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.
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.
The rare condition of neutrophils agglutination in-vitro may give inaccurate neutrophils count. We reported a case of a 71-year-old female admitted with a diagnosis of extended-spectrum beta-lactamase (ESBL) Escherichia Coli (E.coli) septicaemia secondary to the left lower limb cellulitis. Despite underlying infection, total white blood cell count (TWBC) and absolute neutrophil count remained in a normal range. An accidental finding of full blood picture (FBP) using K2 ethylenediaminetetraacetic acid (EDTA) tube presented numerous neutrophils agglutination. Further tests were carried out using citrated and heparinised tubes and tested at room temperature, 4 C, and 37 ͦC. The findings showed a significant reduction in neutrophils agglutination in both citrated and heparinised tubes, including when tested at room temperature (RT) and 4 ͦC. Surprisingly, at 37 ͦC, no neutrophil agglutination was observed. This indicates that temperature-dependent anti-neutrophil IgM antibody may be found in the patient's serum that reacted with the EDTA anticoagulant. In conclusion, white blood cells (WBC) agglutination has been associated with malignancy, sepsis, liver disease, and autoimmune disease. Thus, a baseline FBP is recommended, especially in these categories of patients to optimise their clinical management.
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.
Complex chromosome rearrangements (CCRs) are structural aberrations or rearrangements involving three or more cytogenetics breakpoints on two or more chromosomes [1]. Balanced and unbalanced are known to have significant risk of mental retardation and phenotypic anomalies. CCRs are also associated with infertility in males and recurrent abortion in females. Here we report one case of apparently balanced CCR involving three chromosomes 3, 5 and 12 in a child with abnormal features. G banding and FISH were performed to clarify the nature of this complex abnormality.
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.
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.
Horseshoe crab is one of the oldest existing living fossils comprising four main species today. Of these, Limulus Polyphemus is found in North America and the other three species, Tachypleus tridentatus, Tachypleus gigas and Carcinoscorpius rotundicauda are found in Southeast Asia. Horseshoe crabs play important roles in the regulation of the coastal ecology communities whereby the eggs serve as the main diet of shorebird species during the migrating season. Horseshoe crab is also seen as a versatile organism, useful in the biomedicine field particularly, as its blue blood has been widely integrated to be used for endotoxin tester in vaccines, drugs and injectables. Researchers have explored a material called perivitelline fluid (PVF) from the egg of a fertilized horseshoe crab which is rich in important proteins and amino acids that are crucial for embryogenesis. Previous studies have shown that PVF has the ability to enhance cell growth and differentiation as well as in promoting generation of certain organs. Testing of PVF on many types of cells has shown positive results and hence, it is suggested that PVF could be used as a supplement to support cell growth in future. Highlighting the horseshoe crab as a living fossil, this review brings out the relevance of the blue blood and PVF of the horseshoe crab as sources benefitting molecular research.
— 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.
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.
HbE/β-thalassaemia is a compound heterozygous mutation with a vast clinical phenotype [1]. To improve quality of life, HbE/β-thalassaemia individuals receive different treatment strategies, either individually or in combination with therapy(ies), including blood transfusion, iron chelation and splenectomy [2-3]. Thus far, there are limited studies conducted regarding the effect of treatments in HbE/β-thalassaemia individuals. We hereby investigated the effect of treatments with respect to red blood cell indices, haemoglobin subtypes and gene expressions among 30 HbE/beta-thalassaemia individuals. Statistical analyses were carried out using SPSS 17.0. As compared to single therapy (transfused only individuals) and double therapies (transfused-chelated only individuals), individuals receiving triple therapies (transfused-chelated-splenectomised individuals) showed significantly high mean cell volume (MCV), mean cell haemoglobin (MCH) and reticulocytes count (Fig.1).
These findings suggest that triple therapies are the most effective in ameliorating the severity of the disease in terms of microcytosis and hypochromia [3-5]. The high reticulocyte count in triple therapies also allows the bone marrow to actively produce red blood cells suggesting that these therapies have clinical benefits by suppressing the ineffective erythropoiesis and improving the erythropoietic environment significantly among HbE/β-thalassaemia individuals in our studied group [6-7].
The effectiveness of these treatments is different among each HbE/β-thalassaemia individual whereby clinical variabilities among them could be a contributing factor. Triple therapies giving the best advantage to the HbE/β-thalassaemia patient in this study.
Opioids are opium-like drugs which are commonly used as analgesics to treat moderate to severe pain. Apoptosis is a type of programmed cell death to remove unnecessary or damaged cells in an organism. Recently, the ability of opioids to induce apoptosis especially in cancer cell lines hasgained the interest of many researchers. This fascinating finding hasled to more testing of different kindsof opioids against different kindsof cancer cell lines in the course to search for the potential anticancer drugs. This review provides current information about opioids and apoptosis, and more importantly the compilations of researches over the years on how opioids are related to apoptotic cells death.
This study aims to determine the effects of bioactive glass (BG) combined with Acmella oleracea (AO) extracts on dental pulp stem cells (DPSC) viability. DPSC were exposed to different combinations of BG-AO leave extract-conditioned medium. The BG 45S5 powder was synthesized using the sol-gel method. AO extract was prepared using ethanol extraction method. Gas Chromatography–Mass Spectrometry (GCMS) analysis of the AO ethanol extract was performed on a GCMS system consisting of an Agilent 6890 gas chromatograph coupled with an Agilent 5973 mass spectrometer. Sol-gel BG conditioned medium doped with AO extracts at various concentrations (25, 50, 100 and 250 μg/mL) with BG (1 mg/ mL) were prepared and exposed to DPSC. The DPSC was also treated using BG- and AO- only conditioned medium and non-treated cell as control. The DPSC cells’ responses were assessed using Alamar Blue (AB) assay. The results showed that GCMS analysis revealed the presence of amide, ester, terpenoid, fatty acid, alkene, terpene, carbohydrate, phenolic and alkane groups. Based on the AB assay, the BGAO- conditioned medium promoted DPSC viability. However, an increase in DPSC cell viability is clearly observed at Day 7 and 14 following exposure in BGAO-conditioned medium at the ratio of 1 mg/mL BG with 50 and 100 μg/mL of AO in comparison with AO alone. BGAO-conditioned medium at a dose of 25 μg/mL supported greater DPSC viability compared to other combination doses. The effect of combination of BG and AO towards DPSC at a certain dosage revealed continuous cell viability over the observation period and promoted cell growth that may be contributed by the combined effects of BG dissolution ions into the culture medium and also the presence of identified compound from the AO extracts namely phytol, linoleic acid, palmitic acid and 1, 4, 7,-Cycloundecatriene, 1, 5, 9, 9-tetramethyl, Z, Z, Z. Thus, it may have a significant potential to help in promoting dental and hard tissue regeneration
We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.
Early detection and prompt treatment of eye diseases can prevent visual disability. To our knowledge, there is no published data on factors associated with delayed presentation of eye diseases in Malaysia. Our objective is to determine the proportion of patients with eye disease who had a delayed presentation to an ophthalmologist after an initial screening, as well as the factors associated with delay in seeking treatment. This was a retrospective cohort study of patients with eye diseases detected during a Community Eye Survey (CES) program from September 2004 to December 2012 who were referred to the ophthalmologist in Hospital Universiti Sains Malaysia (USM). Delayed presentation of eye disease was defined as patients who came to the eye clinic more than six months after eye screening. Multiple logistic regression was used for analyses. A total of 434 patients who were referred to Hospital USM, Kubang Kerian were included in the study. Their mean (standard deviation) age was 55.65 (21.62) years. The majority of patients (76%) had delayed presentation of eye disease post screening. Type of ocular diseases was not associated with delayed presentation. The factors associated with delayed presentation were unemployment (adjusted odds ratio (OR): 2.51, 95% CI (1.36, 4.64), p
Study site: Hospital Universiti Sains Malaysia (HUSM)
A 65-year-old lady complained of occasional flashes of light over her left eye for 2 months. She was referred for ocular assessment after she underwent refractive assessment at the optometrist. On examination, best corrected visual acuity in both eyes was 6/9. Both eyes anterior segments were normal, with normal intraocular pressure. The pupils were equal with no relative afferent pupillary defect. Left eye fundus examination was normal. On the contrary, the "normal" right eye fundus examination revealed a huge, well-circumscribed hypo-pigmented elevated choroidal mass. B scan ultrasonography of the right eye showed a mushroom-shaped intraocular mass. Magnetic resonance imaging showed an intraocular lesion. Comprehensive systemic examination and investigations to rule out distant primary malignancy were unremarkable. A provisional diagnosis of right eye primary choroidal melanoma was made. Despite good vision in the affected eye, she underwent right eye enucleation in view of the large intraocular mass. The diagnosis was confirmed by histopathological examination.
A hemangioma is a benign vascular tumor of the brain, which rarely occurs in the cavernous sinus. We report a rare case of cavernous sinus hemangioma presenting with binocular diplopia. A 23-year-old lady presented with binocular diplopia associated with restricted left lateral gaze for 3 months. Visual acuity of both eyes was 6/6 with normal pupillary reaction. Both anterior and posterior segment were unremarkable. Contrasted computed tomography of brain showed an irregular mass within the left cavernous sinus causing pressure effect on the adjacent bone. Cerebral magnetic resonance imaging (MRI) showed a convexity in the left cavernous sinus, with a well-defined heterogeneous lesion with mixed hypo and hyperintensity in T1WI and T2WI; post gadolinium contrast, it was minimally enhanced. The patient was managed conservatively and at one-year post presentation, her symptoms improved but the lesion morphology and size remained static. We highlight the classic radiological presentation of a hemangioma and discuss the features differentiating it from the more commonly observed meningioma seen in the cavernous sinus.
Haemoglobin E (Hb E) is a variant of structurally abnormal haemoglobin that can be found very commonly in the Asian countries particularly the Southeast Asian [1]. [H1] Alpha thalassaemia is a red cell disorder which is caused by deletion or mutation of one or more of the four alpha globin genes leading to absence or decrease in production of alpha globin peptides [2]. This disorder is far more common in South East Asian regions and in Malaysia itself, and the gene frequency is about 4.1% [2]. The interactions of Hb E and alpha thalassaemia are evident in Kelantan which is bordered by southern Thailand. Using capillary electrophoresis (CE), a reduction of Hb E level is noticed as compared to Hb E heterozygotes. DNA analysis should be done to determine the presence of concurrent alpha thalassaemia variant. This study was done to evaluate haematological parameters using automated blood counters, morphology of red cells, Hb separation and quantitation of Hb fractions using CE and molecular analysis for alpha thalassemia. The study also aimed to discover cut off point of Hb E level in heterozygous Hb E patients with concurrent deletional alpha thalassaemia by CE.
Charged particle therapy with carbon ions has advantages over conventional radiotherapy using x-ray beams. The application of charged particle therapy has rapidly increased over the last decades. This is due to its characteristic Bragg peak which has relatively low entrance doses and favourable doses distribution. In this research work, Geant4 based Monte Carlo simulation (MC) method has been used to calculate the radiation transportation and dose distributions in tissue-like media. The main objective of the work was to compare the Geant4 simulated depth dose distributions with experimental measurements and verify the capability of the geant4 simulation toolkit. The carbon ion beams for the therapeutic energy of 350 MeV/u and 400 MeV/u respectively were simulated, with the same settings as the experimental work carried out at the treatment room at Heavy Ion Medical Accelerator (HIMAC), National Institute of Radiological Sciences (NIRS), Chiba, Japan. The simulation results were verified with measurements data. The work was to measure the accuracy and quality of the dose distributions by Geant4 MC methods. The results show that the Bragg peak and spread out Bragg peak (SOBP) distributions in simulation has fairly good agreement with measurements.
It is important to study optimism as it is negatively correlated with anxiety and depressive and positively correlated with quality of life in cancer patients. This study translated and investigated the psychometric properties of the Malay version of the Life Orientation Test-Revised (LOT-R) among Malaysian cancer patients. The validated Malay version of the LOT-R will be used for assessing level of optimism among Malaysian cancer patients in future studies and determine factors associated with it in order to design effective psychosocial intervention which will enhance level of optimism in cancer patients. Concurrent translation and back translation of original English version of the LOT-R to Malay was performed and the Malay version was administered to 195 cancer patients of different cancer diagnoses at baseline assessment and repeated 2 months later at follow up. Reliability was assessed with internal consistency (Cronbach’s α) and test-retest reliability (intraclass correlation coefficient), validity was assessed with face, content, convergent, and discriminant validities. Construct validity was examined with exploratory factor analysis. Two third of the participants (n = 129/195; 66%) were of middle age, three forth were females (n = 142/195; 72.8%) and eight tenth were Malays (n = 160/195; 82.1%). The LOT-R (Malay) total score (Cronbach’s α = 0.58; ICC = 0.62) and its domains (Cronbach’s α [Optimism) = 0.60; Cronbach’s α[Pessimism) = 0.42; ICC[Optimism] = 0.61; ICC[Pessimism] = 0.59) demonstrated questionable internal consistencies but acceptable test-retest reliability. Convergent and discriminant validities were achieved by the LOT-R (Malay). Construct validity was also demonstrated by the LOT-R (Malay) as exploratory factor analysis showed that all the items had factor loadings > 0.4.
The LOT-R (Malay) has acceptable psychometric properties and suitable to assess optimism in Malaysian cancer patients. It should be validated for use in other Malaysian populations.