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Evolution of Cardiac Biomodels from Computational to Therapeutics

Rathinam AK, Mokhtar RA

Heart Surg Forum, 2016;19(4):E208-15.
PMID: 27585205 DOI: 10.1532/hsf.1410

Biomodeling the human anatomy in exact structure and size is an exciting field of medical science. Utilizing medical data from various medical imaging topography, the data of an anatomical structure can be extracted and converted into a three-dimensional virtual biomodel; thereafter a physical biomodel can be generated utilizing rapid prototyping machines. Here, we have reviewed the utilization of this technology and have provided some guidelines to develop biomodels of cardiac structures. Cardiac biomodels provide insights for cardiothoracic surgeons, cardiologists, and patients alike. Additionally, the technology may have future usability for tissue engineering, robotic surgery, or routine hospital usage as a diagnostic and therapeutic tool for cardiovascular diseases (CVD). Given the broad areas of application of cardiac biomodels, attention should be given to further research and development of their potential.
Antioxidant potential of Cymbopogon citratus extract: alleviation of carbon tetrachloride-induced hepatic oxidative stress and toxicity

Koh PH, Mokhtar RA, Iqbal M

Hum Exp Toxicol, 2012 Jan;31(1):81-91.
PMID: 21508074 DOI: 10.1177/0960327111407226

This study was aimed to evaluate the effect of Cymbopogon citratus against carbon tetrachloride (CCl(4))-mediated hepatic oxidative damage in rats. Rats were administrated with C. citratus extract (100, 200 and 300 mg/kg b.w.) for 14 days before the challenge of CCl(4) (1.2 ml/kg b.w. p.o) on 13th and 14th days. Hepatic damage was evaluated by employing serum biochemical parameters (alanine aminotransferase-ALT, aspartate aminotransferase-AST and lactate dehydrogenase-LDH), malondialdehye (MDA) level, reduced GSH and antioxidant enzymes (catalase: CAT, glutathione peroxidase: GPX, quinone reductase: QR, glutathione S-transferase: GST, glutathione reductase: GR, glucose-6-phosphate dehyrogenase: G6PD). In addition, CCl(4)-mediated hepatic damage was further evaluated by histopathological examination. However, most of these changes were alleviated by prophylactic treatment of animals with C. citratus dose dependently (p < 0.05). The protection was further evident through decreased histopathological alterations in liver. The results of the present study indicated that the hepatoprotective effect of C. citratus might be ascribable to its antioxidant and free radical scavenging property.
Fulltext Andrographis paniculata ameliorates carbon tetrachloride (CCl(4))-dependent hepatic damage and toxicity: diminution of oxidative stress

Koh PH, Mokhtar RA, Iqbal M

Redox Rep, 2011;16(3):134-43.
PMID: 21801496 DOI: 10.1179/1351000211Y.0000000003

Andrographis paniculata (hempedu bumi) is a plant that possesses many medicinal values in treating several diseases and for health care maintenance. However, its hepatoprotective activity and mechanism of action have not been fully investigated. Therefore, this study aimed to evaluate the hepatoprotective effects of A. paniculata and its mechanism of action in rats. Carbon tetrachloride (CCl(4)) challenge of rats at a dose of 1.2 ml/kg body weight-induced oxidative stress in the liver. This was evidenced by augmentation in lipid peroxidation, which was accompanied by a decrease in the activities of antioxidant enzymes and depletion in the level of reduced glutathione (P < 0.05). Parrallel to these changes, CCl(4) challenge too, enhanced hepatic damage as evidenced by sharp increase in serum transaminases (e.g. alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase) (P < 0.05). Additionally, the impairment of liver function corresponded to histolopathological changes. However, most of these changes were reversed in a dose-dependent fashion by pre-treatment of animals with A. paniculata (P < 0.05). The ability of A. paniculata to scavenge the 2,2-Diphenyl-2-picrylhydrazyl radical was determined through its EC(50) value. The EC(50) value of A. paniculata was 583.60 ± 4.25 µg/ml. In addition, A. paniculata was found to contain 65.37 ± 1.20 mg/g total phenolics expressed as gallic acid equivalent. From these studies, it is concluded that A. paniculata could be used as a hepatoprotective agent and possesses the potential to treat or prevent degenerative diseases where oxidative stress is implicated.
Mediastinal liposarcoma: a rare visceral mediastinal tumour

Krishnasamy S, Krishna Nair A, Hashim SA, Raja Mokhtar RA

Interact Cardiovasc Thorac Surg, 2019 12 01;29(6):976-977.
PMID: 31363757 DOI: 10.1093/icvts/ivz191

Liposarcoma is the second most common type of soft tissue malignancy in adults. They are malignant tumours with a mesenchymal origin. Mediastinal liposarcoma accounts for <1% of mediastinal tumours and 2% of liposarcoma. We report a patient with mediastinal liposarcoma who presented with cardiac tamponade, 25 years after the initial liposarcoma in the popliteal fossa.
Fulltext A pilot study on development and feasibility of the 'MyEducation: CABG application' for patients undergoing coronary artery bypass graft (CABG) surgery

Noor Hanita Z, Khatijah LA, Kamaruzzaman S, Karuthan C, Raja Mokhtar RA

BMC Nurs, 2022 Feb 04;21(1):40.
PMID: 35120517 DOI: 10.1186/s12912-022-00814-4

BACKGROUND: Patients scheduled for coronary artery bypass graft (CABG) surgery tend to have persistent symptoms of anxiety and depression. Course of hospital stay post-CABG procedure has become increasingly shorter over the last few decades. This pilot study was conducted to develop and test feasibility of MyEducation: CABG application as a learning tool to reduce anxiety and depression levels among patients undergoing CABG Surgery.
METHODS: This study was quasi-experimental in design. Forty-five patients scheduled for CABG surgery were recruited via consecutive sampling from a Tertiary Referral Centre at Kuala Lumpur, Malaysia. MyEducation:CABG application (Web-based education application) was administered among the intervention group (N = 23); while the control group (N = 22) underwent standard care. Web-based education application were implemented by nurses at admission and prior to discharge. Patients were assisted in terms of queries and concerns, upon which corresponding information and support was provided. Sociodemographic data were obtained from patients, prior to administration of Hospital Anxiety and Depression Scale which was used to measure levels of anxiety and depression. The educational application was used to obtain satisfaction rating among intervention group. These measures were administered upon admission, on discharge and one-month post-discharge.
RESULTS: Mean anxiety and depression scores among the intervention group were lower compared to the control. This was significant for anxiety upon admission, on discharge and one-month post-discharge (p
Fulltext Hemorrhagic cardiac tamponade: rare complication of radiofrequency ablation of hepatocellular carcinoma

Loh KB, Bux SI, Abdullah BJ, Raja Mokhtar RA, Mohamed R

Korean J Radiol, 2012 Sep-Oct;13(5):643-7.
PMID: 22977334 DOI: 10.3348/kjr.2012.13.5.643

Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.
Fulltext Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

Johari B, Abdul Aziz YF, Krishnasamy S, Looi LM, Hashim SA, Raja Mokhtar RA

Iran J Radiol, 2015 Apr;12(2):e11197.
PMID: 26060549 DOI: 10.5812/iranjradiol.11197

The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.
Fulltext Effect of sternal closure with biological bone adhesive on pain visual analogue score and serum cytokine

Hashim S, Chin LY, Krishnasamy S, Sthaneswar P, Raja Mokhtar RA

J Cardiothorac Surg, 2015;10:32.
PMID: 25890367 DOI: 10.1186/s13019-015-0230-0

Recently a biocompatible bone adhesive was introduced in addition to the sternal wires to expedite sternal union and improve patient recovery. In this study we aim to objectively assess the biomarker of pain in patient who received the biocompatible bone adhesive.
A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart

Hashim SA, Amin MA, Nair A, Raja Mokhtar RA, Krishnasamy S, Cheng K

Heart Lung Circ, 2018 May;27(5):e59-e63.
PMID: 29246681 DOI: 10.1016/j.hlc.2017.11.011

The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.
Fulltext Biochemical analysis of collagens from the bone of lizardfish (Saurida tumbil Bloch, 1795) extracted with different acids

Jaziri AA, Shapawi R, Mohd Mokhtar RA, Md Noordin WN, Huda N

PeerJ, 2022;10:e13103.
PMID: 35310170 DOI: 10.7717/peerj.13103

BACKGROUND: Lizardfish (Saurida tumbil Bloch, 1795) bone is a fish by-product generated during industrial surimi processing. This by-product is an important source of collagen production since the use of terrestrial animal-based collagens no longer sought due to concern regarding the transfer of infectious diseases and religious issues. Hence, this study was carried out to determine the biochemical analysis of collagens from the bone of lizardfish extracted with different acids.
METHODS: Lizardfish bone collagens were extracted with various acids (i.e., acetic, lactic and citric acids). All extraction processes were conducted in a chiller room (4 °C). The extracted collagens were biochemically characterized, such as hydroxyproline content, Ultraviolet (UV) absorption, X-ray diffraction (XRD), Fourier transform infrared spectroscopy spectra (FTIR), Differential scanning calorimetry (DSC) and solubility in different pH values and NaCl concentrations.
RESULTS: The yield of extracted collagens ranged between 1.73% and 2.59%, with the highest (p
Imaging of an atypical pericardial cyst

Abu Bakar N, Abdul Aziz YF, Singh Sandhu R, Fadzli F, Yaakub NA, Krishnasamy S, et al.

Heart Lung Circ, 2013 Apr;22(4):305-8.
PMID: 22921797 DOI: 10.1016/j.hlc.2012.07.016

Pericardial cysts are uncommon mediastinal lesions that are usually congenital in origin. Patients are usually asymptomatic and the cysts are generally discovered on routine radiography for unrelated purposes. This case illustrates a symptomatic presentation of a haemorrhagic pericardial cyst in which radiographic, echocardiographic and multislice (MRI and CT) imaging were performed. The imaging findings were not typical of pericardial cysts leading to a diagnostic quandary despite the varied imaging techniques. In conclusion, it is important to appreciate that the imaging findings of pericardial cysts can be varied. Radiologists and clinicians alike should be aware of this variability.
Medicinal plants of Southeast Asia with anti-α-glucosidase activity as potential source for type-2 diabetes mellitus treatment

Benjamin MAZ, Mohd Mokhtar RA, Iqbal M, Abdullah A, Azizah R, Sulistyorini L, et al.

J Ethnopharmacol, 2024 Aug 10;330:118239.
PMID: 38657877 DOI: 10.1016/j.jep.2024.118239

ETHNOPHARMACOLOGICAL RELEVANCE: Diabetes mellitus, a widespread chronic illness, affects millions worldwide, and its incidence is increasing alarmingly, especially in developing nations. Current pharmacological treatments can be costly and have undesirable side effects. To address this, medicinal plants with antidiabetic effects, particularly targeting α-glucosidase for controlling hyperglycaemia in type-2 diabetes mellitus (T2DM), hold promise for drug development with reduced toxicity and adverse reactions.
AIM OF THIS REVIEW: This review aims to succinctly collect information about medicinal plant extracts that exhibit antidiabetic potential through α-glucosidase inhibition using acarbose as a standard reference in Southeast Asia. The characteristics of this inhibition are based on in vitro studies.
MATERIALS AND METHODS: Relevant information on medicinal plants in Southeast Asia, along with α-glucosidase inhibition studies using acarbose as a positive control, was gathered from various scientific databases, including Scopus, PubMed, Web of Science, and Google Scholar.
RESULTS: About 49 papers were found from specific counties in Southeast Asia demonstrated notable α-glucosidase inhibitory potential of their medicinal plants, with several plant extracts showcasing activity comparable to or surpassing that of acarbose. Notably, 19 active constituents were identified for their α-glucosidase inhibitory effects.
CONCLUSIONS: The findings underscore the antidiabetic potential of the tested medicinal plant extracts, indicating their promise as alternative treatments for T2DM. This review can aid in the development of potent therapeutic medicines with increased effectiveness and safety for the treatment of T2DM.