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.
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.
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.
— 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.
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.
Hyponatraemia is a common electrolyte imbalance in oncology. Rarely has it been reported as a presentation of nasopharyngeal carcinoma (NPC). A 43-year-old gentleman presented with double vision, headache, weight loss, complex ophthalmoplegia and submandibular lymphadenopathy. Computed tomography (CT) scan and nasopharyngeal biopsy confirmed the diagnosis of NPC. Prior to chemotherapy, he developed severe hyponatraemia. Blood investigations failed to pinpoint a clear diagnosis, and he was not responsive to aggressive supportive treatment. Pituitary gland function tests and MRI subsequently was performed, and found a pituitary extension causing hypocortisolism. Finally, his hyponatraemia was successfully optimised with oral hydrocortisone. This case illustrates that ophthalmoplegia and hyponatraemia are important warning signs of NPC or any other aggressive sellar mass that should not be neglected.
Ki67, a nuclear protein presents in cells that is usually associated
with tumor cell proliferation. Therefore, physical quantification of Ki67 is a direct
measure cell proliferation activity. Immunohistochemical staining is known to be
an effective method of assessing the proportion of tumor cells. Currently, there
are various techniques for counting Ki67 in different types of cancer. This paper
provides an overview of recent scoring methods of Ki67, which includes ‘eyeballing’ estimation, vision counting with a microscope or viewer software,
manual counting of the camera-captured or digital image and automated
counting.
Complex chromosome rearrangements (CCRs) are structural aberrations or rearrangements involving three or more cytogenetics breakpoints on two or more chromosomes [1]. Balanced and unbalanced are known to have significant risk of mental retardation and phenotypic anomalies. CCRs are also associated with infertility in males and recurrent abortion in females. Here we report one case of apparently balanced CCR involving three chromosomes 3, 5 and 12 in a child with abnormal features. G banding and FISH were performed to clarify the nature of this complex abnormality.
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.
The rare condition of neutrophils agglutination in-vitro may give inaccurate neutrophils count. We reported a case of a 71-year-old female admitted with a diagnosis of extended-spectrum beta-lactamase (ESBL) Escherichia Coli (E.coli) septicaemia secondary to the left lower limb cellulitis. Despite underlying infection, total white blood cell count (TWBC) and absolute neutrophil count remained in a normal range. An accidental finding of full blood picture (FBP) using K2 ethylenediaminetetraacetic acid (EDTA) tube presented numerous neutrophils agglutination. Further tests were carried out using citrated and heparinised tubes and tested at room temperature, 4 C, and 37 ͦC. The findings showed a significant reduction in neutrophils agglutination in both citrated and heparinised tubes, including when tested at room temperature (RT) and 4 ͦC. Surprisingly, at 37 ͦC, no neutrophil agglutination was observed. This indicates that temperature-dependent anti-neutrophil IgM antibody may be found in the patient's serum that reacted with the EDTA anticoagulant. In conclusion, white blood cells (WBC) agglutination has been associated with malignancy, sepsis, liver disease, and autoimmune disease. Thus, a baseline FBP is recommended, especially in these categories of patients to optimise their clinical management.
Methicillin Resistant Staphylococcus aureus (MRSA) causing
surgical site infections is one of the most common nosocomial infections
affecting post-surgery patients. Vancomycin is the recommended treatment
with MRSA-resistance breakpoint for minimum inhibition concentration (MIC)
of 2 ug/mL where the pathogen can be considered as susceptible. Here, we
describe the MIC of vancomycin against our MRSA isolates. Retrospective
data of MRSA positive cultures from post-surgical patients who were admitted
to the Clinical Training Centre Sungai Buloh public section from 2016-2017
with documented MIC to vancomycin were analyzed. The specimens consist
of pus swabs, mediastinal fluid, sternal bone, and tissue. A total of 29 MRSA
were isolated from 11 patients. There were 19, 3, 3 and 4 MRSA with
vancomycin’s MIC (ug/mL) of 0.5, 1, 1.5 and 2 respectively. The MRSA with
MIC of 2 ug/mL were observed from two different patients with one of them
showing MIC of 0.5 ug/mL which grew from wound swabs to 2.0 ug/mL which
grew from sternal bone and mediastinal fluid isolates. Vancomycin reduced
susceptibility MRSA has been observed in our clinical training centre with a
1.1% incidence. Identification of possible risk factors and follow up of
outcomes is required to fully elucidate the importance of this occurrence.
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.
To review the clinical profile of retinal vein occlusion (RVO) in Hospital Universiti Sains Malaysia (USM) from 2011 until 2017. This was a retrospective single-centre case series. The medical records of the patients presented to Ophthalmology Clinic with RVO from 2011 to 2017 were reviewed. A total of 24 patients (26 eyes) with a diagnosis of RVO in Hospital USM were reviewed. There was 91.6% of our patients were aged more than 45 years old with predominantly affected male gender (58.3%). Majority of the patients were Malays (87.5%). Hypertension (70.8%), hyperlipidemia (70.8%) and diabetes mellitus (54.2%) were the common systemic comorbidities in RVO patients. Majority of the patients (87.5%) were non-smoker. Based on type of RVO, there were 38.5% central RVO, 26.9% branch RVO, 19.2% macular branch RVO, and 15.4% hemivein occlusion. RVO was bilateral in 2 patients (8.4%). Based on fundus fluorescein angiography, 3 patients (11.5%) showed ischaemic features. Reduce vision (91.6%) was the main presenting symptoms of RVO while intraretinal haemorrhage (100%) and macular oedema (96.2%) were the most common ocular signs found in RVO. There were 16 eyes (61.5%) have visual acuity equal or better than 6/60 at presentation. Patient who had visual acuity equal or better than 6/60 showed promising improvement in visual acuity post treatment. Elderly with multiple comorbidities complaining of worsening of vision should have high index suspicion of RVO. Presenting visual acuity is associated with final visual outcome post treatment.
Glaucoma is a chronic disease that could affect the quality of life and is a potential stressor for patients. Visual field assessment is important in monitoring disease progression among glaucoma patients. Stress could influence the performance of patients in visual field test that may affect the reliability of the test. Our objective in this study was to determine the association between stress score using Depression, Anxiety and Stress Scale (DASS) questionnaire and reliability indices of Humphrey visual field analysis (HFA). A total of 155 primary and secondary glaucoma patients were recruited in the study. Face to face interview using stress component of DASS questionnaire was conducted after automated HFA test. Reliability indices; i.e. fixation loss, false positive, and false negative error, were used to determine the accuracy of HFA result. Only 12 patients (7.7%) were found to have elevated stress score. No significant correlation was found between DASS stress score and the reliability indices of HFA. There was 0.2 folds (95% confidence interval (CI) [-2.35, -0.06], p = 0.039) reduction of fixation loss for every number of HFA done. For every one year increase in age, there was 0.2 folds (95% CI [-0.38, -0.07], p = 0.006) reduction in false positive error in HFA.
Minimal stress may not affect the reliability of HFA assessment. Minimising stress among glaucoma patients is important not only for assessment of visual field but also for improvement of quality of life.
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.
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.
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.
Tunnel vision is a classic sign among patients with advanced glaucoma. However, other conditions such as retinitis pigmentosa, optic neuritis and rod-cone dystrophy may be characterized by similar visual field defects. A 52-year-old lady with a family history of glaucoma presented with bilateral gradual loss of peripheral vision for two years. She claimed to have poor night vision about 20 years prior to this presentation. Her visual acuity was 6/7.5 in both eyes. The anterior chamber depth was moderate bilaterally, with Schaffer grading on gonioscopy of grade I to II. The intraocular pressure was 14 mmHg in both eyes. The optic discs appeared normal. Fundus examination showed scattered hypopigmented changes sparing the fovea. Humphrey visual field test revealed bilateral constricted visual fields. She was diagnosed with retinitis punctata albescens (RPA) based on her symptom of poor night vision, supported by the diffuse hypopigmented changes in her fundi. The management of this condition involves careful counselling regarding the genetic nature of the disease and its progressive course. We discuss this case to illustrate the importance of a thorough history taking and careful fundus examination in the workup of patients presenting with tunnel vision.
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.