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  1. Palasuberniam, Praneetha, Chin, Suliong, Thangiah, Viknesvaran, D’Souza, Urban John Arnold
    MyJurnal
    Medication errors (MEs) are preventable mistakes that occur when there is a failure in the treatment process of any disease that can cause potential harm to patients. Having an effect on patients, health outcomes and costs incurred, it does burden our economically-developing country. Database systems have been created worldwide for the reporting of MEs, but varying countries practise different classifications of MEs hence it poses a challenge to categorize them. This makes it next to impossible to fully curb this continual problem. There are a number of classifications of MEs, based on mistakes and errors based on skills, based on the mistakes itself, based on symptoms and based on the stages of drug delivery system. This review summarizes the pre-existing classifications of MEs.
  2. Palasuberniam P, Tan KY, Tan CH
    PMID: 34616441 DOI: 10.1590/1678-9199-JVATITD-2021-0024
    Background: The Malayan blue coral snake, Calliophis bivirgata flaviceps, is a medically important venomous snake in Southeast Asia. However, the complexity and diversity of its venom genes remain little explored.

    Methods: To address this, we applied high-throughput next-generation sequencing to profile the venom gland cDNA libraries of C. bivirgata flaviceps. The transcriptome was de novo assembled, followed by gene annotation, multiple sequence alignment and analyses of the transcripts.

    Results: A total of 74 non-redundant toxin-encoding genes from 16 protein families were identified, with 31 full-length toxin transcripts. Three-finger toxins (3FTx), primarily delta-neurotoxins and cardiotoxin-like/cytotoxin-like proteins, were the most diverse and abundantly expressed. The major 3FTx (Cb_FTX01 and Cb_FTX02) are highly similar to calliotoxin, a delta-neurotoxin previously reported in the venom of C. bivirgata. This study also revealed a conserved tyrosine residue at position 4 of the cardiotoxin-like/cytotoxin-like protein genes in the species. These variants, proposed as Y-type CTX-like proteins, are similar to the H-type CTX from cobras. The substitution is conservative though, preserving a less toxic form of elapid CTX-like protein, as indicated by the lack of venom cytotoxicity in previous laboratory and clinical findings. The ecological role of these toxins, however, remains unclear. The study also uncovered unique transcripts that belong to phospholipase A2 of Groups IA and IB, and snake venom metalloproteinases of PIII subclass, which show sequence variations from those of Asiatic elapids.

    Conclusion: The venom gland transcriptome of C. bivirgata flaviceps from Malaysia was de novo assembled and annotated. The diversity and expression profile of toxin genes provide insights into the biological and medical importance of the species.

  3. Tan CH, Palasuberniam P, Tan KY
    Toxins (Basel), 2021 07 23;13(8).
    PMID: 34437385 DOI: 10.3390/toxins13080514
    Snakebite envenomation is a serious neglected tropical disease, and its management is often complicated by the diversity of snake venoms. In Asia, pit vipers of the Ovophis species complex are medically important venomous snakes whose venom properties have not been investigated in depth. This study characterized the venom proteomes of Ovophis convictus (West Malaysia), Ovophis tonkinensis (northern Vietnam, southern China), and Ovophis okinavensis (Okinawa, Japan) by applying liquid chromatography-tandem mass spectrometry, which detected a high abundance of snake venom serine proteases (SVSP, constituting 40-60% of total venom proteins), followed by phospholipases A2, snake venom metalloproteinases of mainly P-III class, L-amino acid oxidases, and toxins from other protein families which were less abundant. The venoms exhibited different procoagulant activities in human plasma, with potency decreasing from O. tonkinensis > O. okinavensis > O. convictus. The procoagulant nature of venom confirms that consumptive coagulopathy underlies the pathophysiology of Ovophis pit viper envenomation. The hetero-specific antivenoms Gloydius brevicaudus monovalent antivenom (GbMAV) and Trimeresurus albolabris monovalent antivenom (TaMAV) were immunoreactive toward the venoms, and cross-neutralized their procoagulant activities, albeit at variably limited efficacy. In the absence of species-specific antivenom, these hetero-specific antivenoms may be useful in treating coagulotoxic envenomation caused by the different snakes in their respective regions.
  4. Xiang X, Palasuberniam P, Pare R
    Curr Issues Mol Biol, 2024 Jul 29;46(8):8170-8196.
    PMID: 39194700 DOI: 10.3390/cimb46080483
    Estrogen is a significant hormone that is involved in a multitude of physiological and pathological processes. In addition to its pivotal role in the reproductive system, estrogen is also implicated in the pathogenesis of a multitude of diseases. Nevertheless, previous research on the role of estrogen in a multitude of diseases, including Alzheimer's disease, depression, cardiovascular disease, diabetes, osteoporosis, gastrointestinal diseases, and estrogen-dependent cancers, has concentrated on a single disease area, resulting in a lack of comprehensive understanding of cross-disease mechanisms. This has brought some challenges to the current treatment methods for these diseases, because estrogen as a potential therapeutic tool has not yet fully developed its potential. Therefore, this review aims to comprehensively explore the mechanism of estrogen in these seven types of diseases. The objective of this study is to describe the relationship between each disease and estrogen, including the ways in which estrogen participates in regulating disease mechanisms, and to outline the efficacy of estrogen in treating these diseases in clinical practice. By studying the role of estrogen in a variety of disease mechanisms, it is hoped that a more accurate theoretical basis and clinical guidance for future treatment strategies will be provided, thus promoting the effective management and treatment of these diseases.
  5. Tan CH, Palasuberniam P, Blanco FB, Tan KY
    Trans R Soc Trop Med Hyg, 2021 01 07;115(1):78-84.
    PMID: 32945886 DOI: 10.1093/trstmh/traa087
    BACKGROUND: The Philippine cobra (Naja philippinensis) and Samar cobra (Naja samarensis) are two WHO Category 1 medically important venomous snakes in the Philippines. Philippine cobra antivenom (PCAV) is the only antivenom available in the country, but its neutralization capacity against the venoms of N. philippinensis and hetero-specific N. samarensis has not been reported. This knowledge gap greatly hinders the optimization of antivenom use in the region.

    METHODS: This study examined the immunological binding and neutralization capacity of PCAV against the two cobra venoms using WHO-recommended protocols.

    RESULTS: In mice, both venoms were highly neurotoxic and lethal with a median lethal dose of 0.18 and 0.20 µg/g, respectively. PCAV exhibited strong and comparable immunoreactivity toward the venoms, indicating conserved venom antigenicity between the two allopatric species. In in vivo assay, PCAV was only moderately effective in neutralizing the toxicity of both venoms. Its potency was even lower against the hetero-specific N. samarensis venom by approximately two-fold compared with its potency against N. philippinensis venom.

    CONCLUSION: The results indicated that PCAV could be used to treat N. samarensis envenomation but at a higher dose, which might increase the risk of hypersensitivity and worsen the shortage of antivenom supply in the field. Antivenom manufacturing should be improved by developing a low-dose, high-efficacy product against cobra envenomation.

  6. Palasuberniam P, Chan YW, Tan KY, Tan CH
    Front Pharmacol, 2021;12:727756.
    PMID: 35002690 DOI: 10.3389/fphar.2021.727756
    The Samar Cobra, Naja samarensis, is endemic to the southern Philippines and is a WHO-listed Category 1 venomous snake species of medical importance. Envenomation caused by N. samarensis results in neurotoxicity, while there is no species-specific antivenom available for its treatment. The composition and neutralization of N. samarensis venom remain largely unknown to date. This study thus aimed to investigate the venom proteome of N. samarensis for a comprehensive profiling of the venom composition, and to examine the immunorecognition as well as neutralization of its toxins by a hetero-specific antivenom. Applying C18 reverse-phase high-performance liquid chromatography (RP-HPLC) and tandem mass spectrometry (LC-MS/MS), three-finger toxins (3FTx) were shown to dominate the venom proteome by 90.48% of total venom proteins. Other proteins in the venom comprised snake venom metalloproteinases, phospholipases A2, cysteine-rich secretory proteins, venom nerve growth factors, L-amino acid oxidases and vespryn, which were present at much lower abundances. Among all, short-chain alpha-neurotoxins (SαNTX) were the most highly expressed toxin within 3FTx family, constituting 65.87% of the total venom proteins. The SαNTX is the sole neurotoxic component of the venom and has an intravenous median lethal dose (LD50) of 0.18 μg/g in mice. The high abundance and low LD50 support the potent lethal activity of N. samarensis venom. The hetero-specific antivenom, Philippine Cobra Antivenom (PCAV, raised against Naja philippinensis) were immunoreactive toward the venom and its protein fractions, including the principal SαNTX. In efficacy study, PCAV was able to cross-neutralize the lethality of SαNTX albeit the effect was weak with a low potency of 0.20 mg/ml (defined as the amount of toxin completely neutralized per milliliter of the antivenom). With a volume of 5 ml, each vial of PCAV may cross-neutralize approximately 1 mg of the toxin in vivo. The findings support the potential para-specific use of PCAV in treating envenomation caused by N. samarensis while underscoring the need to improve the potency of its neutralization activity, especially against the highly lethal alpha-neurotoxins.
  7. Zarkasi KA, Ramli NZ, Mohamed K, Palasuberniam P, D’ Souza UJA
    MyJurnal
    Malaysia has high prevalence of general and central obesity which can be signified by measurements of BMI and waist circumference respectively. Both parameters are established risk factors and predictors for non-communicable diseases including diabetes and hypertension. A health screening programme was conducted in a rural district of Sabah, Malaysia where a total of 42 participants were examined for weight, height, BMI, waist circumference, systolic and diastolic blood pressure, pulse rate and capillary blood glucose. Mean age of the participants was 52.4 ± 14.9 years old. General obesity based on BMI was 42.9% while central obesity based on waist circumference was 26.2%. Proportion for hypertension and hyperglycaemia were equal at 33.3%. BMI was strongly correlated to waist circumference (r = 0.873, p < 0.001). Moreover, both BMI and waist circumference were independently correlated with systolic blood pressure (r = 0.418, p = 0.006 and r = 0.383, p = 0.012 respectively). Finally, systolic blood pressure was directly correlated with weight of the participants (r = 0.350, p = 0.023). These findings were found to be closely similar and comparable to currently available epidemiological data.
  8. Thomas FM, Sudi S, Muhamad Salih FA, Palasuberniam P, Suali L, Mohd Sani MH, et al.
    Asian Pac J Cancer Prev, 2022 Aug 01;23(8):2863-2871.
    PMID: 36037145 DOI: 10.31557/APJCP.2022.23.8.2863
    OBJECTIVE: The aim of this study was to investigate the effects of CaM antagonist, PTZ, and TFP on cell proliferation and migration of colon cancer cells and its impact on POPDC protein expression.

    METHODS: The 50% inhibitory concentration (IC50) of PTZ and TFP in SW1116, SW480, HCT-15, and COLO205 colon cancer cell lines are measured using MTT. Western blot and immunocytochemistry were used to determine the expression of PCNA, cyclin D1 (CD1), and POPDC proteins. Cell migration was observed using a scratch wound-healing assay.

    RESULTS: Treatment with PTZ and TFP inhibited colon cancer cells growth in a dose-dependent manner. PTZ and TFP significantly inhibited the activation of proliferation markers, PCNA and CD1, and the migration of colon cancer cells. Furthermore, POPDC protein was significantly suppressed in all cell types of colon cancer, particularly in SW480. Finally, the CaM antagonist upregulates the POPDC1 expression in colon cancer cells.

    CONCLUSION: These findings suggest that CaM antagonists suppress colon cancer cells proliferation via downregulation of CD1 and PCNA. In addition, POPDC protein could be used as a biomarker in colon cancer, and CaM antagonist could be used to regulate POPDC1 expression. This study suggests that targeting POPDC1 with CaM inhibition could be a potential therapeutic strategy for colon cancer treatment. 
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  9. Palasuberniam P, Tan KY, Chan YW, Blanco FB, Tan CH
    Trans R Soc Trop Med Hyg, 2023 Jun 02;117(6):428-434.
    PMID: 36611268 DOI: 10.1093/trstmh/trac125
    BACKGROUND: Philippine Cobra Antivenom (PCAV) is the only snake antivenom manufactured in the Philippines. It is used clinically to treat envenoming caused by the Philippine Spitting Cobra (Naja philippinensis). While PCAV is effective pharmacologically, it is crucial to ensure the safety profile of this biologic that is derived from animal plasma.

    METHODS: This study examined the composition purity of PCAV through a decomplexation proteomic approach, applying size-exclusion chromatography (SEC), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and tandem mass spectrometry liquid chromatography-tandem mass spectrometry (LC-MS/MS).

    RESULTS: SDS-PAGE and SEC showed that the major protein in PCAV (constituting ∼80% of total proteins) is approximately 110 kDa, consistent with the F(ab')2 molecule. This protein is reducible into two subunits suggestive of the light and heavy chains of immunoglobulin G. LC-MS/MS further identified the proteins as equine immunoglobulins, representing the key therapeutic ingredient of this biologic product. However, protein impurities, including fibrinogens, alpha-2-macroglobulins, albumin, transferrin, fibronectin and plasminogen, were detected at ∼20% of the total antivenom proteins, unveiling a concern for hypersensitivity reactions.

    CONCLUSIONS: Together, the findings show that PCAV contains a favorable content of F(ab')2 for neutralization, while the antibody purification process awaits improvement to minimize the presence of protein impurities.

  10. Chin KL, Anibarro L, Chang ZY, Palasuberniam P, Mustapha ZA, Sarmiento ME, et al.
    Curr Res Microb Sci, 2024;7:100295.
    PMID: 39512261 DOI: 10.1016/j.crmicr.2024.100295
    Tuberculosis (TB) is the world's second-deadliest infectious disease. Despite the availability of drugs to cure TB, control of TB is hampered by the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). The presence of MDR/XDR-TB is alarming due to the low detection rate, high treatment failure, and high mortality. The increasing cases of MDR/XDR-TB are mainly due to the limitations in the diagnostic tests to detect the drug susceptibility of the pathogen, which contribute to the spread of the disease through close contacts. Moreover, inconsistent drug therapy or unsuitable drug regimens could also lead to the subsequent development of drug resistance. The close contacts of an index MDR/XDR-TB patient are at increased risk of developing MDR/XDR-TB. Also, the BCG vaccine may exhibit varying protective effects due to BCG strain diversification, host immune status, exposure to environmental non-tuberculous mycobacteria (NTM), and differences in Mycobacterium tuberculosis (Mtb) subspecies infection, as in the case of sub-optimal protection in the case of Beijing family genotypes of Mtb. This review provides an overview of the current state of drug-resistant tuberculosis (DR-TB) within the context of the global TB pandemic, with a focus on diagnosis, treatment, and the potential impact of BCG vaccination. It highlights the limitations of current approaches and aims to identify opportunities for improving TB control strategies.
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