According to tradition, plants and herbs are potential cures for numerous illnesses. In recent decades, they have gained worldwide recognition as critical sources of new drugs, especially for cancer, and the focus on medicinal plant research has increased tremendously. Currently, research scientists attribute the occurrence of post-chemotherapy tumour exacerbation to the presence of cancer stem cells hidden in the bulk of the malignant tumour, forming a rare subpopulation that plays a major role in tumour re-initiation, progression and recurrence. There is increasing evidence of cancer stem cells in a wide array of tumours, and these cells could be the crucial target for future chemotherapy approaches. This review of the major plant-basedphy to chemicals with documented antagonistic activities against cancer stem cells, their molecular targets and the mechanisms involved, may serve as a guide for developing from the existing natural agents, more effective, and broader spectrum anti-cancer stem cell compounds with the potential for clinical application.
The liver is an important organ of the human body, playing a major role in the metabolism and storage of nutrients, synthesis of protein and other nutrients, as well as detoxifying many metabolic by-products. The response of the foetal and newborn liver to external insult and injury is limited. This is because the ability of the closely interdependent structures of a developing liver of expressing in the face of a variety of insults is limited as well. Thus most infants with insults to the liver present as cholestatic jaundice with variable degree of pale stools, enlarged liver and conjugated hyperbilirubinaemia. Biliary atresia, an idiopathic condition characterized by progressive fibrosing obliteration of both intra- and extrahepatic bile ducts, is the most important cause of neonatal cholestasis worldwide, including Malaysia. It is also the most important indication for childhood liver transplantation the world over. Challenges facing infants with biliary atresia include a delay in the diagnosis and late surgery, leading to a poor outcome. This often results from a failure to recognise the potential serious nature of an infant with prolonged cholestatic jaundice and pale stools among health care professionals.
Venous malformations (VM) of vulva, perineum and pelvis are uncommon condition which may present with cutaneous varices or aesthetically disabling swelling of external genitalia. Herein, we report a young woman who presented with a large left vulva bluish tinged swelling, progressively increasing in size since birth. Computed tomography of the pelvis and lower limbs confirmed the diagnosis of extensive VM of pelvis and perineum. She underwent selective angiogram which revealed venous malformations of left vulva and gluteal region with no arterial supply to the lesion. Surgical excision was performed but complicated with bleeding which necessitate multimodal hemostatic procedures and blood transfusion. There is no recurrent swelling after 5 years follow up. Surgical excision of vulvar venous malformation offer good cosmetic outcome. However, appropriate planning with axial scan, angiogram and operative technique including multimodal hemostatic measure are important steps to achieve good result with no recurrence. We discussed on challenges on management of this case in relation to the currently available literature.
The records of 141 consecutive patients with proven tuberculosis (TB) were reviewed to examine for changes in their serum proteins, erythrocyte sedimentation rate (ESR) and tuberculin skin test reactivity. Hypoalbuminaemia was present in 73% of patients and hyperglobulinaemia was seen in 92% of patients. ESR showed a negative correlation with the serum albumin level but a positive correlation with the serum globulin level. In the case of pulmonary TB, ESR was higher in patients with radiologically more extensive disease. Tuberculin reactivity was reduced in patients who were older, those with more severe hypoalbuminaemia and those with disseminated TB. KEYWORDS: Albumin, erythrocyte sedimentation rate, globulin, tuberculin reactivity, tuberculosis
INTRODUCTION: Health-risky behaviours among undergraduates are a course of concern both due to its tendency to be carried towards later adulthood and the emergence of non-communicable diseases at younger age group.
METHODS AND MATERIAL: A cross-sectional study involving 1622 respondents comprising of students undertaking tertiary education was carried out using self-administered questionnaires. (adapted and translated into Bahasa Malaysia from the CDC Health Risk Behaviour Survey)
RESULTS: It is found that 6.9% of the respondents have had sexual intercourse with the mean age of the first intercourse at 18.6 years. Of those who have had intercourse, 25.9% did not practice safe sex. The study showed that 7.2% of the undergraduates who drives have driven after taking alcohol and 19.3% of the respondents have travelled in a car driven by drunk driver. It is also found that 10.8% of the respondents tried smoking at a young age of 15 years. One point two percent (1.2%) of the studied population has also taken recreational drugs previously.
CONCLUSION: Health risk behaviours among undergraduates in Malaysia are presently existing issues which poses serious concerns.
Systemic lupus erythematosus (SLE) is one of the commonest systemic autoimmune diseases that can present with variable clinical manifestations. Intravenous Immunoglobulin (IVIG) has been used as a salvage therapy for severe lupus with encouraging results though there is yet randomised trial to support the usage. This report highlights the efficacy and safety of high dose IVIG in SLE patients with multi-organ involvement particularly lupus nephritis. We also reviewed the literature on the usage of IVIG for lupus nephritis. However, more studies are needed to further clarify the optimal therapeutic dosage and regime for IVIG and to identify the group of patients who might benefit the most from this expensive therapy.
Research into ischaemia and reperfusion injury especially in liver transplantation has been aimed primarily at preventing deterioration of organ function before harvest and at improving organ preservation techniques. Recent studies however, suggest that postischaemic organ function and viability can be improved not only through improved organ protection before ischaemia, but also with therapy aimed at ameliorating the organ reperfusion injury. In order to develop successful therapeutic interventions against ischaemia-reperfusion induced liver injury, it is necessary to consider the primary site of injury as well as to explore the mechanism(s) and possible factors which may contribute to the injury during ischaemia and reperfusion. Studies on hepatic ischaemia-reperfusion injury have focused mainly at hepatocellular level. Until recently, more attention has been drawn t o the important role of hepatic microcirculation on the pathophysiology of the above injury. The argument that hepatic microvasculature is the primary site of ischaemia-reperfusion injury and possible factors which cause this injury are among the issues reviewed in this article. KEYWORDS: ischaemia, reperfusion, liver, microvasculature, oxygen radicals
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.
In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.
Inferior vena cava agenesis (IVCA) is an uncommon congenital anomaly which was first described in the seventeenth century. The detection of such an anomaly is often incidental and patients are asymptomatic until the third to fourth decade of life. Due to the scarcity of these cases, there is no consensus on the subsequent treatment and surveillance of incidental asymptomatic IVC anomalies. Herein, we report on a young male with incidental findings of suprarenal IVC agenesis identified on contrast enhanced computed tomography (CT) scan of the abdomen in the course of treatment for acute appendicitis.
Evidence suggests that breast cancer is taking the form of a chronic illness. This will add on to the present burden of managing chronic diseases in the healthcare delivery system. The burden of breast cancer being a chronic illness, calls for greater efforts to address the many neglected, physical-psycho-social and occupational functioning consequences. Timely efforts are needed to identify and implement interventions that are aim at improving the quality of life of women with breast cancer. At present, research evidence is highlighting that chronic diseases may best be managed using a self-management approach, and best treated by a balance of traditional medical care and the day-to-day practice of self-management skills. This paper presents the perspective of breast cancer as a chronic illness and its implication for rehabilitation and medical education. It is imperative that health professionals be made aware of these survivorship issues through medical education. The goals are to reduce the many disability risks, encourage patient-health provider communication and enhance partnership in care, within a timely, holistic therapeutic program to improve the quality of life of women with breast cancer.
In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.
As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula.
Over the years, the emphasis on research practices in healthcare has received more recognition than the emphasis on teaching practices. Also, in contrast to the strong focus on aligning care-giving practices with evidence of effectiveness; aligning educational practices with evidences of effectiveness has continued to be neglected. This creates a chasm that hinders the delivery of effective health practices. Many challenges in the current healthcare delivery system warrant a call for a revamp of health professionals' education, and for a greater focus in effective teaching, assessment and supervision. This paper highlights the current challenges in health professional education (as revealed by the Institute of Medicine, IOM, 2003). It focusses on five key issues for promoting teaching excellence, and supports the move for new lecturers to be educationally trained so that 'teaching for learning' becomes current, effective and enjoyable. More importantly, the vision for health professional education that "all health professionals are educated to deliver patient-centred-care as members of an interdisciplinary team, emphasising evidence-based practice, quality improvement approaches, and informatics" can be attained. This vision has important implication for medical lecturers as it means they have to be better educated to teach in order to be prepared to meet the demands of a reformed healthcare system.
This article presents a brief overview on the importance of adopting healthy behavior during and after the completion of primary cancer treatment. Increasing evidences are advocating physical activity engagement in cancer survivors due to its convincing beneficial outcomes. Today, outcomes from numerous trials confirmed the need to examine beyond physical activity engagement, into physical inactivity as an independent factor for cancer recurrences. Reducing cancer-risk related behaviors via increase physical activity and reduce inactivity is now receiving much attention in the field of cancer survivorship. Both realms of activity and inactivity are now acknowledged as influential independent factors contributing to better care in the field of cancer survivorship.
We describe a rare encounte.r with a 6-year old Indian boy admitted with acute epiglottitis due to Haemophilus influenzae. Acute epiglottitis is an uncommon cause of lifethreatening upper airway obstruction and a rare presentation of invasive Haemophilus influenzae type b (Hib) disease in this region, compared to Ihe more developed West. The cause for this observation is often attributed to differences in the genetic predisposition and socio-economk parameters. The organism subtype and the host response have been shown to determine the type of invasive Hib disease. However, the evidence to explain this difference is poorly understood and remains an intriguing enigma. KEYWORDS: Epiglottitis, Haemophilus influenzae
Skin closure using simple interrupted nylon sutures was compared with closure using subcuticular nylon sutures in 80 consecutive patients undergoing semiemergency surgery, involving open reduction and internal fixation of either the forearm bones or femur. The simple interrupted technique was shown to be slower than the subcuticular technique with higher early postoperative wound complication rate. It may use an extra packet of sutures particularly if the average wound length is 19.8 cm. There is, however, no statistical difference demonstrated for the late scar complaints or subjective and objective scoring of cosmetic outcomes six months after the surgery. KEYWORDS: Simple interrupted, subcuticular, skin closure, nylon, cosmetic outcome
Youth sexuality is a great concern for many. Sexual health issues facing our youths are: premarital sexual intercourse, sexually transmitted diseases, unwanted and unsafe pregnancies and abortions, sexual diversity, HIV/AIDS, and cybersex. Various factors lead to risky sexual and reproductive health behavior, particularly among those unmarried youths: lack of sexual and reproductive health information and skills in negotiating sexual relationships and the inaccessibility of youth-friendly sexual and reproductive health services. Growing peer pressure of pre-marital sex plays a major role in sexual and reproductive health related decision-making among youths. Another factor is the issue of sexuality education which is still considered a sensitive topic and thus impinging on its implementation, due to cultural and religious constraints. Misunderstanding and a lack of information on sexual diversity have caused a concern for many, as there is a tendency for judgments, stereotypes, discriminations and prejudices towards homosexuality in the society. Online sexual activities or cybersex have become the next sexual revolution. Negative consequences are shown for those hooked on cybersex. Healthy youths are fundamental to the prevention initiatives. Promoting the sexual and reproductive needs and rights of our youths is warranted.
The beginning of this year, 2020, has been a very challenging one as all over the world, we were caught right in the midst of the Coronavirus (COVID-19) pandemic. This pandemic is a serious global health threat, and its devastating effects are felt in all aspects of life. The World Health Organization (WHO) reported that as of 17th May 2020, we have 4,534,731 confirmed cases of COVID-19, and 307,537 deaths in total, throughout the world. In the WHO Western Pacific region, there were 167,546 confirmed cases, and 6,730 deaths while in the WHO Southeast Region, the COVID-19 accounted for a total of 136,314 confirmed cases, and 4,425 deaths (1). In Malaysia, the figure stood, thus far, at 6,872 confirmed cases, and 114 deaths while in Indonesia, there were 17,514 confirmed cases, and 1,148 deaths (2). Different countries are at different phases of this pandemic. While the curve may have flattened in some countries, there might still be spikes here and there. The COVID-19 pandemic has not disappeared; it is here to stay!