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Re: Kozacioglu et al.: Anatomy of the dorsal nerve of the penis, clinical implications (Urology 2014;83:121-125)

Suhaimi FH, Abd Ghafar N, Das S

Urology, 2014 May;83(5):1207-8.
PMID: 24767534 DOI: 10.1016/j.urology.2014.01.033
An interesting case of isolated pancreatic teratoma: lessons to learn

Razman J, Azlanudin A, Eyad AJ, Zahiah M, Das S

Clin Ter, 2012 Nov;163(6):495-7.
PMID: 23306744

Mature cystic teratomas of the pancreas are extremely rare tumours encountered in day-to-day clinical practice. Only few cases have been reported to date involving all age groups. The management, diagnosis and evaluation of this tumor are questionable, with definitive diagnosis taking place intra-operatively. We hereby report the case in a 30 year-old-male who presented with newly diagnosed diabetes mellitus and during the follow up he was noted to have elevated liver enzymes clinically, he was asymptomatic. The computerized tomography revealed a retropancreatic mass and pushing the mesenteric veins anteriorly. The mass was hypodense in nature and there was presence of calcification. Although the patient was asymptomatic, the decision for resecting the mass was made in view of the size and possibility of malignancy. In conclusion, considering the size and approximity of the mass to the pancreas, Whipple procedure's is the most appropriate approach although the histological diagnosis has not been established preoperatively.
Spinal arteriovenous malformation presenting with prolapsed intervertebral disc: a diagnostic dilemma

Farina MY, Harunarashid H, Faridzal F, Jegan T, Das S

Clin Ter, 2012 Nov;163(6):491-3.
PMID: 23306743

The availability of multiple investigating modalities should be utilized to arrive at the correct diagnosis of the spinal arteriovenous malformation (AVM). We hereby report the case of a 21-year-old, obese female, who presented with paraplegia and impaired bowel control two years after an episode of the fall. The Magnetic Resonance Imaging (MRI) of her spine not only revealed disc prolapse at T11-T12, but also tortuous dilated spinal veins and cord oedema. A diagnosis of a spinal arterio-venous fistula was confirmed after a spinal angiogram. The dilemma of treating the right pathology for the clinical signs and symptoms are being discussed.
Pulmonary embolism following histoacryl glue embolization for a large thigh arteriovenous malformation

Harunarashid H, Lily S, Rozman Z, Azim MI, Das S

Clin Ter, 2012;163(5):393-5.
PMID: 23099967

Arteriovenous malformation (AVM) are commonly congenital in origin. We hereby describe the case of a 24-year-old male who was diagnosed of left thigh intramuscular AVM at the time of 14 years old. The computerized tomography (CT) scan confirmed a large deep seated intramuscular AVM with the size of 20 x 15 cm, with dilated and distended feeding vessel from profunda femoris artery (PFA) and superficial femoral artery (SFA). He also had another AVM near the left supracondylar region adherent to the sciatic nerve. The main AVM lesion was earlier treated with surgical resection and it remained for asymptomatic for next seven years. Following this, the patient presented again to the clinic with recurring swelling, pain and occasional paraesthesia on the same site. He was then managed with a series of embolization (total of 6 attempts) with histoacryl glue. These attempts of embolization were successful. The interesting case of pulmonary embolism due histoacryl glue following embolization of an AVM is described.
Fulltext A detailed microscopic study of the changes in the aorta of experimental model of postmenopausal rats fed with repeatedly heated palm oil

Adam SK, Das S, Jaarin K

Int J Exp Pathol, 2009 Jun;90(3):321-7.
PMID: 19563614 DOI: 10.1111/j.1365-2613.2009.00658.x

Hypercholesterolaemia, increase in lipid peroxidation and hyperhomocysteinaemia may contribute to the pathogenesis of atherosclerosis. This study was performed to examine the effects of repeatedly heated palm oil mixed with 2% cholesterol diet on atherosclerosis in oestrogen-deficient postmenopausal rats. Ovariectomy causes disruption of tunica intima layer of the rat aorta simulating a postmenopausal condition in females. Twenty-four ovariectomized female Sprague-Dawley rats were divided into four groups. The control group received 2% cholesterol diet without palm oil. A diet with 2% cholesterol content fortified with fresh, once-heated and five-times-heated palm oil was given to the other treatment groups. The rats were sacrificed at the end of 4 months of study and the aortic arch tissue was processed for histomorphometry and electron microscopy. On observation, there was disruption of the intimal layer of the ovariectomized rat aorta. There was no obvious ultrastructural change in the aorta of the rats fed with fresh palm oil. The ultrastructural changes were minimal with once-heated palm oil, in which there was a focal disruption of the endothelial layer. The focal disruption was more pronounced with five-times-heated palm oil. The results of this study show that the ingestion of fresh palm oil may have a protective effect on the aorta but such a protective action may be lost when the palm oil is repeatedly heated. The study may be clinically important for all postmenopausal women who are susceptible to atherosclerosis.
The effect of topical extract of Momordica charantia (bitter gourd) on wound healing in nondiabetic rats and in rats with diabetes induced by streptozotocin

Teoh SL, Latiff AA, Das S

Clin Exp Dermatol, 2009 Oct;34(7):815-22.
PMID: 19508570 DOI: 10.1111/j.1365-2230.2008.03117.x

Momordica charantia (MC; bitter gourd) is a traditional herb commonly used for its antidiabetic, antioxidant, contraceptive and antibacterial properties. It is also used for the rapid healing of wounds.
Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

Das S, Suri R, Kapur V

Sao Paulo Med J, 2007 Nov 01;125(6):351-3.
PMID: 18317606

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons.
CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.
Fulltext Histological changes in the kidneys of experimental diabetic rats fed with Momordica charantia (bitter gourd) extract

Teoh SL, Abd Latiff A, Das S

Rom J Morphol Embryol, 2010;51(1):91-5.
PMID: 20191126

Momordica charantia (MC) or bitter gourd is widely known for its antidiabetic properties. The aim of the present study was to observe the protective effect of MC extract on the kidneys of streptozotocin-induced diabetic rats. Eighteen male Sprague-Dawley rats (n=18) weighing 200+/-50 g were taken for the study. The study comprised of three groups i.e. a non-diabetic, diabetic untreated and diabetic treated with MC extract, with each group comprising of six (n=6) rats. Diabetes was induced in the overnight fasted rats by intramuscular injection of streptozotocin (50 mg/kg body weight). The MC extract (50 mg/kg body weight) was administered via oral gavage. Both the kidneys were collected on the tenth day following treatment. Histological study using Verhoeff's van Gieson (VvG) and Periodic Acid-Schiff (PAS) stains were performed. The kidneys of the diabetic rats showed thickening of the basement membrane of the Bowman's capsule, edema and hypercellurarity of the proximal tubules, necrosis and hyaline deposits. These features were found to be reversed when the MC extract was administered to the experimental animals. The MC extract acted as an antioxidant thereby preventing the oxidative damage involved in the diabetic kidney. The administration of MC extract prevents oxidative damage in diabetic nephropathy.
A histological study of the structural changes in the liver of streptozotocin-induced diabetic rats treated with or without Momordica charantia (bitter gourd)

Teoh SL, Latiff AA, Das S

Clin Ter, 2009;160(4):283-6.
PMID: 19795081

Aim: Diabetic liver is associated with biochemical, physiological and pathological changes. The aim of the present study was to evaluate the histological changes following administration of Momordica charantia (MC) in the streptozotocin (STZ) induced diabetic rats.

Materials and methods: Eighteen Sprague-Dawley rats (n=18) were taken for this study. The animals were divided into 3 groups:- non-diabetic (n=6), untreated diabetic (n=6) and diabetic treated with MC extract (n=6). Diabetes was induced in the experimental rats via intravenous injection of streptozotocin (45 mg/kg body weight). MC extract (50 mg/kg body weight) was administered orally to the treated diabetic rats 10 days following induction. The liver tissues were collected on the 10th day following treatment and the histological study was performed using different staining methods which included hematoxylin and eosin (H&E), Verhoeff's van Gieson (VvG) and periodic acid Schiff (PAS).

Results: The liver of the diabetic rats showed involvement of the hepatocytes with features of inflammation. The portal triad in the diabetic liver showed extensive involvement in terms of accumulation of mucopolysaccharide deposits. Liver damage in the diabetic animals showed features of healing with administration of the MC extract.

Conclusions: The MC extract due to its antioxidant role may be helpful in reversing the changes in the liver in diabetes mellitus.
Wound healing in diabetes mellitus: traditional treatment modalities

Laitiff AA, Teoh SL, Das S

Clin Ter, 2010;161(4):359-64.
PMID: 20931161

The healing of wound is a complex process which requires the interactions of different cells and extracellular molecules. The normal wound healing process can be divided into four overlapping phases i.e. haemostasis, inflammation, proliferation and remodeling. In diseased condition like diabetes mellitus, the wound healing process is grossly impaired, resulting in chronic wounds which fail to heal. In the past decades, several researchers have tested various traditional medicines obtained from the plants for their wound healing properties. Such traditional plants are Aloe vera, Calotropis procera, Portulaca oleracea, Acalypha langiana, Plagiochasma appendiculatum and Momordica charantia. Perhaps one of the most popular and easily available plant is Momordica charantia (bitter gourd). The present article presents an extensive review on the impaired wound healing process in diabetes mellitus and highlights the use of traditional medicines in diabetic wounds.
Fulltext Vienna nomogram-based prostate biopsy: can it be a much better diagnostic tool than other conventional prostate biopsies?

Ho CC, Ho SE, Das S

Korean J Urol, 2014 Sep;55(9):628.
PMID: 25237467 DOI: 10.4111/kju.2014.55.9.628
Novel agents in the treatment of osteoporosis

Shuid AN, Ima Nirwana S, Das S

Curr Drug Targets, 2013 Dec;14(14):1631.
PMID: 24383964
Fulltext Role of exercise in the management of diabetes mellitus: the global scenario

Thent ZC, Das S, Henry LJ

PLoS One, 2013;8(11):e80436.
PMID: 24236181 DOI: 10.1371/journal.pone.0080436

Background: Exercise training programs have emerged as a useful therapeutic regimen for the management of type 2 diabetes mellitus (T2DM). Majority of the Western studies highlighted the effective role of exercise in T2DM. Therefore, the main aim was to focus on the extent, type of exercise and its clinical significance in T2DM in order to educate the clinicians from developing countries, especially in Asians.

Methods: Pubmed, Science Direct, Scopus, ISI Web of Knowledge and Google scholar were searched using the terms "type 2 diabetes mellitus," "type 2 DM," "exercise," and/or "physical activity," and "type 2 diabetes mellitus with exercise." Only clinical or human studies published in English language between 2000 and 2012 were included. Certain criteria were assigned to achieve appropriate results.

Results: Twenty five studies met the selected criteria. The majority of the studies were randomized controlled trial study design (65%). Most of the aerobic exercise based studies showed a beneficial effect in T2DM. Resistance exercise also proved to have positive effect on T2DM patients. Minimal studies related to other types of exercises such as yoga classes, joba riding and endurance-type exercise were found. On the other hand, United States of America (USA) showed strong interest of exercise management towards T2DM.

Conclusion: Aerobic exercise is more common in clinical practice compared to resistance exercise in managing T2DM. Treatment of T2DM with exercise training showed promising role in USA. A large number of researches are mandatory in the developing countries for incorporating exercise in the effective management of T2DM.
Editorial: novel agents in the treatment of osteoporosis and its complications

Shuid AN, Soelaiman IN, Das S

Curr Drug Targets, 2013 Dec;14(13):1523.
PMID: 24266612
Fulltext An unusual presentation of adult onset Still's disease

Ghosal A, Pal RB, Das SK, Das T

Med J Malaysia, 2012 Oct;67(5):532-3.
PMID: 23770876

Adult onset still's disease usually presents with high grade intermittent fever, polyarthritis, salmon pink evanescent rash and hepatosplenomegaly. Pulmonary involvement in the form of pneumonitis, as a presenting feature is very rare. We report a case of a young lady who presented with fever, cough and respiratory distress. Chest X-ray revealed patchy infiltration in left upper lung zone. She was subsequently diagnosed as Adult onset Still's disease. There was no improvement in clinical condition despite five days of antibiotics. On trans-bronchial lung biopsy (TBLB) proved she had interstitial pneumonitis and responded dramatically to steroid treatment.
New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population

Sinthubua A, Theera-Umpon N, Auephanwiriyakul S, Ruengdit S, Das S, Mahakkanukrauh P

Clin Ter, 2016 Mar-Apr;167(2):33-7.
PMID: 27212570 DOI: 10.7417/CT.2016.1918

Age estimation is one of the major components of forensic identification. Cranial suture closure has long been used as indicator for age estimation. Maxillary sutures have been less studied for estimation of age at death because they vary in their timing of closure with age. The purpose of this study was to estimate age by examining 190 Thai skulls with age ranging between 15-93 years from Forensic Osteology Research Center, Faculty of Medicine, and Chiang Mai University. Four parts of maxillary suture (incisive, anterior, transverse, and posterior sutures) were investigated the suture obliteration of each suture by computerizing from photograph. The suture were measured by pixel counting.The prediction model which based on the support vector machine (SVM) for regression or support vector regression (SVR) was utilized for data analysis. The results showed high correlation (R2 = 0.9086) between the predicted age and actual age. Plot between actual age group and predicted age in seven groups also revealed high correlation (R2 = 0.9434). These can be implied that we are able to use this SVR model to predict age at death using maxillary suture information.The interesting issue is to further apply this model in more cases to ensure the generalization of the finding. This study is the first attempt to estimate age at death using a new method based on novel analysis which considers a characteristic of relationship between maxillary suture closures with age that are not in linear form. The present study may contribute as a basis knowledge and method for further study of age estimation in archaeological and forensic anthropological contexts, especially when only skull or base of skull are found.
The Smart Programmable CRISPR Technology: A Next Generation Genome Editing Tool for Investigators

Chakraborty C, Teoh SL, Das S

Curr Drug Targets, 2017;18(14):1653-1663.
PMID: 27231109 DOI: 10.2174/1389450117666160527142321

BACKGROUND: The present era is fast experiencing rapid innovation in the genome-editing technology. CRISPR Cas9-mediated targeted genetic manipulation is an easy, cost-effective and scalable method. As a result, it can be used for a broad range of targeted genome engineering.
OBJECTIVE: The main objective of the present review is to highlight the structural signature, classification, its mechanism and application from basic science to medicine and future challenges for this genome editing tool kit.
RESULTS: The present review provides a brief description of the recent development of CRISPR-Cas9 genome editing technology. We discuss the paradigms shift for this next generation genome editing technology, CRISPR. The CRISPR structural significance, classification and its different applications are also being discussed. We portray the future challenges for this extraordinary genome in vivo editing tool. We also highlight the role of CRISPR genome editing in curing many diseases.
CONCLUSION: Scientists and researchers are constantly looking one genome editing tool that is competent, simple and low-cost assembly of nucleases. It can target any particular site without any off-target mutations in the genome. The CRISPR-Cas9 has all of the above characteristics. The genome engineering technology may be a strong and inspiring technology meant for the next generation of drug development.
The Burden of Gastrointestinal, Liver, and Pancreatic Diseases: The Global Scenario

Das S, Mahakkanukrauh P, Ho CC

Gastroenterology, 2016 Apr;150(4):1045-6.
PMID: 26930015 DOI: 10.1053/j.gastro.2016.01.036
Fulltext Platelet changes in healthy male smokers.Scientific views

Kosai N, Rajan R, Das S

Saudi Med J, 2015 Dec;36(12):1501.
PMID: 26620998 DOI: 10.15537/smj.2015.12.12885
Diversity and evolution of the envelope gene of dengue virus type 1 circulating in India in recent times

Dey S, Nandy A, Nandy P, Das S

Int J Bioinform Res Appl, 2015;11(6):469-82.
PMID: 26642358 DOI: 10.1504/ijbra.2015.073235

Dengue viral attacks have been reported in various parts of India in recent years. In this paper we report on our studies of the characterisation and evolutionary aspects of gene sequences of the envelope glycoprotein of the prevalent Indian dengue virus type 1. Comparison with sequences from other countries shows that the envelope genes identified in India are closely related to strains from Malaysia. From the evolutionary point of view the envelope gene sequences of this dengue virus of India for past few years show that a marked mutational shift in the nucleotide sequences of the envelope gene have taken place from around the year 2000. Also, phylogenetic relationship with other three sera of dengue virus reported in India from 2005 shows that the dengue virus 1 is more closely related to dengue viruses 3 and 4 and relatively distantly to dengue virus 2.

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