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.
Conventional anticoagulant therapy is the mainstay of medical treatment for deep vein thrombosis disorders. However,there are many complications associated with these agents such as bleeding. Hence, the search for novel anticoagulant derived from natural substances such as plants origin is in high demand nowadays. Ocimum sanctum(O.sanctum) also known as Ocimum tenuiform (OT), tulsi or holy basil from the family of Lamiaceae has been widely used for thousands of years in Ayurveda and Unani systems to cure or prevent a number of illnessessuch as headache, malaria, ulcers, bronchitis, cough, flu, sore throat and asthma. The objective is to investigate theeffect ofO. sanctum(Tulsi) aqueous leaf extract on prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in human plasma. Coagulation activity of O. sanctum was measured via PT, APTT and TT assay in citrated plasma collected from thirty-six healthy regular blood donors. The plasma was tested against different concentrations of O. sanctum aqueous extract as follows: 0.1mg/ml, 0.5 mg/ml and 1.0 mg/ml. Result shows the aqueous extract of O. sanctum prolonged the PT and APTT assays (p0.05). The gas chromatography-mass spectrometry (GC-MS) analysis had identified the linolenic acid at 1-10% of ethanol and aqueousconcentration at different retention time which was responsible for the coagulation activities of O. sanctumin human plasma. This study suggests that O. sanctum does affect coagulation activity in human plasma and can be potentially used as naturally derived anticoagulant products in the future.
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.
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.
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.
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.
We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, thensubsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF.The ocular symptoms resolved completely post embolization of the fistula.
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.
It has been recognized extensively that studies of pharmacogenetics provide massive examples of causal relationship between genotypes and drug effectiveness to account for interindividual phenotypic variations in drug therapy. In most cases, cytochrome P450 (CYP) polymorphisms are one of the major variables that affecting those drug plasma concentration, drug detoxification and drug activation in humans. Thus, understanding of CYP polymorphisms can be crucially valuable in order to allow early and more accurate drug dosage prediction and improve the drug response accordingly. Despite the high level of homologous amino acid sequences, CYP2C9 and CYP2C19 genes are among the most important CYP genes which metabolize a wide range of clinically therapeutic drugs. Several critical reviews have been published relating to the aforementioned genes. However, this minireview aims to systematically merge reported studies on the SNPs frequencies of both genes concentrating only on Malaysian population. It is hoped that, the minireview can be an opener for new opportunities to reevaluate the evidence on the prevalence of CYP2C genes as a potential genetic factor influencing a particular drug efficacy and safety among Malaysian. Such evaluation can be developed to the next level of early prediction of better and specific drug treatment, thereby improving the drug response while helping the government in minimising the drug expenditures.
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.
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.
We describe the first clinical case of contact lens related corneal ulcer caused by Elizabethkingia meningosepticaregistered in Southeast Asia. A 20-year-old female student who wasa regular soft contact lens wearer, presented with pain, photophobia and blurring of vision of the right eye for 3 days. On slit lamp examination, there was a small paracentral anterior stromal infiltrate with an overlying epithelial defect. Microbiological cultures from corneal scrapings, contact lens and its casing were positive for E.meningoseptica. Due to high likelihood of contact lens contamination causing keratitis, topical fortified gentamicin0.9% and ceftazidime 5% were administered empirically. Topical vancomycin 5% was later added tailoring to the culture and sensitivity of the organism. After 8 weeks of treatment, the keratitis subsided and corneal epithelial defect completely healed with residual corneal opacity. Even though uncommon, contact lens related E.meningosepticakeratitis can occur in healthy immunocompetent individuals with no ocular comorbidities.
Muscular dystrophy is a group of diseases that result in progressive muscle weakness and atrophy. Duchenne Muscular Dystrophy (DMD) is classified as dystrophinopathy and is an X-linked recessive disease. It is caused by alterations in the dystrophin gene at Xp21.2 encoding 79 exons [1]. It is characterised by progressive muscle wasting that begins at 3 to 5 years, delay in motor development and eventually wheelchair confinement followed by premature death at about 30 years from cardiac or respiratory complications [2]. Genetic etiology of cases of DMD in Malaysia are still scarcely reported. Here, we report the genetic cause in the case of an 11-year-old Kelantanese Malay boy who has progressive muscle weakness since 5 years old. He has difficulty in getting up from sitting and supine position also in climbing up stairs until 1st floor. He has a strong family history of DMD and musculoskeletal problems. His younger brother was diagnosed with DMD by molecular analysis and his maternal uncle died at the age of 16 with musculoskeletal problems but was never investigated. Physical examination revealed no dysmorphic features, positive Gower sign with absent tounge fasciculation. On neurological examination, tendon reflexes and muscle tone for limbs were normal. Muscle power for bilateral upper limbs were normal, however, bilateral lower limbs showed slight reduction in muscle power with calf hypertrophy.
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.
The large clinical spectrum of Haemoglobin E (HbE)/β-thalassaemia leads to identification of modifiers that cause the complexity1. IGSF4, a member of the immunoglobulin superfamily 4 is known as a thalassaemia-related gene that plays an important role in globin synthesis. Methylation of IGSF4 was reported to interrupt the process of globin synthesis through its interaction with other genes in the regulation network of globin expression2. Specific cells isolation is needed in order to study the methylation profile as the interaction between various haematopoietic cells including nucleated red blood cells (NRBCs) in whole blood could impact the methylation results3. Therefore, the objective of this study was to describe the pattern of DNA methylation at the promoter region of IGSF4 gene that may involve in the alteration of globin synthesis in HbE/β-thalassaemia patients.
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.
Azacytidine (5-Aza) is a chemotherapeutic drug that has been known to restore the expression of Tumour suppressor genes by de-methylation and shown clinical efficacy inMyelodysplastic syndrome (MDS) [1-3]. Currently, 5-Aza is being used in UK for the treatment of some adults with MDS, chronic myelocytic leukemia (CML) and acute myelocytic leukemia (AML) [4]. Majority of CML patients treated with imatinib, a BCR/ABL inhibitor would develop resistance under prolonged therapy. Signal transducer and activator of transcription 3 (STAT3) is an oncogenic transcription factor that is constitutively activated in various human cancers including hematological malignancies. Activation of STAT3 represents an important mechanism of imatinib resistant [5]. Methylation of SHP-1is involved in the constitutive activation of STAT3 [6], and a low level of SHP-1is not sufficient to inhibit activated STAT3 [7]. Epigenetic silencing of SHP-1also plays a role in the development of resistance to imatinib in BCR/ABL positive CML cells.