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Endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: Implementation of an institution safety protocol during the COVID-19 outbreak in Malaysia

Yusoff AR, Ahmad F, Obaid KJ

Med J Malaysia, 2020 11;75(6):764-766.
PMID: 33219198

Coronavirus disease 2019 (COVID-19) is a highly contagious, severe acute respiratory syndrome that poses significant health risks to healthcare providers. A delicate balance is needed between timely intervention for ill patients without apparent COVID-19 infection and the safety of healthcare personnel who provide essential treatment in the midst of the pandemic. We report our experience managing a 70-year-old man who presented with acute gallstone pancreatitis at our hospital during the COVID-19 outbreak in Malaysia. We also describe the safety protocol measures that have been implemented in our institution to protect the healthcare personnel from this disease during endoscopic retrograde cholangiopancreatography. This case illustrates the importance of meticulous planning, risk assessment, effective team communication and strict adherence to recommendations when providing treatment during an unprecedented pandemic.
Fulltext Association between Perceived Oral Symptoms and Presence of Clinically Diagnosed Oral Diseases in a Sample of Pregnant Women in Malaysia

Yunita Sari E, Saddki N, Yusoff A

Int J Environ Res Public Health, 2020 10 08;17(19).
PMID: 33049972 DOI: 10.3390/ijerph17197337

The integration of oral health into primary health care denotes the important role of medical counterparts as the front liners in antenatal care to help screen mothers for oral symptoms and refer them to dentists accordingly. However, the validity of self-perceived oral health status is inconclusive. This study determined the association between self-perceived oral symptoms and the presence of clinically diagnosed oral diseases in a sample of pregnant women. A total of 192 pregnant women participated in this cross-sectional study. Clinical oral examinations were performed to record dental caries experience, gingival health and periodontal health. The women were also asked about their oral symptoms. Most women had at least one oral symptom (84.9%): cavitated tooth (62.0%), bad breath (38.5%), bleeding gums (28.6%), and toothache (22.9%). About half of the women had untreated dental caries (58.9%), and the odds were significantly higher in women who complained of having cavitated tooth. About half of the women had moderate to severe gingivitis (53.7%), and the odds were significantly higher in women who complained of bleeding gums. About half had periodontal pockets (46.3%), and the odds were higher in women who complained of bleeding gums and bad breath although lower in women who complained of swollen gums. In conclusion, the prevalence of dental caries and periodontal disease among pregnant women in this study were relatively high. The presence of untreated dental caries, moderate and severe gingivitis, and periodontal pockets were significantly associated with their corresponding oral symptoms.
Nylon 6,6 modified screen printed carbon electrodes as electrochemical sensors for rapid chlorothalonil determination in water samples using differential pulse cathodic stripping voltammetry

Thanalechumi P, Mohd Yusoff AR, Yusop Z

J Environ Sci Health B, 2019;54(4):294-302.
PMID: 30729855 DOI: 10.1080/03601234.2018.1561057

A newly developed electrochemical sensor for chlorothalonil based on nylon 6,6 film deposited onto screen printed electrode (SPE) with electrochemical modulation of pH at the electrode/solution interface was studied for the first time. Differential pulse cathodic stripping voltammetry (DPCSV) was used to carry out the electrochemical and analytical studies. Experimental parameters such as accumulation potential, initial potential, accumulation time and pH of Britton-Robinson buffer have been optimized. Chlorothalonil gave optimum analytical signal in a medium of 0.04 M Britton-Robinson buffer at pH 6.0. A well-defined reduction peak was observed, at Ep= -0.851 and -0.938 V vs. Ag/AgCl (3.0 M KCl) for both bare SPE and modified SPE, respectively. The peak currents of modified SPE were significantly increased as compared to bare SPE. At the modified SPE, a linear relationship between the peak current and chlorothalonil concentration was obtained in the range from 0.1 to 2.8 × 10-6 M with a detection limit of 1.53 × 10-8 M (S/N= 3). The practical applicability of the newly developed method has been demonstrated on analyses of real water samples. The newly developed sensor shows good reproducibility with RSD of 3.92%. The nylon 6,6 modified SPE showed itself as promising sensor with good selectivity for chlorothalonil determination.
Repeat endoscopy for recurrent iron deficiency anemia: an (un)expected finding from southeast Asia

Mahadeva S, Qua CS, Yusoff W, Sulaiman W

Dig Dis Sci, 2007 Feb;52(2):523-5.
PMID: 17219070
Physicochemical Properties of a Highly Efficient Cu-Ion-Doped TiO₂ Nanotube Photocatalyst for the Degradation of Methyl Orange Under Sunlight

Razali MH, Noor AFM, Yusoff M

J Nanosci Nanotechnol, 2020 02 01;20(2):965-972.
PMID: 31383093 DOI: 10.1166/jnn.2020.16944

In this study, a series of copper-ion-doped titanium dioxide (Cu-ion-doped TiO₂) nanotubes (NTs) were synthesized via a hydrothermal method by the concentration variation of doped Cu ions (0.00, 0.50, 1.00, 2.50, and 5.00 mmol). In addition, the samples were characterized using X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), nitrogen gas adsorption measurements, and ultraviolet-visible (UV-Vis) diffuse-reflectance spectroscopy. The photocatalytic activity of the Cu-iondoped TiO₂ NTs was investigated for the degradation of methyl orange (MO) under sunlight. The results obtained from the structural and morphological studies revealed that, at low concentrations of Cu-doped TiO₂ NTs, Cu is incorporated into the interstitial positions of the TiO₂ lattice, affording a new phase of TiO₂ (hexagonal) instead of the anatase TiO₂ (tetragonal) observed for undoped TiO₂ NTs. EDX analysis confirmed the presence of Cu in the TiO₂-based photocatalyst. All of the investigated samples exhibited a hollow fibrous-like structure, indicative of an NT morphology. The inner and outer diameters of the NTs were 4 nm and 10 nm, respectively. The photocatalysts exhibited a large surface area due to the NT morphology and a type IV isotherm and H3 hysteresis, corresponding to the mesopores and slit-shaped pores. The Cu-ion-doped TiO₂ NTs were excited by sunlight because of their low bandgap energy; and after the incorporation of Cu ions into the interstitial positions of the TiO₂ lattice, the NTs exhibited high visible-light activity owing to the low bandgap.
Fulltext Preserving professional identities, behaviors, and values in digital professionalism using social networking sites; a systematic review

Guraya SS, Guraya SY, Yusoff MSB

BMC Med Educ, 2021 Jul 12;21(1):381.
PMID: 34247617 DOI: 10.1186/s12909-021-02802-9

BACKGROUND: Despite a rapid rise of use of social media in medical disciplines, uncertainty prevails among healthcare professionals for providing medical content on social media. There are also growing concerns about unprofessional behaviors and blurring of professional identities that are undermining digital professionalism. This review tapped the literature to determine the impact of social media on medical professionalism and how can professional identities and values be maintained in digital era.
METHODS: We searched the databases of PubMed, ProQuest, ScienceDirect, Web of Science, and EBSCO host using (professionalism AND (professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics))) AND ((social media) AND ((social media) OR (social networking sites) OR Twitter OR Facebook)) AND (health professionals). The research questions were based on sample (health professionals), phenomenon of interest (digital professionalism), design, evaluation and research type. We screened initial yield of titles using pre-determined inclusion and exclusion criteria and selected a group of articles for qualitative analysis. We used the Biblioshiny® software package for the generation of popular concepts as clustered keywords.
RESULTS: Our search yielded 44 articles with four leading themes; marked rise in the use of social media by healthcare professionals and students, negative impact of social media on digital professionalism, blurring of medical professional values, behaviors, and identity in the digital era, and limited evidence for teaching and assessing digital professionalism. A high occurrence of violation of patient privacy, professional integrity and cyberbullying were identified. Our search revealed a paucity of existing guidelines and policies for digital professionalism that can safeguard healthcare professionals, students and patients.
CONCLUSIONS: Our systematic review reports a significant rise of unprofessional behaviors in social media among healthcare professionals. We could not identify the desired professional behaviors and values essential for digital identity formation. The boundaries between personal and professional practices are mystified in digital professionalism. These findings call for potential educational ramifications to resurrect professional virtues, behaviors and identities of healthcare professionals and students.
Comparison of reconstructed rapid prototyping models produced by 3-dimensional printing and conventional stone models with different degrees of crowding

Wan Hassan WN, Yusoff Y, Mardi NA

Am J Orthod Dentofacial Orthop, 2017 Jan;151(1):209-218.
PMID: 28024776 DOI: 10.1016/j.ajodo.2016.08.019

INTRODUCTION: Rapid prototyping models can be reconstructed from stereolithographic digital study model data to produce hard-copy casts. In this study, we aimed to compare agreement and accuracy of measurements made with rapid prototyping and stone models for different degrees of crowding.
METHODS: The Z Printer 450 (3D Systems, Rock Hill, SC) reprinted 10 sets of models for each category of crowding (mild, moderate, and severe) scanned using a structured-light scanner (Maestro 3D, AGE Solutions, Pisa, Italy). Stone and RP models were measured using digital calipers for tooth sizes in the mesiodistal, buccolingual, and crown height planes and for arch dimension measurements. Bland-Altman and paired t test analyses were used to assess agreement and accuracy. Clinical significance was set at ±0.50 mm.
RESULTS: Bland-Altman analysis showed the mean bias of measurements between the models to be within ±0.15 mm (SD, ±0.40 mm), but the 95% limits of agreement exceeded the cutoff point of ±0.50 mm (lower range, -0.81 to -0.41 mm; upper range, 0.34 to 0.76 mm). Paired t tests showed statistically significant differences for all planes in all categories of crowding except for crown height in the moderate crowding group and arch dimensions in the mild and moderate crowding groups.
CONCLUSIONS: The rapid prototyping models were not clinically comparable with conventional stone models regardless of the degree of crowding.
Fulltext Descriptive study on the medical students well-being workshop

Yusoff MSB, Abdul Rahim AF

Education in Medicine Journal, 2009;1(1):1-6.
MyJurnal

Background: Tertiary education environment has always been regarded as highly stressful to students. Medical training further adds to the already stressful environment. The stress of medical training was associated with negative consequences to the mental and physical health of medical students. We describe in this article a stress-management program known as the 'Medical Student Well-Being Workshop' in our medical school.

Methodology: The workshop was run over two half-days over a weekend. Prior to the workshop the society announced the workshop to the students and participation was voluntary. It was open to students from all years of the medical course except for first year students. A separate stress management workshop is planned for them.

Results: A total of 55 students participated in the workshop, out of which 55 (82%) were female students. The years of study were almost equally represented; 14 students (26%) from years two and three, 20 (37%) from year four and 6 (11%) from year five. All sessions were rated as highly useful; the lowest rated, the introduction session, obtained an overall usefulness rating of 3.73 out of the possible 5 (74.6%).

Conclusion: Medical Students Well-being Workshop is a promising intervention program in improving medical students' ability in managing stress. Perhaps similar approach can be considered relevant to be incorporated in other medical schools.
Fulltext Serum cortisol level and survival rate of juvenile Epinephelus fuscoguttatus following exposure to different salinities

Tahir D, Shariff M, Syukri F, Yusoff FM

Vet World, 2018 Mar;11(3):327-331.
PMID: 29657425 DOI: 10.14202/vetworld.2018.327-331

Background and Aim: Brown-marbled grouper Epinephelus fuscoguttatus is a premium marine food fish with high demand in Asia. In fish, stress due to environmental changes such as fluctuations in the salinity can result in increased cortisol level. Stress in fish increases susceptibility to diseases ultimately resulting in death. Therefore, the aim of this study was to investigate the salinity tolerance of E. fuscoguttatus and their survival in lower salinities.
Materials and Methods: In this study, grouper juveniles (92.43±standard error of the mean 0.51 mm) maintained in 31 ppt seawater were transferred into five tanks with seawater diluted to 25, 20, 15, 10, and 5 ppt. The salinity of the control group was not changed and was maintained at 31 ppt. Serum cortisol was measured using ELISA at 0, 30, 60, and 120 min after the fish were transferred to the different concentrations of salinity.
Results: The survival percentage was recorded for 14 days following the transfer and the results revealed that serum cortisol of fish in a high change in salinity (15, 10, and 5 ppt) was significantly higher than the control group immediately after exposure. At the high salinity change, the cortisol levels gradually decrease at 30 min and 60 min, until no difference in cortisol concentration was observed at 120 min. No mortality was observed in fish exposed to low salinity change (25 and 20 ppt) while in higher salinity change (5 ppt), the survival percentage was 50%.
Conclusion: The study revealed that the serum cortisol concentration was high initially and continues to decrease to resting cortisol level at 120 min indicating that cortisol hormone is released following acute stress as a primary response in grouper juveniles.
Fulltext A simple voltammetric determination of metsulfuron-methyl in water samples using differential pulse cathodic stripping voltammetry

Thanalechumi P, Mohd Yusoff AR, Yusop Z

J Pestic Sci, 2017 May 20;42(2):39-44.
PMID: 30363139 DOI: 10.1584/jpestics.D16-086

The voltammetric determination of metsulfuron-methyl, a type of pesticide, was investigated on a hanging mercury drop electrode using a differential pulse cathodic stripping voltammetry technique. The experimental parameters, such as the pH of the Britton-Robinson buffer, accumulation time, accumulation potential and initial potential were optimized for the metsulfuron-methyl determination. A well-defined reduction peak was observed at pH 2.0 to 4.0 in the potential range of -0.75 to -1.0 V. The pH of 2.0 was chosen as the optimum pH due to a good stripping signal of the reduction peak. There were no significant interfering ion effects on the electroanalysis of metsulfuron-methyl. The optimized parameters were then used to determine metsulfuron-methyl in the commercial pesticide Ally. The proposed method was highly sensitive due to the lower limit of determination (0.04 mg/L), being relatively selective, and consisting of good precision. The recovery values achieved were about 93% in water samples for this analysis.
Fulltext Young Lady with Bilateral Yellowish Lesions on Her Eyelids

Ishak A, Mohd Yusoff SS, Wan Abdullah W

Malays Fam Physician, 2018;13(3):44-46.
PMID: 30800235 MyJurnal

A 26-year-old woman with an unknown medical illness presented with yellowish skin lesions around both eyes, visible for the past 4 years. The lesions were neither itchy nor tender and had increased gradually in size. She had neither constitutional nor hyperthyroidism symptoms. She is the youngest out of four siblings, and none of her family members have cardiovascular disease or similar problems. Upon examination, there were bilateral yellowish plaques over the periorbital region. Her body mass index (BMI) was 23.8 kg/m2. Her vital signs were all normal at every visit.
Adherence to tyrosine kinase inhibitors among adult chronic myeloid leukemia patients in a Malaysia hospital

Lee PM, Chang CT, Yusoff ZM

Int J Clin Pharm, 2021 Feb;43(1):46-54.
PMID: 32524510 DOI: 10.1007/s11096-020-01070-9

Background Tyrosine kinase inhibitors have been demonstrated to improve the survival of patients with chronic myeloid leukaemia. However, medication adherence is vital for patients on chronic treatment. Objective The objective of the current study was to evaluate response to treatment, adherence by patients to tyrosine kinase inhibitors and factors associated with adherence and response. Setting A haematology clinic in a regional referral hospital in Malaysia. Method Patients aged ≥ 13 years who had been on imatinib or nilotinib for ≥ 12 months were included in this cross-sectional study. An optimal response was defined as the achievement of major molecular response at 12 months of treatment. Patient medication adherence was determined using the average medication possession ratio based on the dispensing records. The patients were considered adherent if the medication possession ratio was > 90%. Multiple logistic regression was performed to evaluate the factors associated with adherence. The association of adherence with molecular response was analysed by univariate logistic regression. Main outcome measure The primary outcome measures were the proportion of patients who achieved optimal response and the medication possession ratio. Results A total of 151 patients were screened, and 71 patients were included. Twenty-eight patients (39%) achieved major molecular response at 12 months of treatment. The median time to achieve this was 15.5 months (an interquartile range of 15). The mean medication possession ratio for imatinib and nilotinib was 0.94 (± 0.14) and 0.96 (± 0.10), respectively, but this difference was without statistical significance (t = - 0.517, p = 0.610). Nausea and vomiting (odds ratio [OR] of 0.25, 95% confidence interval [CI]: 0.07-0.83, p = 0.023) and disease phase at diagnosis (OR of 0.20, 95% CI 0.04-1.06, p = 0.059) were associated with patient adherence. An association was not found between patient adherence and molecular response (OR of 1.03, 95% CI 0.35-3.09, p = 0.956). Conclusion The patients in this study demonstrated a relatively deep molecular response and optimal adherence. Nevertheless, one fourth of them were noncompliant with imatinib. Therefore, active interventions are warranted to prevent treatment-associated adverse events and improve adherence.
Fulltext Towards sustainable transport policy framework: A rail-based transit system in Klang Valley, Malaysia

Yusoff I, Ng BK, Azizan SA

PLoS One, 2021;16(3):e0248519.
PMID: 33711053 DOI: 10.1371/journal.pone.0248519

This study examines the sustainable transport policy framework in the case of railway development in Klang Valley, Malaysia. It is guided by the main principle that sustainable transport policy is a result of the integration of broad policy instruments that range from infrastructure provision and management, technological improvements, regulation, information, awareness, education, and pricing and taxation. Although this study is mainly qualitative, performance data available at the ASEAN Statistics Division, World Bank Open Data and Global Competitiveness Reports. This is followed by in-person interviews with experts who have vast knowledge, experience, and direct participation in sustainable railway development in Malaysia, especially those related to the Klang Valley development. The main findings have indicated that the current framework in Malaysia meets the criteria of sustainable development policy framework, which are essentially constituted within environmental protection. It also constitutes the pursuance of long-term growth in terms of economic and societal needs. Nonetheless, the rail-based transit system in Malaysia is highly driven by the Government and there is no clear sign indicating that the public is shifting from the road and private transport to rail-based services.
Chemical characterization and antimicrobial activity of rhizome essential oils of very closely allied Zingiberaceae species endemic to Borneo: Alpinia ligulata K. Schum. and Alpinia nieuwenhuizii Val

Yusoff MM, Ibrahim H, Hamid NA

Chem Biodivers, 2011 May;8(5):916-23.
PMID: 21560240 DOI: 10.1002/cbdv.201000270

Two poorly studied, morphologically allied Alpinia species endemic to Borneo, viz., A. ligulata and A. nieuwenhuizii, were investigated here for their rhizome essential oil. The oil compositions and antimicrobial activities were compared with those of A. galanga, a better known plant. A fair number of compounds were identified in the oils by GC-FID and GC/MS analyses, with large differences in the oil composition between the three species. The rhizome oil of A. galanga was rich in 1,8-cineole (29.8%), while those of A. ligulata and A. nieuwenhuizii were both found to be extremely rich in (E)-methyl cinnamate (36.4 and 67.8%, resp.). The three oils were screened for their antimicrobial activity against three Gram-positive and three Gram-negative bacteria and two fungal species. The efficiency of growth inhibition of Staphylococcus aureus var. aureus was found to decline in the order of A. nieuwenhuizii>A. ligulata ∼ A. galanga, while that of Escherichia coli decreased in the order of A. galanga>A. nieuwenhuzii ∼ A. ligulata. Only the A. galanga oil inhibited the other bacteria and the fungi tested.
Fulltext Classification and Morphology of Rhinocypha spp. (Odonata): A Comprehensive Taxonomic Study Within the Females

Mamat N, Abu A, Yusoff NR

Zool Stud, 2021;60:e47.
PMID: 35003341 DOI: 10.6620/ZS.2021.60-47

Studies on Odonata have gained attention worldwide as well as locally in Malaysia. Although there is a wealth of data available to be utilized for solving taxonomic problems, ecological and behavioural research areas are more favoured than taxonomy and systematics. Thus, there are confusions over how to correctly identify closely related and sympatric species, especially in female odonates. One such example is in the genus Rhinocypha. Consequently, the present study focuses on taxonomic work, employing multi-approaches in the form of morphological (morphological diagnostics, Field Emission Scanning Electron Microscope (FESEM) and geometric morphometric analysis), applying the molecular technique. Seventeen morphological characteristics were created to differentiate between the females of Rhinocypha spp. A FESEM was used on the female's ovipositor to focus on the anal appendages and sheathing valve (V3). Also, the phylogenetic patterns expressed by COI and 16S rRNA genes, and canonical variate analysis for the wing geometric morphometric revealed three clusters that supported the distinction of the Rhinocypha group. In summary, this study effectively developed an integrated approach of classic morphological and trendy molecular, combined with FESEM microscopy techniques, which provided corroborative evidence and resolved taxonomic uncertainties.
Sustainable aquaculture of Asian arowana--a review

Medipally SR, Yusoff FM, Sharifhuddin N, Shariff M

J Environ Biol, 2016 07;37(4 Spec No):829-38.
PMID: 28779745

Asian arowana, Scleropages formosus is a highly valued aquarium fish in the world, particularly in Asian countries, and has been listed as one of the most highly endangered species. This is a freshwater, carnivorous, fairly large mouth breeding fish belonging to the family Osteoglossidae. Arowana can be found in different colour varieties such as green, red, silver and golden. Among these varieties, Malaysian golden is the most valuable fish and is endemic to the Krian riverine system, Malaysia. However, overexploitation, habitat change and pollution have caused a serious decline of this arowana variety. Recently, arowana aquaculture industry is expanding rapidly in Southeast Asian countries. However, difficulties in an accurate differentiation of sex and strains, causing imbalanced stocking ratios for optimum spawning, remain major obstacles in maximizing arowana production. In addition, problems in sustainable water sources of suitable quality and prevention of diseases need to be addressed. Recirculating aquaculture system (RAS) and bioremediation are two possible technologies that could be used to minimize pollution and ensure adequate high-quality water for arowana culture. In addition, the application of appropriate molecular markers for sex and strain identification is also an important strategy required for the improvement of captive breeding. This review discusses several issues such as the importance of arowana as an aquarium fish, its market demand, current problems in the arowana aquaculture industry and the possible technologies to enhance reproductive capacity and increase culture production. ?
Seasonal variations of zooplankton biomass and size-fractionated abundance in relation to environmental changes in a tropical mangrove estuary in the Straits of Malacca

Balqis ARS, Yusoff FM, Arshad A, Nishikawa J

J Environ Biol, 2016 Jul;37(4 Spec No):685-95.
PMID: 28779727

Seasonal variations of zooplankton community in terms of biomass and size-fractionated densities were studied in a tropical Sangga Kechil river, Matang, Perak from June 2010 to April 2011. Zooplankton and jellyfish (hydromedusae, siphonophores and ctenophores) samples were collected bimonthly from four sampling stations by horizontal towing of a 140-?m plankton net and 500 ?m bongo net, respectively. A total of 12 zooplankton groups consisting of six groups each of mesozooplankon (0.2 mm-2.0 mm) and macrozooplankton (2.0 mm-20.0 cm) were recorded. The total zooplankton density (12375?3339 ind m(-3)) and biomass (35.32?14.56 mg m(-3)) were highest during the northeast (NE) monsoon and southwest (SW) monsoon, respectively, indicating the presence of bigger individuals in the latter season. Mesozooplankton predominated (94%) over the macrozooplankton (6%) during all the seasons, and copepods contributed 84% of the total mesozooplankton abundance. Macrozooplankton was dominated by appendicularians during most of the seasons (43%-97%), except during the NE monsoon (December) when chaetognaths became the most abundant (89% of the total macrozooplankton). BIO-ENV analysis showed that total zooplankton density was correlated with turbidity, total nitrogen and total phosphorus, which in turn was positively correlated to chlorophyll a. Cluster analysis of the zooplankton community showed no significant temporal difference between the SW and NE monsoon season during the study period (> 90% similarity). The present study revealed that the zooplankton community in the tropical mangrove estuary in the Straits of Malacca was dominated by mesoplankton, especially copepods.
Fulltext An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre

Mohamed N, Mohd Zin F, Mohd Yusoff SS

Malays Fam Physician, 2017;12(2):29-31.
PMID: 29423128

Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.

Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.

Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.
Fulltext Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006

Goh PP, Omar MA, Yusoff AF

Singapore Med J, 2010 Aug;51(8):631-4.
PMID: 20848059

INTRODUCTION: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.
METHODS: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.
RESULTS: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.
CONCLUSION: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.
Study name: National Health and Morbidity Survey (NHMS-2006)
Fulltext Anticholinesterase inhibitory activity of quaternary alkaloids from Tinospora crispa

Yusoff M, Hamid H, Houghton P

Molecules, 2014 Jan 20;19(1):1201-11.
PMID: 24448061 DOI: 10.3390/molecules19011201

Quaternary alkaloids are the major alkaloids isolated from Tinospora species. A previous study pointed to the necessary presence of quaternary nitrogens for strong acetylcholinesterase (AChE) inhibitory activity in such alkaloids. Repeated column chromatography of the vine of Tinospora crispa extract led to the isolation of one new protoberberine alkaloid, 4,13-dihydroxy-2,8,9-trimethoxydibenzo[a,g]quinolizinium (1), along with six known alkaloids-dihydrodiscretamine (2), columbamine (3), magnoflorine (4), N-formylannonaine (5), N-formylnornuciferine (6), and N-trans-feruloyltyramine (7). The seven compounds were isolated and structurally elucidated by spectroscopic analysis. Two known alkaloids, namely, dihydrodiscretamine and columbamine are reported for the first time for this plant. The compounds were tested for AChE inhibitory activity using Ellman's method. In the AChE inhibition assay, only columbamine (3) showed strong activity with IC50 48.1 µM. The structure-activity relationships derived from these results suggest that the quaternary nitrogen in the skeleton has some effect, but that a high degree of methoxylation is more important for acetylcholinesterase inhibition.

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