Introduction: Systemic lupus erythematosus (SLE) has a broad spectrum of clinical presentations. The diagnosis of SLE remains a challenge and largely depends on the presence of several serum autoantibodies including anti-nuclear antibody (ANA), anti-double-stranded DNA antibody (anti-dsDNA) and anti-Smith antibody (anti-Sm). ANA, a highly sensitive but not specific marker is used for SLE screening Anti-dsDNA and anti-Sm are SLE-specific biomarkers but has lower sensitivity of 80% and 30% for SLE, respectively. However, it is noted that there are SLE patients who are persistently negative for SLE-specific autoantibodies. Anti-dsDNA and anti-Sm were reported to be negative in up to 51.2% and 62.4% of SLE, respectively. This limitation can lead to misdiagnosis and halter proper treatment to SLE patients. Previous studies have suggested that cell membrane DNA (cmDNA) can act as a specific target for the autoantibodies in SLE patients. Autoantibodies towards cmDNA (anti-cmDNA) were reported to have promis-ing value as a reliable biomarker for SLE. In this study, we would like to determine the usefulness of anti-cmDNA in diagnosing SLE as compared to the standard SLE-specific autoantibodies. Methods: Serum samples from 83 SLE patients, 86 other connective tissue diseases and 61 healthy subjects were included in this study. The other connec-tive tissue diseases include samples from 10 Sjogren’s syndrome, 56 rheumatoid arthritis, 12 scleroderma and eight mixed connected tissues disease (MCTD) patients. All samples were analysed by indirect immunofluorescence (IIF) technique using Raji cells as substrate to detect the presence of anti-cmDNA. Anti-cmDNA was reported as positive if there was presence of a fluorescent ring, either continuous or punctate. Sera from SLE patients were also tested for anti-dsDNA and anti-Sm antibodies by using enzyme-immunoassays. Results: Anti-cmDNA positivity was highest in SLE (55.4%) than in other connective tissue diseases (9.3%) and healthy subjects (0%). Anti-cmDNA was 100% spe-cific at differentiating SLE from healthy subjects and 90.7% specific at differentiating SLE from other connective tissue diseases. There was no difference in the sensitivity (55.4%) of anti-cmDNA at differentiating SLE from both groups. Anti-cmDNA were present in 46 SLE samples negative for standard SLE-specific autoantibodies. It was detected in 11 (42.3%) of anti-dsDNA, 23 (63.9%) of anti-Sm and 8 (12.9%) of both anti-Sm and anti-dsDNA negative samples. Conclusion: The high specificity of anti-cmDNA detection using IIF method makes it an excellent diagnostic tool for SLE. Anti-cmDNA is potentially a very useful biomarker for SLE with negative anti-dsDNA or/and anti-Sm antibodies.
Introduction:Alternative treatment for cancer from herbal medicine has gained interest due to its benefits on im-mune modulation, improving the survival and quality of life. Mitragyna speciosa (M. speciosa) or Kratom is an indig-enous plant that can be found in Thailand and northern part of Peninsular Malaysia has becomes popular in recent years due to its ability to exhibit the opioid-like effects of analgesia. Mitragynine is the main alkaloid in M. speciosa which is found to reduce gastrointestinal motility and has been used by local communities as traditional treatment for diarrhoea and many other diseases. However, there is lack of scientific evidence to show that M. speciosa has anti-oxidative and anti-cancer properties especially in colorectal cancer. Therefore, our study aims to evaluate the anti-oxidative properties of M. Speciosa methanolic extract (MSME) and its effects on colorectal cancer cell line, SW480. Methods: The anti-oxidant content and scavenging activity of MSME were determined by total phenolic content (TPC) assay and total flavonoid content (TFC) assay as well as 2,2’-azino-bis (3-ethylbenzothiazoline-6-sul-phonic acid) (ABTS) assay and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay respectively. Cytotoxicity and cytokine inhibitory effects of MSME on SW480 cells were determined by (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxy-phenyl)-2-(4-sulfophenyl)-2H-tetrazolium) (MTS) and cytokine beads array (CBA), respectively. Results: The TPC of MSME (0.1mg/ml = 85.85 ± 8.25 mg GAE/g extract; 1mg/ml = 167.43 ± 13.50 mg GAE/g extract; 10mg/ml = 408.94 ±7.17 mg GAE/g extract) was lower than pterostilbene, the positive control drug (76.37 ± 2.75; 230.52 ± 10.92; 835.44 ± 6.84 mg GAE/g extract). Conversely, the TFC of MSME (0.1mg/ml = 32.17 ± 27.92 mg QE/g extract; 1mg/ml = 347.72 ± 15.97 mg QE /g extract; 10mg/ml = 739.81 ± 5.56 mg QE /g extract) was slightly higher than pteros-tilbene (ND; 212.73 ± 17.92; 700.50 ± 3.47 mg QE/g extract). In DPPH assay, MSME showed comparatively similar antioxidant scavenging activity (IC50=4.34μg/ml) with pterostilbene (IC50=4.393μg/ml). However, MSME showed lower anti-oxidant scavenging activity (IC50=4.26μg/ml) than pterostilbene (IC50=1.556μg/ml) as measured by ABTS assay. In cytotoxicity assay, IC50 of MSME on SW480 cells was determined to be at 1.486 mg/ml. Overexpression of cytokines such as IL-6, IL-8 (CXCR8) and IL-10 could potentially promote tumour cell proliferation, growth and metastasis. Increased production of these cytokines through LPS stimulation in SW480 was slightly reduced by treat-ment with MSME. Conclusion: MSME could have a potential bioactive compound that possesses anti-oxidative and anti-cancer properties that would be beneficial as an alternative treatment of colorectal cancer.
Introduction: Diabetes-associated autoantibodies (DAA) is the hallmark of T1DM and LADA which are frequently tested in young diabetes patients. It was noted that up to 10-15% of patients with initial diagnosis of T2DM also exhibit DAA. Regardless of the classification, the presence of DAA suggests an underlying islet autoimmunity which lead to progressive pancreatic β-cell failure. There is limited data reported on DAA in young diabetes patients in Malaysia. This study aims to determine the frequency of DAA positivity and its association with demographic and clinical characteristics among this cohort. Methods: A retrospective study using secondary data obtained from Al- lergy and Immunology Research Centre, Institute for Medical Research, Malaysia. This study included 194 diabetes patients who were diagnosed before the age of 40 years old and tested for GADA, ICA, IA2A and IAA. Results: From 194 patients, 91 (46.9%) were positive for least one of the following DAA: ICA (79, 40.7%), GADA (61, 31.4%), IA2A (37, 19.1%) and IAA (9, 4.6%). Multiple positivity was higher (73.6%) compared to single positivity. Highest com- bination of double positivity was ICA+GADA (54, 59.3%) and triple positivity was ICA+GADA+IA2A (25, 27.5%). Simultaneous positivity of four autoantibodies was seen in only one (1.1%) patient. ICA, GADA and IA2A were asso- ciated with age group and ethnicity (all p < 0.001). Only IA2A was associated with gender (p = 0.012). Conclusions: GADA, ICA ad IA2A are more significant in young Malaysian diabetes patients. IAA has a very low frequency in this studied population.
Bullous pemphigoid (BP) is a chronic and the most frequent immune-mediated subepidermal blistering disorder which mainly affects elderly individuals. The autoantibodies produced following T-cell dysregulation are directed against BP180 (BPAg2) and BP230 (BPAg1), hemidesmosomal proteins located in the basement membrane zone (BMZ) of the epidermis. BP may present with polymorphic dermatological features including non-bullous manifestations and blisters. Therefore, a wide range of differential diagnoses such as eczema, urticaria, pemphigus and the differentials for subepidermal blister with eosinophils such as epidermolysis bullosa acquisita (EBA) and bullous drug eruptions should be considered in such cases. The associations of solid organ internal malignancies and BP are quite rare and vary between studies. Here, we present a case of paraneoplastic bullous pemphigoid (PNBP) in a patient with underlying renal cell carcinoma who was initially diagnosed with worsening hand-foot syndrome (HFS) which has led to withdrawal of his oral chemotherapy treatment.
Introduction: Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical deterioration experienced
by some HIV-infected patients in response to antiretroviral therapy (ART). There is still limited published data on
IRIS from this region including Malaysia. This study aimed to determine IRIS prevalence, clinical manifestations
and possible predictors among HIV-infected patients in an infectious disease centre in Peninsular Malaysia.
Method: This retrospective study was conducted in Hospital Sungai Buloh involving secondary data of 256
HIV-infected patients who were initiated on ART in the year 2017. Medical record of each patient was reviewed
for up to 12 months following ART initiation to identify IRIS diagnosis which was made by the treating physician.
Relevant clinical and laboratory information were retrieved from hospital electronic database. Results: IRIS has
occurred in 17.6% of patients. Infections by Mycobacterium tuberculosis (53.3%), Pneumocystis jirovecii (11.1%)
and Talaromyces marneffei (6.6%) were the commonest three aetiologies of IRIS. Subacute lupus erythematosus was
the only non-infectious IRIS identified. Baseline HIV viral load, CD4+ T-cell count and haemoglobin level between
IRIS and non-IRIS patients were significantly different. Risk of developing IRIS was increased seven times in patients
with CD4+ T-cell count < 100 cells/µL and four times in patients with HIV RNA viral load > 5.5 log10 copies/ml prior
to ART initiation. Conclusion: Mycobacterium tuberculosis infections were the highest IRIS manifestation. Although
rare, non-infectious IRIS does occur and should be part of the differential diagnosis. Patients with positive predictors
should be appropriately monitored for possible IRIS development once initiated on ART.
Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid; however, the management team withheld treatment until they were certain of the identity of the bacteria. The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain. The case report highlights the importance of the microbiology investigations for appropriate management in this case.
Lipoma arborescens is a non-neoplastic, reactive condition due to chronic synovial inflammation and irritation, characterized by frond-like or villous proliferation of mature adipose tissue covered by hyperplastic synovium. The knee is the most commonly affected site particularly the suprapatellar pouch. We report a case of lipoma arborescens affecting the right knee of an elderly Chinese gentleman associated with bilateral knee and hand osteoarthritis. He presented with progressive worsening of right knee swelling and pain. Partial synovectomy of the right knee was performed and no lesion recurrence was noted at one year post-operation. The clinical and imaging findings, pathological features, together with differential diagnoses were discussed.