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  1. Rate and extent of mitragynine and 7-hydroxymitragynine blood-brain barrier transport and their intra-brain distribution: the missing link in pharmacodynamic studies
    Yusof SR, Mohd Uzid M, Teh EH, Hanapi NA, Mohideen M, Mohamad Arshad AS, et al.
    Addict Biol, 2019 09;24(5):935-945.
    PMID: 30088322 DOI: 10.1111/adb.12661
    Mitragyna speciosa is reported to be beneficial for the management of chronic pain and opioid withdrawal in the evolving opioid epidemic. Data on the blood-brain barrier (BBB) transport of mitragynine and 7-hydroxymitragynine, the active compounds of the plant, are still lacking and inconclusive. Here, we present for the first time the rate and the extent of mitragynine and 7-hydroxymitragynine transport across the BBB, with an investigation of their post-BBB intra-brain distribution. We utilized an in vitro BBB model to study the rate of BBB permeation of the compounds and their interaction with efflux transporter P-glycoprotein (P-gp). Mitragynine showed higher apical-to-basolateral (A-B, i.e. blood-to-brain side) permeability than 7-hydroxymitragynine. 7-Hydroxymitragynine showed a tendency to efflux, with efflux ratio (B-A/A-B) of 1.39. Both were found to inhibit the P-gp and are also subject to efflux by the P-gp. Assessment of the extent of BBB transport in vivo in rats from unbound brain to plasma concentration ratios (Kp,uu,brain ) revealed extensive efflux of both compounds, with less than 10 percent of unbound mitragynine and 7-hydroxymitragynine in plasma crossing the BBB. By contrast, the extent of intra-brain distribution was significantly different, with mitragynine having 18-fold higher brain tissue uptake in brain slice assay compared with 7-hydroxymitragynine. Mitragynine showed a moderate capacity to accumulate inside brain parenchymal cells, while 7-hydroxymitragynine showed restricted cellular barrier transport. The presented findings from this systematic investigation of brain pharmacokinetics of mitragynine and 7-hydroxymitragynine are essential for design and interpretation of in vivo experiments aiming to establish exposure-response relationship.
    Matched MeSH terms: Blood-Brain Barrier/metabolism*; Brain/blood supply
  2. Lateral flow dipstick antigen assay for human cystic echinococcosis
    Khanbabaie S, Riazi M, Chang CH, Yunus MH, Noordin R
    Acta Trop, 2019 Feb;190:171-176.
    PMID: 30458123 DOI: 10.1016/j.actatropica.2018.11.018
    Cystic echinococcosis (CE) is a neglected zoonotic disease with a worldwide distribution and is a major public health problem in some areas. Diagnosis of CE is mainly based on clinical symptoms, imaging and serological testing, however, improvement in serodiagnosis is still needed. This study was aimed at detecting circulating Echinococcus antigen in CE patients using a lateral flow dipstick (LFD) assay. Three types of hydatid antigens i.e. hydatid cyst fluid (HCF), native antigen B (nAgB) and recombinant antigen B (rAgB) were prepared and polyclonal rabbit antiserum was raised against each antigen. Purified IgG fractions were prepared and a portion was conjugated to gold nanoparticles. After a series of optimizations, a final antigen detection LFD assay was developed using a combination of anti-nAgB-IgG and gold-conjugated anti-HCF-IgG. Evaluation of the assay showed that 27 out of 35 (77%) serum samples from CE patients gave positive results. Meanwhile, the test showed a diagnostic specificity of 82% when tested with sera from 38 healthy individuals and 13 patients with other parasitic diseases. In conclusion, the antigen detection LFD assay seemed to be useful for diagnosis of CE and possibly for post-treatment follow-up, and merit further evaluation studies. We foresee that it may improve serodiagnosis of CE when used in tandem with an antibody detection test.
    Matched MeSH terms: Echinococcosis/blood*; Lipoproteins/blood*; Helminth Proteins/blood*
  3. Fulltext Cerebral venous thrombosis as an initial manifestation of acute myeloid leukemia
    Tang ASO, Yeo ST, Law WC, Chew LP
    Oxf Med Case Reports, 2019 Jan;2019(1):omy118.
    PMID: 30697435 DOI: 10.1093/omcr/omy118
    Cancer-associated thromboembolism is not an uncommon complication in patients with malignancies. No study has reported the occurrence of thromboembolism prior to the diagnosis of acute myeloid leukemia (AML). Most reports are anectodal and data are scarce on this subject. In this report, we present a case of extensive cerebral venous thrombosis (CVT) that was detected a few weeks before the diagnosis of AML, in which case the patient responded well to chemotherapy and anticoagulation.
    Matched MeSH terms: Blood Coagulation
  4. Fulltext Calculation of free and bioavailable vitamin D and its association with bone mineral density in Malaysian women
    Thambiah SC, Wong TH, Das Gupta E, Radhakrishnan AK, Gun SC, Chembalingam G, et al.
    Malays J Pathol, 2018 Dec;40(3):287-294.
    PMID: 30580359
    INTRODUCTION: Low 25-hydroxyvitamin D [25(OH)D] levels have not been consistently associated with bone mineral density (BMD). It has been suggested that calculation of the free/bioavailable 25(OH)D may correlate better with BMD. We examined this hypothesis in a cohort of Malaysian women.

    MATERIALS AND METHODS: A cross-sectional study of 77 patients with rheumatoid arthritis (RA) and 29 controls was performed. Serum 25(OH)D was measured using the Roche Cobas E170 immunoassay. Serum vitamin D binding protein (VDBP) was measured using a monoclonal enzyme-linked immunosorbent assay (ELISA). Free/bioavailable 25(OH)D were calculated using both the modified Vermuelen and Bikle formulae.

    RESULTS: Since there were no significant differences between RA patients and controls for VDBP and 25(OH)D, the dataset was analysed as a whole. Calculated free 25(OH)D by Vermeulen was strongly correlated with Bikle (r = 1.00, p < 0.001). A significant positive correlation was noted between measured total 25(OH)D with free/bioavailable 25(OH)D (r = 0.607, r = 0.637, respectively, p < 0.001). Median free/bioavailable 25(OH)D values were significantly higher in Chinese compared with Malays and Indians, consistent with their median total 25(OH)D. Similar to total 25(OH)D, the free/bioavailable 25(OH)D did not correlate with BMD.

    CONCLUSION: In this first study of a multiethnic female Malaysian population, free/bioavailable 25(OH)D were found to reflect total 25(OH)D, and was not superior to total 25(OH)D in its correlation with BMD. Should they need to be calculated, the Bikle formula is easier to use but only calculates free 25(OH)D. The Vermuelen formula calculates both free/bioavailable 25(OH)D but is more complex to use.
    Matched MeSH terms: Arthritis, Rheumatoid/blood*; Vitamin D/blood; Vitamin D-Binding Protein/blood*
  5. Determining weight-bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention
    Yapp JH, Raja Ahmad RMK, Mahmud R, Mohtarrudin N, Mohamad Yusof L, Abdul Rahim E, et al.
    Wound Repair Regen, 2019 05;27(3):225-234.
    PMID: 30667138 DOI: 10.1111/wrr.12698
    Frequent repositioning is important to prevent pressure ulcer (PU) development, by relieving pressure and recovering damages on skin areas induced by repetitive loading. Although repositioning is the gold standard to prevent PU, there is currently no strategy for determining tissue condition under preventive approaches. In this study, the peak reactive hyperemia (RH) trends and ultrasonographic (US) features are compared with the tissue condition under histopathological examination to determine the potential use of these features in determining the tissue condition noninvasively. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385-485 g, were categorized into three groups and subjected to different recovery times, each with three repetitive loading cycles at skin tissues above of right trochanter area. The first, second, and third groups were subjected to short (3 minutes), moderate (10 minutes), and prolonged (40 minutes) recovery, respectively, while applying fixed loading time and pressure (10 minutes and 50 mmHg, respectively), to provide different degree of recovery and tissue conditions (tissue damage and tissue recovery). Peak RH was measured in the three cycles to determine RH trend (increasing, decreasing, and inconsistent). All rat tissues were evaluated using ultrasound at pre- and post-experiment and rated by two raters to categorize the severity of tissue changes (no, mild, moderate, and severe). The tissue condition was also evaluated using histopathological examination to distinguish between normal and abnormal tissues. Most of the samples with increasing RH trend is related to abnormal tissue (71%); while inconsistent RH trends is more related to normal tissue (82%). There is no relationship between the tissue conditions evaluated under ultrasonographic and histopathological examination. Peak RH trend over repetitive loading may serve as a new feature for determining the tissue condition that leading to pressure ulcer.
    Matched MeSH terms: Regional Blood Flow/physiology*; Skin/blood supply*
  6. Fulltext Clinical dilemma-management of low rectal cancer in a Jehovah’s Witness
    Azhani C., Azmi M.N., David O.
    International Medical Journal Malaysia, 2018;17(3):81-84.
    MyJurnal
    Jehovah’s Witness followers pose a clinical dilemma to the medical practitioners due to their religious belief of an absolute prohibition of blood transfusion under any circumstances. We present a case of Jehovah’s Witness follower who underwent an ultra-low anterior resection for rectal cancer after neo-adjuvant chemo-radiotherapy. The challenges in the perioperative management are highlighted and managed accordingly.
    Matched MeSH terms: Blood Transfusion
  7. Fulltext A study on the frequency of iron deficiency and thalassaemia in blood donors at Pusat Darah Negara, Kuala Lumpur
    Lim WC, Hanachi P, Faraizah AK, Norhanim A, Yasmin A, Duraisamy G
    Malaysian Journal of Medicine and Health Sciences, 2005;1(1):33-40.
    Objective: This study was done to identify blood donors with thalassaemia and iron deficiency. A cross sectional study was carried out at Pusat Darah Negara (PDN), Kuala Lumpur in November 2003.
    Methods: Full blood counts were done on 242 blood donors (166 males and 76 females) Hb analysis and serum ferritin assay were done for all the samples. The first time donors were used as controls.
    Results: Only 20 (8.3%) donors had MCV <80 fL and MCH <26pg. Six of the 25 donors with iron deficiency had a low MCV <80 fL) and low MCH <26 pg) but all the 8 (40%) donors with thalassaemia or HbE had a low MCV and MCH! The mean ferritin levels were found to be lower among regular blood donors (95.3 ug/L) compared to first time blood donors (116.6 ug/L) but this was not statistically significant. There were 25 donors who were iron deficient: one was a first time donor and 24 were regular donors - 12 (50%) had donated 3 times a year in the last two years. Iron deficiency was seen in 12 Malays, and 9 Chinese, and 4 Indians. 13.3% of the males (22 out of 166 donors) and 4% (3 of 76) of female donors were iron deficient. Thalassaemia and HbE were found in 8 donors. HbE trait was identified in 5 Malay donors. One Malay and 1 Chinese donor had beta-thalassaemia trait. Another Chinese had alpha (a^o) thalassaemia trait. Neither HbE nor thalassaemia were seen in the Indian donors.
    Conclusion: In this study thalassaemia and RbE were seen in 3.3% and iron deficiency in 10.3% of the 242 blood donors at PDN. Iron deficiency was present in 3.2% of the first time donors and 12.8% of the regular donors. Regular donors should have the serum ferritin done for their iron status and if their MCV and MCH are low, Hb analysis for thalassaemia or haemoglobinopathy.
    Keywords: Blood donors, serum ferritin, iron deficiency, haemoglobinopathy
    Matched MeSH terms: Blood Donors
  8. Sifat fizikal dan kajian in vitro tablet matriks pelepasan tertahan ketoprofen
    Ibrahim Ijang, Mohd Cairul Iqbal Mohd Amin, Bukhori Abu Bakar
    Sains Malaysiana, 2010;39.
    Penggunaan formulasi tablet pelepasan tertahan untuk dadah anti-inflamatori bukan steroid (DAIBS) seperti aspirin berupaya melindungi lapisan perut dari kesan buruk jus asid tubuh. Kajian ini dilakukan untuk menilai keberkesanan formulasi tablet matriks pelepasan tertahan dengan kepelbagaian kepekatan polimer bersama ketoprofen sebagai model. Tablet dibangunkan dengan menggunakan kaedah granulasi basah yang terdiri daripada polimer hidrofilik (hidroksipropil metilselulosa), polimer hidrifobik bersandar pada pH (Eudragit L100-55) dan polimer tak bersandar pada pH (Eudragit R100) sebagai bahan asas pembentukan matriks pada kepekatan 10, 20 dan 30%b/b. Semua formulasi dimampatkan dengan menggunakan mesin pentabletan yang mempunyai penebuk berbentuk cembung bersaiz 10 mm. Tablet yang terhasil diuji daripada segi keseragaman berat, kekerasan, kerapuhan, ketebalan, peratus kandungan dadah dan kajian pelepasan in vitro menggunakan kaedah BP 2007. Hasil menunjukkan kadar pelepasan dadah dikawal oleh jenis dan kepekatan polimer di dalam formulasi matriks. Secara umumnya peningkatan kepekatan kandungan polimer di dalam tablet matriks didapati mengurangkan kadar pelepasan dadah. Perbandingan polimer melalui kepekatan yang sama menggunakan t50%, pula mendapati terdapat perbezaan statistik bermakna (p<0.05) pada kadar pelepasan dadah. Berdasarkan kepada pelepasan dadah dalam kajian in vitro, polimer hidrofobik bersandar pada pH (Eudragit L100-55) menunjukkan profil pelepasan dadah secara tertib sifar yang terbaik berbanding polimer yang lain.
    Matched MeSH terms: Blood Proteins
  9. Efficacy and quality of life in 30 hypertensive patients treated with low dose captopril
    Choy YW, Cheong I
    Family Physician, 1989;1:19-22.
    This study was carried out on 30 patients to: i) determine the efficacy of low dose captopril as monotherapy (with or without a diuretic) in the treatment of various grades of hypertension. ii) assess the quality of life of these patients 12 weeks after commencement of therapy. Our results showed that there was a sustained and significant fall in both mean systolic and diastolic blood pressure from 171.9 ± 24 to 150.5 ± 25 mm Hg and 109.0 ± 14 to 93.6 ± 15mmHg respectively (p<0.001). Improvement in quality of life was however not statistically significant (p<0.05). We concluded that low dose captopril used alone or in combination with a diuretic can be considered for the initial therapy of mild to moderate hypertension. The optimal dosage and the longterm benefits on quality of life need further evaluation in a larger series.
    Matched MeSH terms: Blood Pressure
  10. The need for and the utility of a simple method of blood-sugar test
    Krishna KV
    Malayan Medical Journal, 1937;12:69-71.
    Matched MeSH terms: Blood Glucose
  11. Agranulocytic angina
    Hughes W
    Malayan Medical Journal, 1935;10:111-2.
    Matched MeSH terms: Blood Cell Count
  12. Fulltext Screening diabetes using 2HPP urine sugar. [Ujian tapisan diabetes mellitus menggunakan 2HPP gula urin.]
    Ali O
    Family Physician, 1989;1(1):42-43.
    The validity of the 2-hour post-prandial (2HPP) urine glucose was determined among a Malay community in Kuala Selangor. Fifty glycosuric and 80 non-glycosuric samples had their capillary blood glucose and fasting blood sugar tested to determine their diabetic status. It was found that the test was very sensitive but less specific (sensitivity 100% and specificity 72.1%). Samples with 2HPP urine glucose of 3 + had a higher probability of being diabetic than the others.
    Matched MeSH terms: Blood Glucose
  13. A six-year review of tubal sterilization at a district hospital (1981-1986)
    Sivalingam N, Bhagat S, Pereira R
    Family Physician, 1989;1:23-27.
    Matched MeSH terms: Blood Pressure
  14. Fulltext Doctors, do not forget to advise your diabetic patient to exercise
    Hassan, B. M.
    Asian Journal of Medicine and Biomedicine, 2018;1(1):17-18.
    MyJurnal
    As primary care doctors, treating patients with Type 2 DM is our bread and butter, as the majority of them seek treatment at health clinics. It is true that some of the patients have managed to achieve good glycaemic control, but more than half of them still have poorly controlled blood sugar as compared to the clinical practice guideline recommendation [1]. And usually, the first thing that comes to our mind when seeing these patients is to increase the dosage of anti-diabetic medication that they are currently on or to add another agent, including insulin. We also frequently tell them that the high blood sugar level is not surprising, as such is the nature of diabetes, where the worsening of blood sugar is expected due to progressive deterioration of pancreatic beta cell function.
    Matched MeSH terms: Blood Glucose
  15. Establishment of an immunofluorescence assay to detect IgM antibodies to Nipah virus using HeLa cells expressing recombinant nucleoprotein
    Kaku Y, Park ES, Noguchi A, Inoue S, Lunt R, Malbas FF, et al.
    J Virol Methods, 2019 07;269:83-87.
    PMID: 30954461 DOI: 10.1016/j.jviromet.2019.03.009
    A novel indirect fluorescent antibody test (IFAT) for detection of IgM against Nipah virus (NiV) was developed using HeLa 229 cells expressing recombinant NiV nucleocapsid protein (NiV-N). The NiV IFAT was evaluated using three panels of sera: a) experimentally produced sera from NiV-N-immunized/pre-immunized macaques, b) post-infection human sera associated with a Nipah disease outbreak in the Philippines in 2014, and c) human sera from a non-exposed Malaysian population. Immunized macaque sera showed a characteristic granular staining pattern of the NiV-N expressed antigen in HeLa 229 cells, which was readily distinguished from negative-binding results of the pre-immunized macaque sera. The IgM antibody titers in sequential serum samples (n = 7) obtained from three Nipah patients correlated well with previously published results using conventional IgM capture ELISA and SNT serology. The 90 human serum samples from unexposed persons were unreactive by IFAT. The IFAT utilizing NiV-N-expressing HeLa 229 cells to detect IgM antibody in an early stage of NiV infection is an effective approach, which could be utilized readily in local laboratories to complement other capabilities in NiV-affected countries.
    Matched MeSH terms: Antibodies, Viral/blood*; Immunoglobulin M/blood*; Henipavirus Infections/blood
  16. Changes in skeletal muscle thickness and echogenicity and plasma creatinine concentration as indicators of protein and intramuscular fat mobilization in periparturient dairy cows
    Megahed AA, Hiew MWH, Ragland D, Constable PD
    J Dairy Sci, 2019 Jun;102(6):5550-5565.
    PMID: 30954258 DOI: 10.3168/jds.2018-15063
    High-producing dairy cows experience a state of negative energy balance in the periparturient period that is partially addressed by increasing the rate of fat and protein mobilization. Previous studies have focused on the rate of fat mobilization, and consequently the rate of protein mobilization has not been well characterized. The objective of this study was therefore to determine the change in indicators of muscle mass during early lactation using ultrasonographic measurement of muscle thickness and changes in plasma creatinine concentration. The maximum thickness of the gluteus medius and longissimus dorsi muscles of 106 Holstein cows (34 primiparous, 72 multiparous) was determined ultrasonographically on d -3, 0, 3, 7, 14, 21, and 28 relative to the day of parturition. Plasma creatinine concentration was measured periodically during the same period. Mixed models analysis and Passing-Bablok regression were used to analyze the data. Gluteus medius thickness, longissimus dorsi loin thickness (LDLT), and longissimus dorsi thoracic thickness (LDTT) were decreased at 28 d postpartum compared with d 3 antepartum. Plasma creatinine concentration was weakly associated with gluteus medius thickness, LDLT, and LDTT (Spearman's rho = 0.31, 0.39, and 0.32, respectively). Plasma creatinine concentration in primiparous and multiparous cows at 28 d postpartum decreased by 0.24 and 0.30 mg/dL, respectively, compared with values 3 d antepartum. We concluded that ultrasonographic measurement of LDLT and LDTT and change in plasma creatinine concentration may provide practical methods for monitoring the rate of protein mobilization in periparturient dairy cows. Ultrasonographic examination of LDLT and LDTT therefore complements ultrasonographic measurement of backfat thickness and may be useful in the evaluation of energy reserve mobilization in periparturient dairy cows.
    Matched MeSH terms: Cattle/blood*; Creatinine/blood*; Postpartum Period/blood
  17. Fulltext A study of (a) the prevalence of hypertension (b) the distribution of blood groups, in Sibu, Sarawak, July - August 1988
    Hu CH
    Family Practitioner, 1988;11(3):67-69.
    Matched MeSH terms: ABO Blood-Group System
  18. Serum and urine interleukin-17A levels as biomarkers of disease activity in systemic lupus erythematosus
    Nordin F, Shaharir SS, Abdul Wahab A, Mustafar R, Abdul Gafor AH, Mohamed Said MS, et al.
    Int J Rheum Dis, 2019 Aug;22(8):1419-1426.
    PMID: 31179646 DOI: 10.1111/1756-185X.13615
    OBJECTIVES: This study examined the correlations of both serum and urine interleukin-17A (IL-17A) levels with disease activity in systemic lupus erythematosus (SLE). This study was also aimed at determining their sensitivity and specificity as biomarkers of disease activity in SLE.

    METHODS: A cross-sectional study was performed involving SLE patients (n = 120 patients) from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Serum and urinary IL-17A levels were determined by immunoassay while disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) and British Isles Lupus Assessment Group's 2004 index (BILAG 2004) scores. The correlations between serum and urinary IL-17A levels with total SLEDAI-2K and BILAG 2004 scores were determined using bivariate correlation analyses. Receiver operating characteristic curves were calculated to determine their sensitivity and specificity as disease activity biomarkers.

    RESULTS: Both serum and urinary IL-17A levels correlated with total scores of BILAG 2004, BILAG renal, BILAG mucocutaneous, and SLEDAI-2K (P 

    Matched MeSH terms: Lupus Erythematosus, Systemic/blood*; Biomarkers/blood; Interleukin-17/blood*
  19. Fulltext Modeling the Physical Properties of Gamma Alumina Catalyst Carrier Based on an Artificial Neural Network
    Majdi HS, Saud AN, Saud SN
    Materials (Basel), 2019 May 29;12(11).
    PMID: 31146451 DOI: 10.3390/ma12111752
    Porous γ-alumina is widely used as a catalyst carrier due to its chemical properties. These properties are strongly correlated with the physical properties of the material, such as porosity, density, shrinkage, and surface area. This study presents a technique that is less time consuming than other techniques to predict the values of the above-mentioned physical properties of porous γ-alumina via an artificial neural network (ANN) numerical model. The experimental data that was implemented was determined based on 30 samples that varied in terms of sintering temperature, yeast concentration, and socking time. Of the 30 experimental samples, 25 samples were used for training purposes, while the other five samples were used for the execution of the experimental procedure. The results showed that the prediction and experimental data were in good agreement, and it was concluded that the proposed model is proficient at providing high accuracy estimation data derived from any complex analytical equation.
    Matched MeSH terms: Blood Physiological Phenomena
  20. Fulltext Defining Disease Progression and Drug Durability in Type 2 Diabetes Mellitus
    Kalra S, Kamaruddin NA, Visvanathan J, Santani R
    Eur Endocrinol, 2019 Aug;15(2):67-69.
    PMID: 31616495 DOI: 10.17925/EE.2019.15.2.67
    This communication shares insights into the definition of disease progression and drug durability in type 2 diabetes. Disease progression may be defined as gradual worsening of beta-cell function, clinically observed as an increase in drug dosage, drug frequency or number of glucose lowering drugs needed to maintain HbA1c control; and/or a ≥0.5% rise in HbA1c, unexplained by acute, modifiable factors, while using the same drug regimen; and/or as the occurrence or worsening of cardiovascular or microvascular complications, in spite of standard care, over a pre-specified time period. Durability of a drug or a drug combination may be defined as its ability to postpone or delay progression of disease, in a safe and well tolerated manner. Thus, all drugs that are able to prevent disease progression (i.e., postpone loss of glycaemic control, need for intensification of therapy or onset or worsening of complications) may be termed 'durable'.
    Matched MeSH terms: Blood Glucose
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