, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (p<0.05).

    CONCLUSION: The Piper sarmentosum extract improved fracture healing, as assessed by the reduced callus volumes and reduced callus scores. This extract is beneficial for fractures in osteoporotic states.

  17. Role of blood bag temperature indicators in maintaining patent temperature of the returned unused blood bags in blood bank
    Nurasyikin Y, Leong CF, Fadhlullah TM, Hafiz WM, Nadiah Z, Atieqah AN, et al.
    Clin Ter, 2011;162(1):19-22.
    PMID: 21448541
    The main objective of the present study was to evaluate the temperature chain of red blood cells (RBC) returned unused blood bags using blood temperature indicator and ascertain the factors like transportation time, type, size of coolant box and number of bags per box.
  18. Immunohistochemical expression of vascular endothelial growth factor (VEGF) and p53 in breast lesions
    Noranizah W, Siti-Aishah MA, Munirah MA, Norazlin MH, Rohaizak M, Naqiyah I, et al.
    Clin Ter, 2010;161(2):129-37.
    PMID: 20499026
    Vascular endothelial growth factor (VEGF) is a leading factor for tumour angiogenesis and p53 protein is the product of a tumor suppressor gene. The main aim of the study was to assess the association of p53 protein with VEGF expression in breast carcinoma.
  19. Plasma vitamin C and tocotrienols changes in response to dietary supplementation among young male adults
    Zahara AM, Lee CC, Fatimah IS, Poh BK, Khairul O, Das S, et al.
    Clin Ter, 2010;161(2):121-4.
    PMID: 20499024
    Intake of the antioxidant vitamins C and E lowers the oxidative stress. The study aimed to determine plasma concentrations of vitamin C and tocotrienols after supplementation of both vitamins in young male adults.
  20. Non-secretory multiple myeloma with diagnostic challenges
    Hamidah NH, Azma RZ, Ezalia E, Das S, Umar NA, Swaminathan M, et al.
    Clin Ter, 2010;161(5):445-8.
    PMID: 20949241
    Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM). In NSMM, no monoclonal gammopathy can be detected in serum or urine by conventional techniques, making the diagnosis more difficult. We describe a 71-year-old man who had been diagnosed and treated for granulocytic sarcoma one year prior to his recent problems of progressive low-back pain of two months duration. Skeletal X-rays showed diffuse osteolytic lesions with multiple pathological fractures but there was no monoclonal gammopathy in the serum or urine. The biopsy of the lytic lesion on the upper part of the femur showed infiltration by abnormal plasma cells. A diagnosis of NSMM was made and he was treated with chemotherapy. The early diagnostic difficulty and the challenges faced regarding the case are discussed.
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