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Fulltext The association of Streptococcus bovis/gallolyticus with colorectal tumors: the nature and the underlying mechanisms of its etiological role

Abdulamir AS, Hafidh RR, Abu Bakar F

J Exp Clin Cancer Res, 2011;30:11.
PMID: 21247505 DOI: 10.1186/1756-9966-30-11

Streptococcus bovis (S. bovis) bacteria are associated with colorectal cancer and adenoma. S. bovis is currently named S. gallolyticus. 25 to 80% of patients with S. bovis/gallolyticus bacteremia have concomitant colorectal tumors. Colonic neoplasia may arise years after the presentation of bacteremia or infectious endocarditis of S. bovis/gallolyticus. The presence of S. bovis/gallolyticus bacteremia and/or endocarditis is also related to the presence of villous or tubular-villous adenomas in the large intestine. In addition, serological relationship of S. gallolyticus with colorectal tumors and direct colonization of S. gallolyticus in tissues of colorectal tumors were found. However, this association is still under controversy and has long been underestimated. Moreover, the etiological versus non-etiological nature of this associationis not settled yet. Therefore, by covering the most of up to date studies, this review attempts to clarify the nature and the core of S. bovis/gallolyicus association with colorectal tumors and analyze the possible underlying mechanisms.
Fulltext Molecular detection, quantification, and isolation of Streptococcus gallolyticus bacteria colonizing colorectal tumors: inflammation-driven potential of carcinogenesis via IL-1, COX-2, and IL-8

Abdulamir AS, Hafidh RR, Bakar FA

Mol. Cancer, 2010;9:249.
PMID: 20846456 DOI: 10.1186/1476-4598-9-249

Colorectal cancer (CRC) has long been associated with bacteremia and/or endocarditis by Streptococcus gallolyticus member bacteria (SGMB) but the direct colonization of SGMB along with its molecular carcinogenic role, if any, has not been investigated. We assessed the colonization of SGMB in CRC patients with history of bacteremia (CRC-w/bac) and without history of bacteremia (CRC-wo/bac) by isolating SGMB from feces, mucosal surfaces of colorectum, and colorectal tissues and detecting SGMB DNA, via PCR and in situ hybridization (ISH) assays targeting SodA gene in colorectal tissues. Moreover, mRNA of IL1, IL-8, COX-2, IFN-γ, c-Myc, and Bcl-2 in colorectal tissues of studied groups was assessed via ISH and RT-PCR.
Fulltext In vitro immunogenic and immunostimulatory effects of zwitterionized 23-valent pneumococcal polysaccharide vaccine compared with nonzwitterionized vaccine

Abdulamir AS, Hafidh RR, Abubaker F

Curr Ther Res Clin Exp, 2010 Feb;71(1):60-77.
PMID: 24683251 DOI: 10.1016/j.curtheres.2010.02.004

It was hypothesized that the observed slight immunostimulatory effect of the 23-valent pneumococcal polysaccharide (pneumo-23) vaccine might be due to the presence of low levels of zwitterionic motifs. Therefore, it was hypothesized further that introducing zwitterionic motifs experimentally into polysaccharides of pneumo-23 vaccine might render it an effective immunostimulatory agent.
In vitro degradation of poly (D, L-lactide-co-glycolide) nanoparticles loaded with linamarin

Hussein AS, Abdullah N, Ahmadun FR

IET Nanobiotechnol, 2013 Jun;7(2):33-41.
PMID: 24046903

Linamarin-loaded poly (lactide-co-glycolide) (PLGA) nanoparticles (NPs) were prepared by the double emulsion solvent evaporation technique. The formulated PLGA (50:50) and PLGA (85:15) NPs were spherically shaped, having an average particle size < 190 nm, drug entrapment efficiency (50-52%) and zeta potentials ranging from -25 to -30 mV. Interestingly, all formulated PLGA NPs exhibited a controlled biphasic release profile. Polymer degradation was investigated in the current research to determine the major degradation products and then the polymer biocompatibility as well as safety. The PLGA NPs degradation behaviour was investigated by measuring water uptake, mass loss, change of pH of the degradation medium, morphological changes, and lactic and glycolic acid concentrations. Gravimetrical methods, pH meter, scanning electron microscope and high-performance liquid chromatography were employed, respectively. PLGA (50:50) NPs were found to degrade faster than PLGA (85:15) NPs. With regard to water uptake, mass loss and pH change, the degradation behaviour of PLGA (50:50) NPs was significantly (rho < 0.05) different from that of PLGA (85:15) NPs. A complete degradation of PLGA (50:50) NPs was achieved after 102 days, whereas, only about 60% of PLGA (85:15) NPs were degraded within the same period. Complete degradation and release of the degradation products naturally by the body ensures safety of the delivery carrier.
Fulltext The anti-cancer effects of Tualang honey in modulating breast carcinogenesis: an experimental animal study

Ahmed S, Othman NH

BMC Complement Altern Med, 2017 Apr 11;17(1):208.
PMID: 28399853 DOI: 10.1186/s12906-017-1721-4

BACKGROUND: Honey has been shown to have anti-cancer effects, but the mechanism behind these effects is not fully understood. We investigated the role of Malaysian jungle Tualang honey (TH) in modulating the hematological parameters, estrogen, estrogen receptors (ER1) and pro and anti-apoptotic proteins expression in induced breast cancer in rats.
METHODS: Fifty nulliparous female Sprague-Dawley rats were used and grouped as follows: Group 0 (healthy normal rats control), Group 1 (negative control; untreated rats), Groups 2, 3 and 4 received daily doses of 0.2, 1.0 and 2.0 g/kg body weight of TH, respectively. The rats in groups 1, 2, 3, 4 were induced with 80 mg/kg of 1-methyl-1-nitrosourea (MNU). TH treatment in groups 2, 3 and 4 was started one week prior to tumor induction and continued for 120 days.
RESULTS: The TH-treated rats had tumors of different physical attributes compared to untreated negative control rats; the tumor progression (mean 75.3 days versus 51.5 days); the incidence (mean 76.6% versus 100%); the multiplicity (mean 2.5 versus 4 tumor masses per rat); the size of tumor mass (mean 0.41 cm versus 1.47 cm [p
Fulltext Mismatch between furniture dimension and anthropometric measures among primary school children in Putrajaya

Adib Asmawi Mohd Yusoff, Irniza Rasdi, Ahmed S. Mahmoud Ben Hameid, Karmegam Karuppiah

Malaysian Journal of Public Health Medicine, 2016;16(10):0-0.
MyJurnal

Ergonomic is important in classroom. Sitting for protracted period in class may lead students to develop musculoskeletal disorders. Their physical health and performance in the class may increase by designing school furniture that match with human body. In Malaysia, there is a lack of ergonomic assessment for school environment especially in urban areas. The aim of this study is to determine the mismatch between the furniture dimension and anthropometric parameters among primary school children in Putrajaya. This is a cross-sectional study which involved 100, Year 1 and Year 6 primary school students randomly selected in Putrajaya. Five anthropometric measurements (popliteal height, buttock popliteal length, elbow height, shoulder height (sitting), hip breadth) as well as five furniture dimensions (seat height, seat depth, seat width, backrest height and seat to desk height) were measured. Instrument used is Martin type anthropometer set, SECA body meter, and SECA weighing scale. Calculation for determining mismatch between the furniture and anthropometric measures were calculated using a standard mismatch formula. There was 100% mismatch for seat height, seat depth, and seat to seat to desk height for Year 1. As for Year 6, mismatch was reported 100% for backrest height and seat to desk height. There were significance difference for parameters of popliteal height between Year 1 and Year 6 and between male and female of Year 1. There was a presence of mismatch between furniture dimension and children anthropometric measurement. Proposed dimension of furniture shows decrease in percentage of mismatch for the most parameter of anthropometric measurement.
Fulltext Honey as a potential natural anticancer agent: a review of its mechanisms

Ahmed S, Othman NH

Evid Based Complement Alternat Med, 2013;2013:829070.
PMID: 24363771 DOI: 10.1155/2013/829070

The main treatment for cancer is by using chemotherapy and radiotherapy which themselves are toxic to other viable cells of the body. Recently, there are many studies focusing on the use of natural products for cancer prevention and treatment. Of these natural products, honey has been extensively researched. The mechanism of the anti-cancer activity of honey as chemopreventive and therapeutic agent has not been completely understood. The possible mechanisms are due to its apoptotic, antiproliferative, antitumor necrosis factor (anti-TNF), antioxidant, anti-inflammatory, estrogenic and immunomodulatory activities. We collate the findings of several studies published in the literature in order to understand the mechanism of its action.
Fulltext Review of the medicinal effects of tualang honey and a comparison with manuka honey

Ahmed S, Othman NH

Malays J Med Sci, 2013 May;20(3):6-13.
PMID: 23966819 MyJurnal

Tualang honey (TH) is a Malaysian multifloral jungle honey. In recent years, there has been a marked increase in the number of studies published in medical databases regarding its potential health benefits. The honey is produced by the rock bee (Apis dorsata), which builds hives on branches of tall Tualang trees located mainly in the north-western region of Peninsular Malaysia. This review collates the results of the various studies of TH that range from research on tissue culture to randomised control clinical trials. Findings thus far show that, TH has antimicrobial, anti-inflammatory, antioxidant, antimutagenic, antitumor, and antidiabetic properties, in addition to wound-healing attributes. Some of its properties are similar to the well-researched Manuka honey (New Zealand and/or Australian monofloral honey). Distinct differences include higher phenolics, flavonoids, and 5-(hydroxymethyl) furfural (HMF). Compared with Manuka honey, TH is also more effective against some gram-negative bacterial strains in burn wounds.
Genotypes of rotavirus diarrhoea in a children hospital of Bangladesh

Ahmed S, Hussain M, Akhter S, Islam T, Ahmed SU, Kabir ML

Mymensingh Med J, 2012 Jul;21(3):497-502.
PMID: 22828550

Globally, rotaviruses are the single most important etiologic agents of severe childhood dehydrating diarrhea that accounts for more than 125 million of cases, 25-55% of all hospital admissions for diarrhea and ≈600,000 deaths every year. In Bangladesh, while overall diarrhea related deaths are declining, the proportion of diarrhea deaths due to rotavirus is increasing. This study was aimed at estimating the burden of rotavirus diarrhea and isolating the genotypes of rotavirus in a children hospital of Bangladesh; thereby endorsing a logical search for an appropriate rotavirus vaccine. This cross sectional study was carried out in the Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh during 2006-2007. Children aged between one month and five years suffering form diarrhea were enrolled in the study. Stool samples were analyzed by ELISA for rotavirus antigen. The rotavirus-positive samples were further analyzed for genotype determination. Among 656 stool samples, 39.5% samples were positive for rotavirus antigen. The mean age of the children studied was 12±9.9 months; the peak being in the second half of infancy. G2 was identified as the most dominant genotype (45.5%) followed by G1 (24.8%), G12 (9.6%), G9 (8.5%) and G4 (2.1%) genotypes. Since G2 were found to be the predominant circulating rotavirus strain in this study and some other studies in Bangladesh, the recommended vaccine for prevention of rotavirus infection in Bangladesh should cover this strain to have maximum effectiveness.
Novel Epstein-Barr virus immunoglobulin G-based approach for the specific detection of nasopharyngeal carcinoma

Abdulamir AS, Hafidh RR, Abu Bakar F, Abbas K

Am J Otolaryngol, 2010 Nov-Dec;31(6):410-7.
PMID: 20015794 DOI: 10.1016/j.amjoto.2009.06.006

PURPOSE: This study was designed to find a reliable Epstein-Barr virus (EBV) immunoglobulin (Ig) G-based diagnostic/screening test for nasopharyngeal carcinoma (NPC) able to demarcate between the NPC-related seropositivity of EBV IgG antibodies and that of other head and neck cancer (HNCA) and control groups. The NPC-associated immunosuppression affects EBV IgA much more than IgG, leading to inconsistent detection of NPC using EBV IgA antibodies.
MATERIALS AND METHODS: One hundred twenty-two HNCA patients, 42 NPC, 66 laryngeal carcinoma, and 14 hypopharyngeal carcinoma and 3 groups of 100 control subjects were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) was used to find a specific cutoff value for the NPC-related seropositivity of EBV IgG antibodies.
RESULTS: NPC group showed higher serum level of EBV IgG antibodies than control and other HNCA groups (P < .05). However, the traditional cutoff value, mean + 2 SDs of control subjects, failed to demarcate the seropositives of NPC patients from those of healthy population (P > .05). The new cutoff value, mean + 2 SDs of the seropositives group of control subjects who had already been grouped by the traditional cutoff value, proved successful. It succeeded to demarcate between the NPC-related EBV IgG seropositivity and that issued from the persistent, latent, or reactivated EBV infection in the population (P < .05). The sensitivity/specificity of NPC detection by the new cutoff-based ELISA kit, 76.19% and 86%, was close or higher than that of EBV IgA antibodies.
CONCLUSION: EBV IgG-based ELISA could be used for the diagnosis of NPC using a new cutoff threshold that excludes the population baseline of EBV IgG seropositivity.
Fulltext Tumor markers of bladder cancer: the schistosomal bladder tumors versus non-schistosomal bladder tumors

Abdulamir AS, Hafidh RR, Kadhim HS, Abubakar F

J Exp Clin Cancer Res, 2009;28:27.
PMID: 19243595 DOI: 10.1186/1756-9966-28-27

The aim of this study is to comparatively elucidate the underlying molecular pathways and clinicopathological criteria in schistosomal bladder tumor (SBT) versus non-schistosomal bladder tumor (NSBT).
Fulltext Mechanism of Hepatoprotective Effect of Boesenbergia rotunda in Thioacetamide-Induced Liver Damage in Rats

Salama SM, Abdulla MA, Alrashdi AS, Hadi AH

Evid Based Complement Alternat Med, 2013;2013:157456.
PMID: 23997791 DOI: 10.1155/2013/157456

Background. Researchers focused on developing traditional therapies as pharmacological medicines to treat liver cirrhosis. Objectives. Evaluating the hepatoprotective activity of Boesenbergia rotunda (BR) rhizome ethanolic extract on thioacetamide-induced liver cirrhosis in rats. Methods. Male Sprague-Dawley rats were intraperitoneally injected with 200 mg/kg TAA 3 times/week and daily oral administration of 250 mg/kg, 500 mg/kg of BR extract, and 50 mg/kg of the reference drug Silymarin for 8 weeks. At the end of the experiment, Masson's trichrome staining was used to measure the degree of liver fibrosis. Hepatic antioxidant enzymes (CAT and GPx), nitrotyrosine, cytochrome (P450 2E1), matrix metalloproteinase (MMP-2 and MMP-9), tissue inhibitor of metalloproteinase (TIMP-1), and urinary 8-hydroxyguanosine were measured. Serum levels of transforming growth factor TGF- β 1, nuclear transcription factor NF- κ B, proinflammatory cytokine IL-6, and caspase-3 were evaluated. Serum protein expression and immunohistochemistry of proapoptotic Bax and antiapoptotic Bcl-2 proteins were measured and confirmed by immunohistochemistry of Bax, Bcl-2, and proliferating cell nuclear antigen (PCNA). Results. BR treatment improved liver histopathology, immunohistochemistry, and biochemistry, triggered apoptosis, and inhibited cytokines, extracellular matrix proteins, and hepatocytes proliferation. Conclusion. Liver cirrhosis progression can be inhibited by the antioxidant and anti-inflammatory activities of BR ethanolic extract while preserving the normal liver status.
Fulltext Efficacy of Boesenbergia rotunda Treatment against Thioacetamide-Induced Liver Cirrhosis in a Rat Model

Salama SM, Bilgen M, Al Rashdi AS, Abdulla MA

Evid Based Complement Alternat Med, 2012;2012:137083.
PMID: 22988470 DOI: 10.1155/2012/137083

Background. Experimental research in hepatology has focused on developing traditional medicines into potential pharmacological solutions aimed at protecting liver from cirrhosis. Along the same line, this study investigated the effects of ethanol-based extract from a traditional medicine plant Boesenbergia rotunda (BR) on liver cirrhosis. Methodology/Results. The BR extract was tested for toxicity on 3 groups of rats subjected to vehicle (10% Tween 20, 5 mL/kg) and 2g/kg and 5g/kg doses of the extract, respectively. Next, experiments were conducted on a rat model of cirrhosis induced by thioacetamide injection. The rats were divided into five groups and, respectively, administered orally with 10% Tween-20 (5 mL/kg) (normal control group), 10% Tween-20 (5 mL/kg) (cirrhosis control group), 50 mg/kg of silymarin (reference control group), and 250 mg/kg and 500 mg/kg of BR extract (experimental groups) daily for 8 weeks. The rats in normal group were intraperitoneally injected with sterile distilled water (1 mL/kg) 3 times/week, and those in the remaining groups were injected intraperitoneally with thioacetamide (200 mg/kg) thrice weekly. At the end of the 8 weeks, the animals were sacrificed and samples were collected for comprehensive histopathological, coagulation profile and biochemical evaluations. Also, the antioxidant activity of the BR extract was determined and compared with that of silymarin. Data from the acute toxicity tests showed that the extract was safe to use. Histological analysis of the livers of the rats in cirrhosis control group revealed uniform coarse granules on their surfaces, hepatocytic necrosis, and lymphocytes infiltration. But, the surfaces morphologically looked much smoother and the cell damage was much lesser in those livers from the normal control, silymarin and BR-treated groups. In the high-dose BR treatment group, the livers of the rats exhibited nearly normal looking lobular architecture, minimal inflammation, and minimal hepatocyte damage, the levels of the serum biomarkers and liver enzymes read nearly normal, and these results were all comparable to those observed or quantified from the normal and silymarin-treated groups. The BR extract had the antioxidant activity about half of what was recorded for silymarin. Conclusion. The progression of the liver cirrhosis can be intervened using the ethanol-based BR extract, and the liver's status quo of property, structure, and function can be preserved. This capability of the extract warrants further studies exploring the significance of its pharmacologic potential in successfully treating the liver cirrhosis in humans.
Fulltext Expanded DEMATEL for determining cause and effect group in bidirectional relations

Falatoonitoosi E, Ahmed S, Sorooshian S

ScientificWorldJournal, 2014;2014:103846.
PMID: 24693224 DOI: 10.1155/2014/103846

Decision-Making Trial and Evaluation Laboratory (DEMATEL) methodology has been proposed to solve complex and intertwined problem groups in many situations such as developing the capabilities, complex group decision making, security problems, marketing approaches, global managers, and control systems. DEMATEL is able to realize casual relationships by dividing important issues into cause and effect group as well as making it possible to visualize the casual relationships of subcriteria and systems in the course of casual diagram that it may demonstrate communication network or a little control relationships between individuals. Despite of its ability to visualize cause and effect inside a network, the original DEMATEL has not been able to find the cause and effect group between different networks. Therefore, the aim of this study is proposing the expanded DEMATEL to cover this deficiency by new formulations to determine cause and effect factors between separate networks that have bidirectional direct impact on each other. At the end, the feasibility of new extra formulations is validated by case study in three numerical examples of green supply chain networks for an automotive company.
The current state of diagnostic genetics for conditions affecting sex development

Alhomaidah D, McGowan R, Ahmed SF

Clin Genet, 2017 02;91(2):157-162.
PMID: 28127758 DOI: 10.1111/cge.12912

Disorders of sex development (DSD), are a group of rare congenital conditions. Unlike 46, XX DSD where the cause is usually clear, identification of a cause of XY DSD is often unclear and may be attributed to a disorder of gonadal development, androgen synthesis or androgen action. Reaching a firm diagnosis is challenging and requires expertise within a framework that abides by the highest standards of clinical care. Whilst conditions associated with altered sex development have improved our fundamental understanding of sex and gonadal development, it is debatable whether this improvement in our understanding has improved the lives of people with DSD. Thus, there is a need for more emphasis on showing that a firm diagnosis for conditions associated with DSD is associated with a change in clinical practice that benefits the patient. With the rapid advances in diagnostic technology, there is also a need for clearer guidance on the relative merits of biochemical vs genetic evaluation. The standardization and harmonization of complex genetic and biochemical analyses for rare conditions are issues that require further guidance and it is probably that international networks and registries for rare conditions will facilitate the development of this framework.
The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes

Hasan SS, Ahmadi K, Santigo R, Ahmed SI

Climacteric, 2014 Aug;17(4):456-64.
PMID: 24228772 DOI: 10.3109/13697137.2013.864269

OBJECTIVES:
To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes.

METHODS:
A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbach's α.

RESULTS:
The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOL's PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01-2.02).

CONCLUSIONS:
This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

KEYWORDS:
DIABETES; MENOPAUSE; QUALITY OF LIFE; VALIDITY
Fulltext Identification of hemoglobin AC heterozygote status in a Malay family: a decision between hemoglobin electrophoresis and high performance liquid chromotography

Rosline H, Roshan TM, Ahmed SA, Ilunihayati I

Southeast Asian J. Trop. Med. Public Health, 2007 May;38(3):543-5.
PMID: 17877232

Thalassemia is a common public health problem among Malays. Hemoglobin C (Hb C) is a hemoglobin beta variant resulting from a single base mutation at the 6th position of the beta-globin gene leading to the substitution of glycine for glutamic acid. Hb C is commonly detected in West Africans and in African American but has not been reported in Malaysia. It can be falsely diagnosed as HbE trait in the Malaysian Thalassemia Screening Program which utilizes cellulose acetate hemoglobin electrophoresis. This is the first reported case of Hb AC heterozygote status in a Malay family, with unusual splenomegaly in one of the family members.
Fulltext Clinical profile of acute flaccid paralysis

Rasul CH, Das PL, Alam S, Ahmed S, Ahmed M

Med J Malaysia, 2002 Mar;57(1):61-5.
PMID: 14569719

This study was done to determine the clinical course, cause and outcome of Acute Flaccid Paralysis (AFP) in children. All AFP cases (< 15 years) in the children's ward of Khulna Medical College Hospital (Bangladesh) were recorded, investigated and followed up to sixty days as a part of passive surveillance. Main outcome variables were vulnerable age group, vaccine status, predominant limb involvement, clinical variants, virus isolation and residual paralysis. Thirty-four children with AFP were admitted in hospital in the last three years with the highest number (14) in 1998. The majority of children belonged to the age group 5-9 years with a male female ratio of 1.3:1. Nearly one third of the cases were either partially vaccinated or not vaccinated at all. The lower limbs bore the brunt of paralysis excepting a few (14.7%). Clinically, Guillain Barre Syndrome was the commonest (47.1%) followed by encephalomyelitis. No poliovirus was isolated from these cases. Residual paralysis was observed in four out of ten cases who returned for follow up. AFP will continue to occur even after eradication of poliomyelitis and Guillain Barre Syndrome is the most important clinical entity for this.
Inhibitory effects of Malaysian tualang honey and Australian/New Zealand Manuka honey in modulating experimental breast cancers induced by n-methyl-n-nitrosourea (mnu): A comparative study

Othman NH, Ahmed S, Sulaiman SA

Pathology, 2016 Feb;48 Suppl 1:S148.
PMID: 27772925 DOI: 10.1016/j.pathol.2015.12.403
Primary versus secondary immune thrombocytopenia in adults; a comparative analysis of clinical and laboratory attributes in newly diagnosed patients in Southern Pakistan

Sultan S, Ahmed SI, Murad S, Irfan SM

Med J Malaysia, 2016 10;71(5):269-274.
PMID: 28064294

BACKGROUND: Immune thrombocytopenic purpura (ITP) is a hemorrhagic diathesis, characterized by platelets destruction alongside impaired production. Patients from Asian regions often exhibit distinctive characteristics in comparison to the western patients. We accomplished this study to evaluate the prevalence of primary versus secondary ITP along with the comparative analysis between them. The secondary objective was to determine the etiological spectrum of secondary ITP.
METHODS: We illustrate the results of a large cohort of newly diagnosed adults ITP from southern Pakistan. The study extended from January 2009-December 2013. Complete blood counts, HbsAg, Anti-HCV, ANA, stool for Helicobacterpylori were done on all. HIV, TSH, anti-dsDNA, RA factor, APLA and direct coombs test were evaluated in cases where indicated.
RESULTS: A total of 417 patients were included with a mean age of 40.95±14.82 years. Primarily disease was observed in the 3rd decade of life. Male to female ratio was 1:1.5. Mean platelets count was 46.21±27.45x109/l. At diagnosis 43.16% (n=180) patients had hemorrhagic manifestations whilst 56.8% (n=237) were asymptomatic. None of the patient presented with visceral, retropharyngeal or intracranial bleed. The prevalence of secondary ITP was substantially higher (64.8%) as compared to primary ITP (35.2%). Secondary ITP was predominantly seen in HCV reactive patients (24.4%) followed by helicobacter-pylori infection (11%). Nevertheless 16.4% patients had underlying autoimmune disorders. Providentially no study subject was found to be HIV reactive.
CONCLUSIONS: Our study revealed predominance of secondary ITP. However bleeding manifestations and degree of thrombocytopenia were high in primary-ITP. Infectious etiology followed by autoimmune disorders is mainly implicated for secondary ITP in our setting.

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