To report on a rare case of an intralenticular foreign body which
demonstrates that use of a spring-powered airsoft gun can result in a severe
ocular injury. A 2-year-old male presented following a trauma to the left eye.
The trauma was caused by a wooden matchstick from a spring-powered airsoft
gun being shot into his eye. On examination, there was a shallow anterior
chamber with a full thickness corneal laceration, with fragmented matchstick
pieces embedded in the cornea and in the lens. The corneal foreign bodies
were removed, corneal laceration wound sutured and lensectomy done. There
were no post-operative complications, and the cornea wound healed with a
scar. A few months later, he underwent a successful secondary intraocular lens
implantation surgery with an iris claw lens. Airsoft guns are easily available to
children who are unaware of its dangers. It can cause significant ocular
morbidity despite successful surgical treatment of the injury.
— 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.
To report a rare case of an elderly gentleman who presented with herpes zoster ophthalmicus, complicated with persistent hyphema and orbital apex syndrome. A 75-year-old Malay gentleman presented with left herpes zoster ophthalmicus that was complicated with complete ophthalmoplegia and ptosis. He developed total hyphema in the affected eye with a secondary elevated intraocular pressure after a week. He was treated with oral acyclovir and topical corticosteroids. However, the total hyphema persisted that required an anterior chamber washout surgery. Herpes Zoster Ophthalmicus complicated with persistent hyphema and orbital apex syndrome is rare and very challenging to manage. Radiological imaging is important to exclude other causes of OAS. It is recommended to treat HZO with systemic acyclovir for a longer duration in view of ocular and neurological involvement.
Alpha thalassemia is a common genetic disorder with more than 20% of the world population to be a carrier of some form of α–thalassemia, as estimated by The World Health Organization [1]. It has heterogeneity in its presentation and inheritance and characterised according to their deficient or absent in alpha globin chain involved [2]. The affected individuals may be asymptomatic with hypochromic microcytic anemia or in silent alpha thalassemia may have no clinical signs with normal to mild haematological changes [3]. Current voluntary thalassemia screening programme in Malaysia is mainly based on MCH level of less than 27 before molecular study for alpha thalassemia is done if Hb analysis showed normal results, to exclude alpha thalassemia. Accurate characterization of hematologic parameters is important for selection of appropriate molecular test to determine the carrier genotype, as the test is expensive, time-consuming and not always available. This study was aimed to evaluate the correlation of hematological parameters (Hb, RBC, MCV, MCH, RDW and platelet) with various types of deletional alpha-thalassemia among patients in HUSM.
An 11- month-old girl with accidental findings of pale and hepatosplenomegaly. She was the last child of three siblings from a non-consanguineous marriage. The father and the mother were Hb E trait and Hb Constant Spring (Hb CS) trait respectively. Clinically the child was small for age with frontal bossing and hepatosplenomegaly. Sytemic examination was unremarkable. Her full blood picture showed moderate hypochromic microcytic anaemia with marked anisopoikilocytosis (Hb of 7.1g/dl, MCV of 44.6 fl, with MCH of 13.8 pg and RDW-CV of 24.0%). Quantitation of haemoglobin by using High Performance Liquid Chromatography (HPLC) and gel electrophoresis report showed that the patient has compound heterozygous E/ß+ thalassaemia with Hb H-CS. She had increased of Hb A2/E (28.9%), and Hb F (11.2%) with presence of pre-run peak and a tiny peak at C window. Gel Electrophoresis by using agarose gel at alkaline pH discovered prominent A2 band and fast band to the left of Hb A band. H inclusions were positive. Further confirmation of diagnosis was done by molecular study. Alpha molecular study using Multiplex GAP PCR showed heterozygous --/SEA deletion (Fig. 1), while beta molecular study using Multiplex Amplification Refractory Mutation Systems (ARMS) revealed Cd 26 (G-A) and CAP +1 (A-C) mutations [Fig. 2]
Hemoglobin (Hb) E is common in Southeast Asia [1]. HbE disorders may be found heterozygous (AE) which usually asymptomatic, homozygous (EE) and compound heterozygous state with widely variable clinical features, ranging from transfusion dependence to a complete absence of symptoms [2]. Considering her history, clinical findings and investigations, the most likely diagnosis in our case is Compound heterozygous E/ß+ thalassaemia with Hb H-CS. She had moderate hypochromic microcytic anaemia, raised Hb A2/E and Hb F with presence of pre-run peak and a tiny peak at C window support the diagnosis. Unfortunately, we’re unable to confirm the presence of Hb CS in view of no modalities available in our setting. However, with the family history of mother with Hb CS trait, the presence of Hb CS in this patient cannot be denied as a factor contributing to Hb H disease. Previous study reported Hemoglobin Constant Spring is often missed by routine laboratory testing, especially in subjects with co-inheritance of β-thalassaemia or β-variants. Hb CS detection clearly seen in capillary electrophoresis compared to HPLC [3]. As in this case only a very tiny peak of Hb CS noted on the HPLC. The molecular analysis for detection of Hb CS should be performed as for confirmation test. Hb H-CS has a severe phenotype than a deletional Hb H disease [4]. The diagnosis was confirmed by molecular analysis. Hence, genetic testing and family study are of particular importance to establish the exact genetic defect causing the abnormal Hb in this patient.
In view of thalassaemia is common in our region, it is important to identify complete genotyping to provide proper management, make clinical predictions and improve genetic counseling.
Haemolytic Disease of Foetus and Newborn (HDFN) and Haemolytic Transfusion Reaction (HTR) may occur due to antibodies against Kidd antigen. In Malaysia, the prevalence of RBC alloimmunization due to Kidd antibody for cases of HDFN and HTR have been reported [1-2] however there is insufficient data in Hospital Umum Sarawak (HUS).The aim of this study is to determine whether Kidd alloimmunization causes HDFN and HTR. Indirectly categorize Kidd phenotype blood in regular blood donors.
The most common inherited monogenic disorders in the world are the haemoglobinopathies and thalassaemia. Thalassaemia is a heterogeneous group of genetic disorders of haemoglobin synthesis, characterised by a reduction in the production of one or more of the subunits of haemoglobin chains [1]. Haemoglobin A2 (HbA2) level is an important parameter in thalassaemia diagnosis. High HbA2 level (≥4.0) detected in Hb analysis, points to the diagnosis of beta thalassaemia and other haemoglobinopathies. However, in some cases, the HbA2 levels are apparently normal or borderline high despite abnormal haematological profile. In these cases, further testing is required to confirm the diagnosis. The aim of this study is to examine any abnormality at molecular level in cases of Hb analysis results with normal or borderline high HbA2 level.
In Malaysia, Sabah population constitutes the most number of β-thalassaemia cases ranging from asymptomatic to transfusion dependent. Filipino β°-deletion has been reported as the predominant mutation in Sabah [1]. Despite having the same primary mutation, co-inheritance of genetic variants at HbF quantitative trait loci of HBS1L-MYB intergenic region may cause variability in clinical features by affecting the haemoglobin (Hb) subtypes level, especially HbF. Study suggested that MYB would activate γ-globin repressor gene directly and subsequently initiate the molecular HbF repression mechanisms. Polymorphisms within HBS1L-MYB intergenic region would inhibit binding of transcription factor on MYB and leading to elevation of HbF levels [2]. This can act as an ameliorating factor in the clinical presentation of β-thalassaemia patients [3]. This study aimed to elucidate the association of Hb subtypes levels with three HBS1L-MYB variants among 134 Filipino β°-deletion carriers. PCR-RFLP analysis was done for HBSIL-MYB rs4895441 (A→G) while tetra-primers ARMS PCR analysis was done for HBSIL-MYB rs9399137 (T→C) and rs11759553 (A→T) (Fig.1).
Odontogenesis is a complex process regulated by both genetic and molecular controls. The development of a tooth in the embryo stage is controlled by a series of signals which occur between tooth-forming epithelium and neural crest-derived ectomesenchyme. Though many genes are involved in tooth formation involving major signalling molecules, the bone morphogenetic protein and fibroblast growth factor are the most important ones involved in odontogenesis. Supernumerary tooth occurs because of imbalance in the expression of the signalling pathways and their inhibitors. This review highlights the various signalling molecules that play a role in odontogenesis in order to provide a better understanding on of the molecular mechanisms involved in the formation of supernumerary tooth in humans.
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 aim of this study was to design and systematically optimize
triclosan loaded nanoparticles (TCS-loaded NPs) formulation for the treatment
of periodontal disease. Triclosan (TCS) is a broad spectrum antimicrobial
agent that has been used in the treatment of the disease. The free drug has
poor aqueous solubility and therefore may encounter permeability problems
when applied to the oral cavity. Resolution IV model of Design-Expert®
software (version 10) was used for the design of experiment and optimization
of TCS-loaded NPs. The nanoparticles (NPs) were prepared using the solvent
displacement method. Effect of factors that were investigated include drugpolymer ratio, surfactant concentration, stirring speed, stirring duration, and
drug-polymer injection rate. Particle size, zeta potential, polydispersity index
(PDI) and entrapment efficiency (EE) were the critical quality attributes
selected for the study. Desirability function determined by the software for
optimized TCS-loaded NPs was 0.704. The observed particle size, PDI, zeta
potential and EE of the optimized TCS-loaded NPs was found to be 135 ± 2.3
nm, 0.1 ± 0.012, -30 ± -4 mV and 75 ± 6%, respectively. It was found that
particle size increases by elevating the concentration of polymer and
decreases with an increase in surfactant concentration and stirring speed.
Zeta potential was found to increase when surfactant concentration was
reduced. Both surfactant concentration and drug to polymer ratio were found
to negatively affect PDI while % EE was positively influenced by the increase
in polymer concentration and decrease in surfactant concentration. The use of
Design-Expert®
software helped in identifying suitable levels of critical quality
parameters for preparing improved NPs formulation for delivery of TCS into
the periodontal pocket.
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.
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.
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.
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.
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
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.
The aim of the study is to evaluate the effects of contact and non-contact laser photocoagulation (LP) on ocular surface changes and Ocular Surface Disease Index (OSDI) score in patients with proliferative diabetic retinopathy (PDR). This was a single center, prospective, randomised, parallel-controlled trial of pilot study in Hospital Universiti Sains Malaysia between June 2013 and May 2014. Eye with PDR was selected and randomised into 2 groups (Contact LP group and Non-contact LP group) by using random sampling envelope method. Contact LP group was treated with contact LP via slit lamp laser delivery system. Non-contact LP group was treated with non-contact LP via binocular laser indirect ophthalmoscopy system. Main outcome measures were Schirmer test value, tear film break-up time (TBUT) and OSDI score at baseline and at 3 months post laser therapy. Statistical analyses were performed using SPSS version 22.0. A total of 60 eyes were recruited (30 eyes in Contact LP and 30 eyes in Non-contact LP). Contact LP showed significant reduction of TBUT (p = 0.038) and significant increase in mean OSDI score (p = 0.001) at 3 months post laser therapy. However, there was no significant difference of mean change of Schirmer test value and TBUT between the two groups except for OSDI score (p = 0.044). Both mode of laser deliveries (contact LP and non-contact LP) showed comparable effects on ocular surface disease in PDR patient that underwent laser pan retinal photocoagulation.
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.
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.