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.
The repair process of airway epithelium involves cell migration, spreading, proliferation and re-differentiation. Objective: Cellular and molecular responses to tracheal brush induced injury were investigated using a rabbit model. Methods: Eighteen New Zealand white rabbits were divided into uninjured and injured groups. After tracheal brushing, the animals were maintained in the laboratory before being sacrificed at given time points (1, 12 hours, 3, 7, and 21 days). The trachea of each rabbit was retrieved and preserved before being subjected to haematoxylin and eosin staining and real time PCR. Results: After injury, the remained epithelial cells underwent an instant response by proliferating and migrating into the damaged site. This finding was in accordance with the proliferative and migration activity-related gene expression results (MMP-9, TIMP1, vimentin, and ß-integrin). The increased activity of these genes was crucial at the early time points, as it encouraged the remaining cells to repopulate the damaged area. Conclusions: Continuous regulation of MMP-9, vimentin and ß-integrin plays important roles in promoting cellular homing especially the cells bordering the lesion to migrate and repair of the damaged ECM. Thus, this activation enhanced regeneration and repair of the damaged tracheal epithelium as early as 1 h and complete at 21 d following injury.
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).
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.
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.
The aims of this study are to identify and characterize the Haemoglobin G Makassar. Haemoglobin G Makassar was identified in Makassar, Sulawesi (Celebes), Indonesia in 1969 and has been reported in a family of Thai origin in 2002. Haemoglobin G Makassar was found to share identical properties with haemoglobin S in routine haemoglobin separation by cation-exchange HPLC. It is therefore, patients with Haemoglobin G Makassar and Haemoglobin S may sometimes be mistakenly identified for each other.
There were four cases identified from year 2015 to 2016 in Peninsular Malaysia by Molecular Genetics Laboratory, Institute for Medical Research. All patients were asymptomatic with mild hypochromic microcytic anaemia. All patients were analysis with Haemoglobin S trait. Analysis by Capillary Electrophoresis showed that these patients had 39.9 to 44.0% of haemoglobin variant in zone S. Alpha and Beta globin gene analysis were performed on these samples.
DNA sequence analysis, revealed a single nucleotide substitution GAG to GCG at codon 6 of the beta-globin gene (Glu>Ala), indicating of Haemoglobin G Makassar for all the patients (Fig. 1). All patients were positive with Haemoglobin S trait. Multiple Amplification Refractory Mutation System (MARMS) PCR for Haemoglobin S was negative in all cases. However alpha-globin gene analysis showed that two of them had single alpha deletion (α3.7). The mean reading for HGB is 11.95 g/dL, for MCV is 72.1 fL and for MCH is 23.65 pg which all are lower than normal peoples.
The screening method may mistakenly identify Haemoglobin G Makassar as Haemoglobin S. Therefore identification and characterization of Haemoglobin G Makassar by several molecular methods such as polymerase chain reaction (PCR) and sequence analysis are necessary for confirmation of the diagnosis.
— 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.
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.
Breast cancer in young pregnancy is a breast cancer diagnosed in a young lady at the age of less than 30 years old during pregnancy. Diagnosis and treatment of breast cancer during pregnancy are challenging as both maternal and fetal outcome must be considered in terms of their short and long-term effects. It requires multidisciplinary treatment. Instead, pregnancy should be preserved whenever possible, while treating the underlying breast cancer. It is important not to compromise the treatment of breast cancer because of the pregnancy. The overall therapeutic concept basically depends on timing of delivery, staging of the underlying disease, treatment mode and the impacts of treatment recommended as well as foetal outcome in relation to treatment that administered to the mother during pregnancy. We present a case of young pregnant lady at the age of 23 with breast cancer as it is a rare event and the challenges encountered in managing her and to highlight the treatment options for the patient and the baby.
Hb Malay was first described in 1989 following an investigation of anaemia in a 22-year-old Malay gentleman who was homozygous for this chain variant. This Hb variant is caused by AAC AGC mutation at codon 19 of the globin gene resulting in the substitution of serine for asparagine [1]. The mutation creates cryptic RNA splice site in exon 1 of the -globin gene leading to an abnormal RNA processing. Thus, this mutation not only produces variant haemoglobin but also a mild + thalassemia phenotype [2].
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.
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.
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.
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
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.
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.
Toxoplasmic optic neuropathy is rare and usually occurs monoocularly. This case report demonstrates a rare presentation of bilateral
juxtapapillary retinochoroiditis (Jensen disease) due to toxoplasma infection in
a young healthy patient. A 20-year-old lady presented with bilateral painless
blurring of central vision for 5 days duration. It was preceded by fever, upper
respiratory tract symptoms and headache. There was no history of contact or
being scratched by a cat. Visual acuity was counting fingers for the right eye
and 6/45 for the left eye. There was presence of relative afferent pupillary
defect in the right eye. Optic nerve functions were impaired bilaterally which
was severe in the right eye. Both eyes showed the presence of mild anterior
segment inflammation and vitritis. Fundus examination revealed juxtapapillary
retinochoroiditis bilaterally with swollen optic disc. Optical coherence
tomography (OCT) showed presence of intra-retinal and sub-retinal fluid at
macular area bilaterally. Serology for anti-toxoplasma Immunoglobulin G (IgG)
was positive with titre of 1450 IU/ml. Computed tomography scan (CT scan) of
brain and orbit was normal. A diagnosis of bilateral juxtapapillary
retinochoroiditis or Jensen disease was made. Oral azithromycin 500 mg daily
and guttae prednisolone 4 hourly for 6 weeks was commenced. Oral
prednisolone 50 mg daily (1 mg/kg/day) was added after completion of 1 week
of antibiotic and was tapered down within 5 weeks. There was improvement of
vision as early as 3 weeks post initiation of the treatment. Upon 6 weeks
completing the treatment, her vision has improved to 6/7.5 on both eyes with
resolution of optic disc swelling and sub-retinal fluid. Early recognition and
initiation of treatment in toxoplasma infection associated with juxtapapillary
retinochoroiditis usually result in good visual prognosis.