The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage.
Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Human immunodeficiency virus (HIV)-1 epidemics in Asian countries are driven by varying exposures. The epidemiology of the regional pandemic has been changing with the spread of HIV-1 to lower-risk populations through sexual transmission. Common HIV-1 genotypes include subtype B and circulating recombinant form (CRF) 01_AE. Our objective was to use HIV-1 genotypic data to better quantify local epidemics. TASER-M is a multicenter prospective cohort of HIV-infected patients. Associations between HIV exposure, patient sex, country of sample origin and HIV-1 genotype were evaluated by multivariate logistic regression. Phylogenetic methods were used on genotypic data to investigate transmission relationships. A total of 1086 patients from Thailand, Hong Kong, Malaysia and the Philippines were included in analyses. Proportions of male patients within countries varied (Thailand: 55.6%, Hong Kong: 86.1%, Malaysia: 81.4%, Philippines: 93.8%; p
Nonepithelial ovarian cancer (NEOC) is a rare cancer that is often misdiagnosed as other malignant tumors. Research on this cancer using fresh tissues is nearly impossible because of its limited number of samples within a limited time provided. The study is to identify potential genes and their molecular pathways related to NEOC using formalin-fixed paraffin embedded samples. Total RNA was extracted from eight archived NEOCs and seven normal ovaries. The RNA samples with RNA integrity number >2.0, purity >1.7 and cycle count value <28 cycles were hybridized to the Illumina Whole-Genome DASL assay (cDNA-mediated annealing, selection, extension, and ligation). We analyzed the results using the GeneSpring GX11.0 and FlexArray software to determine the differentially expressed genes. Microarray results were validated using an immunohistochemistry method. Statistical analysis identified 804 differentially expressed genes with 443 and 361 genes as overexpressed and underexpressed in cancer, respectively. Consistent findings were documented for the overexpression of eukaryotic translation elongation factor 1 alpha 1, E2F transcription factor 2, and fibroblast growth factor receptor 3, except for the down-regulated gene, early growth response 1 (EGR1). The immunopositivity staining for EGR1 was found in the majority of cancer tissues. This finding suggested that the mRNA level of a transcript did not always match with the protein expression in tissues. The current gene profile can be the platform for further exploration of the molecular mechanism of NEOC.
Chikungunya virus, a mosquito-borne alphavirus, is endemic in Africa and Southeast Asia but is rarely reported in Taiwan. We report the case of a Taiwanese woman who developed Chikungunya fever, which was first diagnosed by a clinician rather than by fever screening at an airport. The woman presented with fever, maculopapular rash, and arthralgia, the triad for the disease, on the day she returned home after a trip to Malaysia. These symptoms are very similar to those of dengue fever, which is endemic in Southern Taiwan. Chikungunya infection was confirmed by reverse transcriptase-polymerase chain reaction and seroconversion on paired serum specimens. For approximately 40 years until 2006, no cases of Chikungunya fever had been found in Taiwan. Clinicians in Taiwan should consider Chikungunya fever as a possible diagnosis for a febrile patient with arthralgia, rash, and a history of travel to an endemic area, such as Africa or Southeast Asia.
Problem-based learning (PBL) is an excellent opportunity for students to take responsibility for their learning and to develop a number of cognitive skills. These include identifying problems in the trigger, generating hypotheses, constructing mechanisms, developing an enquiry plan, ranking their hypotheses on the basis of available evidence, interpreting clinical and laboratory findings, identifying their learning needs, and dealing with uncertainty. Students also need to work collaboratively in their group, communicate effectively, and take active roles in the tutorials. Therefore, interaction in the group between students and their tutor is vital to ensure deep learning and successful outcomes. The aims of this paper are to discuss the key principles for successful interaction in PBL tutorials and to highlight the major symptoms of superficial learning and poor interactions. This comprises a wide range of symptoms for different group problems, including superficial learning. By early detection of such problems, tutors will be able to explore actions with the group and negotiate changes that can foster group dynamics and enforce deep learning.
Lectures are of great value to students. However, with the introduction of hybrid problem-based learning (PBL) curricula into most medical schools, the emphasis on lectures has decreased. This paper discusses how lectures can be used in a PBL curriculum, what makes a great lecture, and how to deliver a lecture that fits with these changes.
Portfolios have been used in the medical curriculum to evaluate difficult-to-assess areas such as students' attitudes, professionalism and teamwork. However, their use early in a problem-based learning (PBL) course to foster deep learning and enhance students' self-directed learning has not been adequately studied. The aims of this paper are to: (1) understand the uses of portfolios and the rationale for using reflection in the early years of a PBL curriculum; (2) discuss how to introduce portfolios and encourage students' critical thinking skills, not just reflection; and (3) provide students with tips that could enhance their skills in constructing good portfolios.
Our study aimed to assess the psychometric validity of the conceptual disorganization item and other items of the Brief Psychiatric Rating Scale (BPRS) for detecting disorganized speech in patients with schizophrenia. We included 357 schizophrenia patients with disorganized speech and 1082 without disorganized speech from the survey centers in India, Indonesia, Japan, Malaysia, and Taiwan, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. After adjusting the effects of confounding variables, a binary logistic regression model was fitted to identify BPRS items independently associated with disorganized speech. Receiver operating characteristic (ROC) curves were used to identify optimum cut-off scores and their sensitivities and specificities for detecting disorganized speech. After adjusting the effects of confounding variables, the fitted binary logistic regression model indicated that conceptual disorganization (P
Age-related macular degeneration (AMD) is the most widely recognised cause of irreversible vision loss and previous studies have suggested that the advancement of wet AMD is influenced by both modifiable and non-modifiable elements. Single nucleotide polymorphism (SNPs) and copy number of variations (CNVs) have been associated with AMD in various populations, however the results are conflicting. Our aim is to determine the CNVs of Complement Factor H-Related genes among Malaysian subjects with wet AMD. 130 patients with wet AMD and 120 healthy controls were included in this research. DNA was extracted from all subjects and CNVs of CFH, CFHR1 and CFHR3 genes; determined using quantitative real-time PCR and were compared between the two groups. A consistent association was observed between CFH gene and wet AMD susceptibility (P
In the present study, a simple, economic and practical technique was employed for stool examination. Of a total of 6,146 fecal samples from foreign workers in Northern Taiwan between 1999 and 2000 were examined, 615 were found to be positive for parasitic infection and the overall infection rate was 10%. Newly arriving foreign workers had a significantly higher infection rate (15%) than those who had worked in Taiwan for 6-12 months (8%). The foreign workers came from Indonesia, Philippines, Thailand, Malaysia, and Vietnam. Except for the small number of workers from Malaysia which was not included, the infection rate order by nationality was Vietnamese (21%) > Indonesian (13%) > Philippino (10%) > Thai (4%). The female examined workers were about 3-fold of males and their infection rate (11%) was also significantly higher than the males (5%). The order of rates by age was 20-30 years (11%) > 31-40 years (8%) > 41-50 years (5%). According to the species of parasites, 569 foreign workers were infected with 1 species (9%) > with 2 species (0.7%) > with 3 species (0.1%). Totally, 14 species (10 helminths including 1 plant nematode, Heterodera and 4 protozoa; hookworm might include 2 or 3 species, but counted as one species here) were found, of which 10 species were pathogenic (9 helminths and 1 protozoa) and 4 non-pathogenic. Foreign workers from Indonesia harbored 12 species of parasites > from the Philippines, 9 species > from Thailand, 8 species > from Vietnam, 7 species.