The quality of pap smear determined by the specimen adequacy of cervical smears. It plays an important role to detect changes in the cervix particularly the transformation zone (TZ). This study aimed to determine factors associated with poor pap smear quality in Barat Daya District, Penang. This is a cross-sectional study of 276 randomly selected specimens of woman who underwent pap smear test in all government health clinics in Barat Daya District, Penang between January until June 2019. Study proforma was based on cytological report issued by Pathology Department, Penang Hospital and staff records in Nursing Unit, Barat Daya District Health Office. 30.1% has poor smear quality. Women who are menopause are twice the risk to have poor smear quality [Adjusted OR (95% CI): 2.34(1.14, 4.84), p
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.
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.
Medicinal plants have healing properties and are able to synthesize various chemical compounds. These chemicals (also known as phytochemical compounds) play vital roles in determining the pharmacological properties existing in certain plants. The phytochemical compounds present in plants are associated with primary and secondary constituents. Most of the time, the secondary constituents exhibit the bioactivities in plants such as antimicrobial, antioxidant, antidiabetic, antibacterial and anti-inflammatory properties. Some common medicinal plants that have been used in curing various diseases by traditional practitioners in Malaysia are Ficus deltoidea Jack, Andrographis paniculata, Curcuma longa, Clinacanthus nutans and Eurycoma longifolia Jack. This review discusses the morphology, phytochemical compounds and phytochemical properties of selected medicinal plants in Malaysia. The plants of focus have been found to possess anti-cancer and anti-diabetic effects. This review, it is hoped will enable Malaysian researchers to explore further on the potential of these plants in investigating new and novel drugs in the future.
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.
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.
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.
Thalassaemia screening programme was conducted to reduce the burden of the disease [1]. Here, we describe one unexpected discovery in a 33-year-old gentleman and also the importance of DNA analysis in detecting the globin gene mutation.
nfectious endophthalmitis is a devastating and potentially sight-threatening condition.The objective is toanalyse the microbiological profile and visual outcome of culture positive endophthalmitis seen in Hospital Universiti Sains Malaysia. All patients with endophthalmitis admitted to Hospital Universiti Sains Malaysia over a 7-year period from January 2007 until December 2013 were recruited into this study. Retrospective review of medical and microbiology records was conducted among patients clinically diagnosed with endophthalmitis in Hospital Universiti Sains Malaysia from January 2007 until December 2013. Sixteen patients were admitted with endophthalmitis during this study period. Seven (43%) were culture-positive, in which five (71%) cases were from vitreous culture and two (29%) from blood specimens. The mean age for culture positive patients of presentation was44 years. The most common bacterial isolate was Pseudomonas spp., while the most common fungus was Candida spp. Other organisms isolated were Fusariumsp., Aspergillus sp., Staphylococcus sp.and Enterococcus sp. The risk factors for culture-positive cases were ocular trauma, corneal keratitis, ocular chemical injury, severe urinary tract infection and retropharyngeal abscess. Only three of the affected eyes could be salvaged. The final visual acuity waspoor in all the culture-positive eyes. Two cases underwent evisceration while one case underwent enucleation. As a conclusion,Culture-positive endophthalmitis in this study were mainly attributed to Pseudomonas spp. and Candida spp. The visual outcome of culture-positive endophthalmitis was poor.
Orbital cellulitis is a clinical diagnosis. Once the diagnosis is made, an empirical antibiotic is started, and in most cases, the clinical improvement can be observed within 24-48 hours. We discuss treatment options in managing orbital cellulitis in a 34-year-old male in which no improvement was seen despite being started on empirical broad-spectrum antibiotic. Patient had a prior history of being bitten by an insect in the left upper eyelid while doing gardening about 5 days prior to admission. The patient developed left orbital cellulitis a few days following the insect bite. Patient was started empirical broad-spectrum antibiotic immediately, but no improvement observed. Culture and sensitivity taken from the upper eyelid grew methicillin-resistance Staphylococcus aureus (MRSA) which was sensitive to vancomycin. Patient was treated with intensive fourteen days of intravenous vancomycin. The infection resolved as evidenced by clinical improvement and reduction of white blood cells count.
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.
Pre-eclampsia may have an impact on women’s health beyond their
pregnancies and has been associated with increased risks for future hypertension
and cardiovascular disease. We report a case of a patient with history of preeclampsia and emergency caesarean section at 31 weeks of gestation due to
impending eclampsia who defaulted follow up and presented with malignant
hypertension and acute loss of vision 10 years later. A 34-year-old Malay female,
presented with generalized painless reduced vision of 5 days duration which was
preceded by an intermittent headache for 1 months duration. She had a history of
pre-eclampsia during her last childbirth 10 years ago and was not started on any
antihypertensive medication as her blood pressure normalized 2 weeks post-delivery.
Subsequently, she defaulted on her follow up. Visual acuity was counting finger at 1
meter in both eyes with no relative afferent pupillary defect. Funduscopy revealed
bilateral grade IV hypertensive retinopathy with the presence of optic disc swelling
and macular star. Optical coherence tomography showed bilateral sub-retinal fluid at
the macula. Her blood pressure was 255/168 mmHg with other systemic
examinations being normal. Ultrasonography of the kidneys showed the presence of
bilateral renal parenchymal disease with elevation of serum urea and creatinine
levels. Her blood pressure was controlled with triple oral antihypertensive agents. Her
vision improved to 6/36 and 6/6 with a pinhole in both eyes and resolution of
papilloedema and sub-retinal fluid at three months follow-up. Patients with a history
of pre-eclampsia must be closely monitored during the postpartum period. Even
though her blood pressure was normalized, careful monitoring and long-term medical
follow up plan must be clearly explained to the patient as she might develop chronic
or essential hypertension afterward. Our patient most likely had essential
hypertension superimposed with pre-eclampsia during her last pregnancy and
currently presented with malignant hypertension due to undiagnosed chronic
hypertension as she defaulted her medical follow up.
The aim of this study is to determine the risk factors for retinopathy of prematurity (ROP), and also to screen Norrie Disease Pseudoglioma (NDP) gene mutation in order to determine if mutation in the NDP gene may play a role in the development of ROP among Malay premature infants. This was a case control studyamong Malay premature infants from Hospital Universiti Sains Malaysia (USM) conducted from August 2011 to May 2013. Written consent were taken from their parents before conducting the study. The stage of ROP, systemic risk factors (gestational age and birth weight) and enviromental risk factors (oxygen exposure and duration of ventilation)were reviewed from patients’medical records. DNA was extracted from venous blood and subjected to polymerase chain reaction (PCR) before direct sequencing of NDP gene. A total of 56 Malay premature infants (Case group = 28 ROP premature infants, Controlgroup = 28 non-ROP premature infants)from Hospital USMwere enrolled in this study. Out of 28 premature infants with ROP, 11 (39.3%) premature infants were in stage 3. Only 1 (3.6%) premature infant in stage 4 and 2 (7.2%) premature infants in stage 5. The gestational age (p = 0.010) and birth weight (p = 0.010) were the significant risk factors for ROP. There was no significant difference ofenvironmental risk factors between the two groups. The NDPgene mutation was not detected in Malay premature infants with ROP and also in control group. The gestational age and birth weight were important risk factors of ROP.Although NDPgene mutations were being linked to ROP but NDPgene mutation was not detected in premature infants with ROPas well as premature infants with non-ROP among Malay ethnic background.
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.
Laryngopharyngeal tuberculosis (TB) is a rare disease and usually associated with pulmonary tuberculosis. Mostly, it occurs in adults without BCG vaccination or in immuno-compromised patients (such as AIDS patients). A 34-year-old gentleman with odynophagia and poor oral intake was referred to us to rule out malignancy. Direct laryngoscopy examination revealed ulcerative lesion involving right tonsillar fossa extending downward till right pyriform sinus. Panendoscopy and biopsy was performed. Laryngopharyngeal TB was diagnosed based on the histopathological examination and Ziehl-Neelsen staining.
Lung cancer is the second most common contributor to overall cancer–associated death in Malaysia after breast cancer. Many cases of late diagnosis are due to patient’s failure in recognizing the signs and symptoms of this disease. Objective: The aim of this research was to evaluate the knowledge on lung cancer and perception on its screening among IIUM Kuantan students. Method: This was a cross-sectional study whereby convenient sampling was used as the sampling method strategy. A total of 186 students participated, whereby majority was female students, single, and aged between 21 to 29 years old. Knowledge and perception scores were analyzed using descriptive statistics by denoting it in terms of frequency and percentages. Independent t-test, as well as one-way ANOVA, Mann-Whitney and Pearson correlation tests was used to find the association of gender, faculty, marital status, age and year of study (respectively) with knowledge and perception of students. Association between knowledge of lung cancer with perception of its screening was also evaluated using Pearson correlation test. Results: Most of IIUM Kuantan students portrayed good level of knowledge and perception. Socio-demographic factors that were significantly associated with students’ knowledge were age (p=0.001), year of study (p=
Immunization has been introduced for decades to eradicate fatal infectious diseases by inoculating attenuated, killed or toxoid of microorganisms such as bacteria and virus. The triggering action to the immune system would not harm the host; despite can boost the immune responses to any infection. However, several cases of the eradicated infectious disease have re-emerged due to the existence of vaccine hesitancy group. Vaccine hesitancy has been observed emerging worldwide due to rejection in receiving vaccine. The main obstacle in vaccination program was identified according to the misconception that they received from internet or any mass media without boundaries. Various actions from the government have met the needs to enforce and educate the public especially the hesitant group towards better disease prevention with vaccination. The strategy would cover any interaction activities or programs with the public in transferring the information about the vaccination and its benefit to the health of herd community.
The molecular biology knowledge in β-thalassaemia is limited due to the involvement of various erythropoeitic processes where the genetic information is lack due to nucleus ejection throughout the maturation of red blood cell activities concurrence with the accumulation of haemoglobin. Nucleated red blood cells (NRBCs) are typically found in peripheral blood (PB) of β-thalassaemia transfusion dependent patients and abundant in post splenectomy (Fig. 1A) [1]. The presence of NRBCs will provide further understanding on the molecular aspect of ineffective erythropoiesis in β-thalassaemia patients. Therefore, the objectives of this study were to isolate the NRBCs using CD71 magnetic beads from PB of β-thalassaemia patients and to compare the quantity of NRBCs enriched between non-splenectomised transfusion dependent and post-splenectomised transfusion dependent β-thalassaemia patients.
Introduction: Isolation of specific cell types is important in providing a better understanding of hematological disorders. The knowledge of molecular biology aspect in β-thalassemia is still limited. This is because hemoglobin disorder involves various erythropoietic processes in which the genetic information is lack due to enucleation of red blood cells occurs in bone marrow. It is invasive to collect samples from bone marrow and cord blood although nucleated red blood cells (NRBCs) are abundant in these sites. NRBCs are precursors of red blood cells and typically found in peripheral blood (PB) of β-thalassemia major patients and abundant post-splenectomy. The utilization of PB NRBCs will provide a further understanding of the molecular aspects of ineffective erythropoiesis in β-thalassemia major patients. Objective: The objective of this study was to isolate the NRBCs using CD71 magnetic beads from PB of β-thalassemia major; non-splenectomy and post-splenectomy patients. Methods: NRBCs were isolated from 6 mL PB of β-thalassemia major patients based on density gradient and magnetic activated cell sorting (MACS) for NRBCs enrichment using a CD71 marker. Cell count was determined by using hemocytometer (Weber Scientific, NJ, USA) and BD FACSCantoTM II flow cytometry (Becton-Dickson, NJ, USA) was performed for method validation. Results: NRBCs were successfully isolated from the PB of both non-splenectomy and post-splenectomy β-thalassemia major patients with >90% specificity by flow cytometric analysis. The median number of enriched NRBCs (x104 ) was 58.5 (283) and 340 (338) respectively using hemocytometer. Conclusion: The MACS method was found to be convenient and efficient in the isolation of the targeted cells for downstream applications.