Hospital-acquired infections (HAIs) are responsible for over 40% of cases in acute-care hospitals and commonly associated with catheter-sassociated urinary tract infections (CAUTIs). Current nanotechnology approach focus on improving the aseptic procedures for medical devices and manage the HAIs risk. TiO2 and ZnO nanoparticles (NPs) have been widely reported independently, to have a photocatalytic killing potential. The present study evaluates the antibacterial activity of heterojunction between TiO2 and ZnO NPs on several types bacterial pathogens model including Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The antibacterial screening test on TiO2/ZnO nanoparticles (NPs) were done under dark and light conditions with different molar ratio 25T75Z, 50T50Z and 75T25Z according to Clinical Laboratory Standards Institute (CLSI) guidelines MO2-A11. ZnO and TiO2/ZnO (25T75Z and 50T50Z) NPs at the highest concentration (1000µg/µL) showed mean diameters of the zones of inhibition (mm); (12.5 ± 0.58), (12.13 ± 0.85), and (7.25 ± 1.44) in dark condition. Increment in inhibition zones was obtained under light condition; (21.38 ± 0.48), (17.50 ± 1.0), and (12.38 ± 1.80). Findings from this study highlights the heterogeneous TiO2 and ZnO NPs could become a promising bacteriostatic and/or bactericidal agent to combat against the HAIs.
Methicillin Resistant Staphylococcus aureus (MRSA) causing
surgical site infections is one of the most common nosocomial infections
affecting post-surgery patients. Vancomycin is the recommended treatment
with MRSA-resistance breakpoint for minimum inhibition concentration (MIC)
of 2 ug/mL where the pathogen can be considered as susceptible. Here, we
describe the MIC of vancomycin against our MRSA isolates. Retrospective
data of MRSA positive cultures from post-surgical patients who were admitted
to the Clinical Training Centre Sungai Buloh public section from 2016-2017
with documented MIC to vancomycin were analyzed. The specimens consist
of pus swabs, mediastinal fluid, sternal bone, and tissue. A total of 29 MRSA
were isolated from 11 patients. There were 19, 3, 3 and 4 MRSA with
vancomycin’s MIC (ug/mL) of 0.5, 1, 1.5 and 2 respectively. The MRSA with
MIC of 2 ug/mL were observed from two different patients with one of them
showing MIC of 0.5 ug/mL which grew from wound swabs to 2.0 ug/mL which
grew from sternal bone and mediastinal fluid isolates. Vancomycin reduced
susceptibility MRSA has been observed in our clinical training centre with a
1.1% incidence. Identification of possible risk factors and follow up of
outcomes is required to fully elucidate the importance of this occurrence.
Abstract—The functions displayed by exosomes derived from saliva and
other body fluids have been established. This paper studied the stability of
human salivary exosome beginning from the collection mode, storage, and its
preservation methods. Unstimulated saliva samples were collected from
healthy subjects. Protease inhibitor was added into each samples and stored
under different temperatures and at varying periods of time. The exosomes
were isolated by ultracentrifugation and confirmed by using Western Blot.
Exosome morphology was inspected by Scanning Electron Microscope (SEM)
and the protein concentration was determined using the Protein (Bradford)
Assay. The exosome particle size distribution and concentration were
calculated using Nanoparticle Tracking Analysis (NTA). The protein assay
showed no significant differences in the exosome protein concentration values
for all conditions. Western Blot analysis also showed no differences in the
presence of exosome and all the samples were positive for protein CD63.
SEM analysis showed the fine shape of exosome which is round, in vesicle
form with the size ranging between 10 nm and 100 nm. NTA determined the
individual mean and the clumping exosome size was 203 nm. Human salivary
exosomes remained intact in the absence of protease inhibitor and in different
storage temperatures.
The aims of the study were to investigate the anti-cancer effects of 5-
Aza and TSA in two leukemic cell lines (CCRF-CEM and HL-60). Inhibition
concentration of 5-Aza and TSA were measured using trypan blue exclusion
assay. 5-Aza and TSA at IC50 were treated to both CCRF-CEM and HL-60 cell
lines for 4-6 days. To confirm the inhibition effects of these agents, Annexin-V
stained cells were analyzed using flow cytometry to evaluate the apoptotic
induction. The IC50 values of CCRF-CEM were 2.01±0.1µM and 2.65±0.3µM for
5-Aza- and TSA-treated, respectively. Whereas, the IC50 values of HL-60 were
1.98±0.2µM and 2.35±0.2µM for 5-Aza- and TSA-treated, respectively. To
further substantiate the findings, the time-dependent exposure of both drugs was
studied. CCRF-CEM cells were reduced to 49.4%±5.0, 49.4%±2.5 and
41.5%±5.6 by 5-Aza; 56.5%±7.0, 45.3%±4.2 and 40.2%±4.2 by TSA treatment
at first, third and sixth day. HL-60 cells were reduced to 72.0%±4.5, 51.0%±1.5
and 40.6%±2.6 by 5-Aza at first, third and sixth day. Meanwhile, HL-60 cells
reduced to 55.6%±4.5, 45.2%±4.0 and 36.3%±2.9 by TSA at first, second and
fourth day. Both cell lines were significantly inhibited (p
The practice of traditional medicine has been deduced based on
available evidences from the Malay, Chinese and Indian communities in
Malaysia. Based on extensive review of previous literature, the study
discovered that there is limited empirical documentation on the types of floras
used as Traditional and Complementary Medicine (TCM) by the rural
communities in Sabah, especially those residing along the Ramsar site. Thus,
this article aims to document the types of floras used in TCM by the rural
communities in the Dagat village at the Lower Kinabatangan-Segama area.
The data for the study were obtained from a series of in-depth interviews and
field observations. The findings revealed that the rural communities in the
Dagat village utilized floras available around the village as TCM in their daily
lives. TCM using floras have helped to save lives in emergency cases,
especially for pregnant women with high risks during pregnancy. This study is
significant as it presents an empirical documentation of floras for TCM
practices among the local community in Sabah, Malaysia.
Tuberculosis, an ancient disease, still thrives today as the leading infection caused by Mycobacterium tuberculosis. Diagnosis of ocular tuberculosis poses a great challenge due to the varied clinical presentations. We report 3 cases of primary ocular tuberculosis with varied presentations: conjunctival abscess, sclera-uveitis and occlusive vasculitis. There were no symptoms suggestive of pulmonary tuberculosis in all cases. All patients presented with acute, unilateral painful red eye. The first case had good visual acuity (VA) OD (6/9) with a swollen upper lid, localized perilimbal-hemorrhagic conjunctival swelling superiorly, keratic precipitates and mild anterior chamber reaction. The posterior segment was normal. The second case had a VA of 6/60 OD. There was presence of conjunctival injection, keratic precipitates, posterior synechiae and anterior chamber reaction of 1+. A few days later, there was a progression to vitritis OU and hyperemic optic disc OD with choroidal folds, cystoid macula edema and a positive T sign on B scan ultrasonography. The third case had VA of 6/6 OU, AC reaction of 2+ OD. There was multiple peripheral choroiditis with peripheral vasculitis seen in the posterior segment OU. Fundus fluorescein angiography (FFA) showed peripheral periphlebitis in all 4 quadrants OU. All 3 cases had positive Tuberculin Skin Test (Mantoux test) results which were more than 20mm. Anti-tuberculous treatment was promptly started and all patients showed significant clinical improvement. This case series highlights the diverse clinical presentations of ocular tuberculosis. A high clinical index of suspicion led to prompt initiation of anti-tuberculous therapy which resulted in good clinical outcomes for all cases.
Ki67, a nuclear protein presents in cells that is usually associated
with tumor cell proliferation. Therefore, physical quantification of Ki67 is a direct
measure cell proliferation activity. Immunohistochemical staining is known to be
an effective method of assessing the proportion of tumor cells. Currently, there
are various techniques for counting Ki67 in different types of cancer. This paper
provides an overview of recent scoring methods of Ki67, which includes ‘eyeballing’ estimation, vision counting with a microscope or viewer software,
manual counting of the camera-captured or digital image and automated
counting.
Macular branch retinal vein occlusion (BRVO), a type of retinal vein occlusion, is rarely recognised as a distinct entity. Macular BRVO has unique clinical features and different natural courses than the major BRVO. We report a case of a young patient with macular BRVO with macular oedema who was successfully treated with intravitreal ranibizumab injection. A 43 year-old Chinese man with no underlying medical illness presented with 2 weeks history of left eye painless reduced central vision which was worsening over time. On examination, his left eye visual acuity was 6/30 and Amsler chart drawing showed a lower central scotoma. Dilated fundus examination found marked flame-shaped retinal hemorrhages with cotton wool spot over the superior macular area bounded superiorly by superior arcade and macular thickening. An optical coherence tomography revealed cystoid macular oedema; and fundus fluorescein angiography showed occlusion of a small venous branch draining a superior part of macula to superior temporal venous arcade. A complete medical investigation found that he has hypertriglyceridemia and he was managed accordingly. His vision had improved to 6/6 after receiving 3 injections of intravitreal ranibizumab with no residual central scotoma and complete resolution of macular oedema.
Acute lymphoblastic leukemia (ALL) is the most common
childhood leukaemia. It is a malignant neoplasm caused by the proliferation of
poorly differentiated precursors of the lymphoid cells. It is relatively
uncommon in adult. In adult ALL, central nervous system (CNS) involvement
is associated with poor prognosis. The incidence of CNS involvement has
been reported between 7% and 15 %. We report a case of optic nerve
infiltration in ALL in a 49 years old gentleman. He was diagnosed with
precursor-B ALL. He was treated with chemotherapy and CNS prophylactic
regime. He presented with sudden left eye loss of vision for one-day duration
with history of right eye inferior visual field loss for the past three months. His
visual acuity was no perception to light on the left eye and 6/9 on the right
eye. There was marked left relative afferent pupillary defect. The right eye
showed decreased in optic nerve function with inferior visual field defect.
Anterior segment examination was unremarkable in both eyes. Left optic disc
appeared normal but the right optic disc was pale. Blood investigation
showed no sign of infection or haemoconcentration. Cerebral spinal fluids
examination revealed abundant of white cells and blast cells. Magnetic
resonant imaging showed bilateral optic nerve enhancement suggesting of
bilateral optic nerves infiltration. He was started on a new regime of
chemotherapy followed by cranial radiotherapy. Unfortunately, he succumbed
to death due to septicaemia. There are variations in clinical presentation of
optic nerve infiltration in leukaemic patients. Normal appearance of optic disc
may not exclude the possibility of infiltration by malignancy. Assessment of
the optic nerve function and imaging is helpful for the detection of leukaemic
infiltration. Early detection of optic nerve infiltration is important for initiation or
change of therapy to prevent mortality.
Sino-nasal osteoma is a common benign tumour of paranasal
sinuses and usually asymptomatic. Here, we presented a case of a huge sinonasal osteoma. Despite the large size of the tumour, the only presentation
was epiphora. There were no headache, facial pain or diplopia. Nasal
obstruction only occurred after involvement of the nasal cavity. In diagnosing
aetiology of the epiphora, sino-nasal pathology needed to be ruled out after
excluding ocular causes. Multidisciplinary approach between otolaryngology
(ORL) team and ophthalmology team was essential in managing the case.
The tumour was successfully removed surgically via endoscopic approach;
and dacryocystorhinostomy (DCR) was performed to alleviate the epiphora.
— To report clinical features and management of toxic keratopathy
induced by inadvertent intrastromal trypan blue injection (0.06%) during
cataract surgery. We report two cases of toxic keratopathy induced by
iatrogenic intrastromal trypan blue injection during cataract surgery. The
two cases were performed by ophthalmology residents at our centre.
Intraoperatively in both cases, trypan blue dye was inadvertently injected
into the corneal stromal via side port wound. Surgery was abandoned due
to development of corneal oedema. They were treated as toxic keratopathy
due to the bluish discoloration of the cornea, generalized (limbal to limbal)
panstromal edema and marked Descemet membrane folds. There were
epithelial microbullae and mild circumcorneal injection. Both patients’ vision
deteriorated with only minimal anterior chamber reaction and normal
intraocular pressure. Intensive topical corticosteroid, prophylactic antibiotic,
gutt hypertonic saline 5%, and cycloplegic agent eyedrops were given. The
cornea edema and staining in both patients resolved completely by 6
weeks. They underwent uncomplicated elective phacoemulsification 3
months after the incident. Intraoperative Iatrogenic inadvertent intrastromal
vision blue injection during cataract surgery can cause toxic keratopathy. A
decision to abandon the surgery and prompt management to reverse the
complication can produce excellent outcome.
Iron deficiency anaemia (IDA) frequently occurs in haemodialysis
(HD) patients undergoing recombinant human erythropoietin (rHuEPO)
therapy and is commonly associated with rHuEPO hypo-responsiveness.
However, the conventional iron indices are inadequate to exhibit the status or
utilisation of iron during erythropoiesis. The aim of this study was to elucidate
the accuracy and usefulness of the reticulocyte haemoglobin (RET-He) test
for diagnosing IDA in HD patients undergoing rHuEPO therapy. Methods: In
this cross-sectional study, fifty-five blood samples of HD patients on rHuEPO
therapy were collected and analysed for haematological and biochemical
parameters. A receiver operating characteristics curve was also plotted for
sensitivity and specificity analysis. IDA detection rates by RET-He, soluble
transferrin receptor (sTfR) and serum ferritin were 63.64%, 3.64% and 0%,
respectively. RET-He level was significantly correlated with sTfR level, mean
cell volume, mean cell haemoglobin level and the transferrin receptor-ferritin
index. The sensitivity and specificity of RET-He in detecting IDA were 78.3%
and 92.0%, respectively, with an area under the curve of 0.864. IDA was more
frequently detected by RET-He than by ferritin or sTfR in HD patients
undergoing rHuEPO therapy. The RET-He level also showed higher sensitivity
and specificity for the iron status in these patients. Therefore, RET-He is a
useful biomarker for the detection of IDA in HD patients undergoing rHuEPO
therapy.
Zinc oxide (ZnO) nanoparticles (NPs) has become as promising candidate for antibacterial agents against Escherichia coli (E.coli), commensal hospital- acquired infections (HAIs). This study investigates the antibacterial action of ZnO NPs in three difference shapes; nanorod, nanoflakes and nanospheres against E.coli ATCC 25922. The antibacterial activity of ZnO NPs was determine through two standard protocols known as Clinical Laboratory Standards Institute (CLSI) MO2-A11 under light conditions of 5.70 w/m2 and American standard test method (ASTM) E-2149. Preliminary screening shows ZnO NPs did not inhibit the growth of E.coli. Further analysis using ASTM E-2149 in dynamic conditions revealed antibacterial activity after 3 hours with 100% reduction for ZnO NPs nanoflakes and 6 hours with 94.63% reduction for ZnO nanospheres, respectively. It demonstrated the ZnO NPs in nanoflakes and nanospheres exerted higher antibacterial activity possibly through release of ios, free radicals, ROS generation and electrostatic collision which contribute to bacterial death. Further analysis is needed to investigate biocompatibility of these samples for future biomedical applications.
Oesophageal perforation is a rare clinical situation. However, it is associated with high morbidity and mortality rate. A 39-year-old lady with underlying epilepsy was admitted to hospital for alleged accidental ingestion of broken dentures while sleeping. She underwent emergency direct laryngoscopy, oesophagoscopy and oesophagogastroduodenoscopy. However, no foreign body was found. She was subsequently discharged home. Two days later, the patient presented again with dyspnoea, fever and chest discomfort. A chest radiograph showed bilateral pleural effusion, left pneumothorax and right mediastinal shift. A suspicion of oesophageal perforation was raised. Upper gastrointestinal study revealed an oesophageal perforation. Under conservative management, her condition was complicated with thoracic empyema. She subsequently underwent video assisted thoracoscopy and decortication. Fortunately, after one month of hospitalization, she regained full recovery. In conclusion, any chest symptoms which arise after oesophagogastroduodenoscopy should be dealt with extra caution. Patients outcome after oesophageal injury are time dependent, thus any delay in obtaining radiological assessment should be avoided.
Alzheimer’s disease (AD) is a brain disease attributed to the accumulation of extracellular senile plaques comprising β-amyloid peptide (Aβ). In this study, a transgenic Caenorhabditis elegans (C. elegans) containing the human beta amyloid Aβ42 gene which exhibited paralysis when expressed, was used to study the anti-paralysis effect of salvianolic acid A. Various concentrations ranging from 1 μg/ml to 100 μg/ml of salvianolic acid A were tested which exhibited the highest effect on the worm at the concentration of 100 μg/ml. For anti-aggregation effect, 14 μg/ml of salvianolic acid A (within 4 mg/ml of Danshen) showed a significant level of inhibition of the formation of Aβ fibrils. An amount of 100 μg/ml of salvianolic acid A had the potential in reducing the reactive oxygen species (ROS) but did not totally obliterate the ROS production in the worms. Salvianolic acid A was found to delay the paralysis of the transgenic C. elegans, decrease Aβ42 aggregation and decrease Aβ-induced oxidative stress.
Wounds are inevitable events that can occur daily due to many factors such as; physical, chemical and biological, which can cause tissue, cell and in some events bone damage. The process of wound healing is complicated as it involves many factors; therefore, an effective and safe agent is essential to ensure good healing process. Herbal medicine is considered safe and effective. Flaxseed (Linum usitatissimum) is an effective plant when it comes to wound healing and has been used for decades as a traditional healing agent. The bioactivities of flaxseed extract have been reported to demonstrate many beneficial effects such as antimicrobial, antioxidant and anti-inflammatory effects. It has been shown that flaxseed has positive effects on many types of wounds such as skin wound healing, burns and burn scar healing, bone healing and also has demonstrated positive results in the healing of oral ulceration besides exhibiting anti-bacterial effects in the oral cavity. This review describes the positive effects of flaxseed in multiple types of wound healing. Additionally, it is also aimed to introduce the potential applications of flaxseed in socket healing which involves series of complex changes to both soft and hard tissues in the oral cavity.
Haemoptysis is the clinical features of pulmonary tuberculosis (PTB) (32.5%) in Malaysia, in which if massive and left untreated it carries out a mortality risk of more than 50%. In the majority of cases, the main bleeder arises from the bronchial artery, with the pulmonary arterial circulation as a rare cause of bleeding, accounting for less than 10% of cases. Rasmussen aneurysm is a rare phenomenon following the weakening of the pulmonary artery wall resulting from adjacent cavitary tuberculosis. The sequelae which follow include pseudoaneurysm formation and subsequent rupture.
To review the clinical profile of retinal vein occlusion (RVO) in Hospital Universiti Sains Malaysia (USM) from 2011 until 2017. This was a retrospective single-centre case series. The medical records of the patients presented to Ophthalmology Clinic with RVO from 2011 to 2017 were reviewed. A total of 24 patients (26 eyes) with a diagnosis of RVO in Hospital USM were reviewed. There was 91.6% of our patients were aged more than 45 years old with predominantly affected male gender (58.3%). Majority of the patients were Malays (87.5%). Hypertension (70.8%), hyperlipidemia (70.8%) and diabetes mellitus (54.2%) were the common systemic comorbidities in RVO patients. Majority of the patients (87.5%) were non-smoker. Based on type of RVO, there were 38.5% central RVO, 26.9% branch RVO, 19.2% macular branch RVO, and 15.4% hemivein occlusion. RVO was bilateral in 2 patients (8.4%). Based on fundus fluorescein angiography, 3 patients (11.5%) showed ischaemic features. Reduce vision (91.6%) was the main presenting symptoms of RVO while intraretinal haemorrhage (100%) and macular oedema (96.2%) were the most common ocular signs found in RVO. There were 16 eyes (61.5%) have visual acuity equal or better than 6/60 at presentation. Patient who had visual acuity equal or better than 6/60 showed promising improvement in visual acuity post treatment. Elderly with multiple comorbidities complaining of worsening of vision should have high index suspicion of RVO. Presenting visual acuity is associated with final visual outcome post treatment.
Hyponatraemia is a common electrolyte imbalance in oncology. Rarely has it been reported as a presentation of nasopharyngeal carcinoma (NPC). A 43-year-old gentleman presented with double vision, headache, weight loss, complex ophthalmoplegia and submandibular lymphadenopathy. Computed tomography (CT) scan and nasopharyngeal biopsy confirmed the diagnosis of NPC. Prior to chemotherapy, he developed severe hyponatraemia. Blood investigations failed to pinpoint a clear diagnosis, and he was not responsive to aggressive supportive treatment. Pituitary gland function tests and MRI subsequently was performed, and found a pituitary extension causing hypocortisolism. Finally, his hyponatraemia was successfully optimised with oral hydrocortisone. This case illustrates that ophthalmoplegia and hyponatraemia are important warning signs of NPC or any other aggressive sellar mass that should not be neglected.
Blood donation in Malaysia is practised as voluntary non-remunerated. However, recruiting and retaining blood donors remain a challenge in the transfusion service. The main aim of this study was to understand the factors affecting the return of first-time blood donors. This was a retrospective study involving 480 first-time temporarily deferred whole blood donors from National Blood Centre (NBC), Kuala Lumpur. Data of donors who were deferred from 2010 to 2014 were extracted from the Blood Bank Information System. Deferred blood donors were categorised into two main groups, namely, a group of donors who returned for blood donation and a group that did not return for the donation. Each blood donor was contacted personally via telephone. Donors who returned were younger (p < 0.001), with females in a higher proportion (61.3%) compared to males (38.8%) (p < 0.001). Singles (68.3%) were more likely to return for donation compared to married donors (31.7%) (p < 0.001). Donors who lived in urban areas were more likely to return for donation compared to donors who lived in rural areas (34.6%) (p < 0.005). The most common factor that had motivated these donors to return was self-satisfaction (29.9%), while the most common factor that hindered them from returning for donation was the lack of time (28.50%). As a conclusion, more awareness and education regarding regular blood donation should be considered to donors from a rural areas. Additionally, mobile blood donation drives should be made easier for blood donors who have a busy lifestyle.