Journal of the Asian Medical Students Association
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Identification of Gut Bacterial Enzymes for Conversion of Donor Blood Groups to Universal O Type
Full text linkAbstract
Using an α-galactosidase, B erythrocytes can be converted to blood group O without affecting their viability in vitro nor their survival after transfusion to individuals of groups O, A, and B. This technique has the potential to generate enzymatically converted group O cells for transfusion therapy. 1 Similarly, by using the appropriate a-N-acetylgalactosaminidase, it should be possible to convert A cells to group O cells.
Objective
Correct matching of blood types is a central requirement of blood transfusion since the plasma of individuals of blood group A contains antibodies against the B antigen and vice versa. Thus, incompatible transfusions can result in the activation of complement and red blood cell (RBC) lysis, which can be lethal. Access to effective enzymes capable of converting A and B-type red blood cells to ‘universal’ donor O would significantly increase the amount of blood available for transfusions.
Method
A literature review was conducted by searching data on Pubmed, Google Scholar, Nature, and Science using keywords like ABO Blood Groups, Blood Transfusion, and Gut Microbiome.
Result
The functional metagenomic screening of the human gut microbiome for enzymes that can remove the cognate A and B type sugar antigens was reported. Among the genes encoded, 19,500 expressed fosmids bearing gut bacterial DNA. 2 An enzyme pair from the obligate anaerobe Flavonifractor plautii was identified to efficiently convert the A antigen to the H antigen of O-type blood, via a galactosamine intermediate. The X-ray structure of the N-acetylgalactosamine deacetylase reveals the active site and mechanism as the first member of an esterase family. 3 The galactosaminidase extends activities within the CAZy family GH36. Their ability to completely convert A to O of the same rhesus type at very low enzyme concentrations in whole blood simplifies their incorporation into blood transfusion practice, broadening blood supply. 2
Conclusion
The discovery of enzymes from Flavonifractor plautii capable of converting A-type RBCs to O-type represents a significant advancement in transfusion medicine. The ability to convert blood types simplifies the process of generating universal donor blood. This finding has the potential to increase blood supply, enhancing the safety and availability of blood for transfusions. Further research and development of these enzymes could lead to practical, cost-effective solutions for broadening the universal blood supply and improving patient outcomes in transfusion medicine
Diagnosis of Rare Duodenal Neuroendocrine Tumor with Carcinoid Syndrome
Full text linkIntroduction
Duodenal carcinoids are malignant tumors originating from enterochromaffin cells. They develop distant metastases and account for approximately one-third of gastrointestinal neuroendocrine tumors (NETs). They are the primary cause of carcinoid syndrome, a prominent neuroendocrine neoplasm presentation. Primary duodenal carcinoids, accounting for less than 2% of all GI-NETs, are linked to loss of function mutations of the MEN1 gene, and the related NETs show loss of heterozygosity on chromosome 11q13.
Background
Duodenal carcinoids are rare tumors, and the secondary manifestation of carcinoid syndrome makes them a unique occurrence. The incidence is estimated to be approximately 1-2.4 cases per 100,000 population.
Case
A 34-year-old adult male presented with upper abdominal pain, diarrhea, cutaneous flushing, dry cough, exertional dyspnea, and right-sided heart disease due to regurgitant tricuspid valve deposits. Multiple nodules, both <10 mm and ≥10 mm in size, were found in the upper parts of the duodenum, along with long segment wall thickening on contrast-enhanced CT. Duodenal carcinoid elements were confirmed via positive chromogranin A in endoscopy-guided biopsy material and elevated 24-hour urine 5-hydroxyindoleacetic acid (5-HIAA). A 2-dimensional echocardiographic evaluation suggested the diagnosis of carcinoid heart disease.
Discussion
To support clinical decision-making, recent scientific publications from the last 10 years were reviewed using the keyword “duodenal carcinoid” on PubMed. One systematic review and 20 literature reviews were found. Advanced imaging tools for assessing tumor distribution, lesion size, depth of invasion, metastatic conditions, and multifocal disease in the gastrointestinal tract were discussed. The Ki67 proliferative index and depth of invasion were considered in deciding between surgical and endoscopic resection. Approaches to non-resectable metastasized NETs included Peptide Receptor Radionuclide Therapy or 90Y radioembolization as alternative treatments.
Conclusion
The patient, symptomatic with multiple tumors in the duodenum, required radical surgery and regional lymphadenectomy, as tumor size, depth of invasion, and multifocality could not reliably predict lymph nodal metastasis. The benefits of chemotherapy were not proven. The patient was subsequently referred to specialized oncology care. This case report aims to highlight the often-overlooked clinical manifestations of duodenal carcinoids to aid in early recognition and diagnosis, focusing also on the diagnostic methods employed. Large-scale research is required to better understand various aspects of this disease
Covid-19 Unveils Stage 3 Esophageal Cancer: Gastric Transposition Surgery Following Accidental Diagnosis
Full text linkAbstract
Following the COVID-19 pandemic, medical professionals around the globe are finding it more and more difficult to diagnose and treat a wide range of medical conditions. This work offers a compelling case study that clarifies the relationship between the middle-aged patient’s COVID-19 infection and the later identification and treatment of Stage 3 esophageal cancer. After contracting COVID-19 for the first time, the 49-year-old patient started a convoluted medical odyssey full of unanticipated detours. Even though the viral illness was quickly resolved; the return of enduring symptoms prompted a comprehensive medical assessment, which coincidentally revealed covert cancer in the lower esophagus. Following diagnosis, the patient received a complete course of treatment that included esophageal reconstruction surgery with the novel gastric transposition technique and chemotherapy. The postoperative phase was not without difficulties, either, as complications including the development of a hernia and gastrointestinal troubles required close observation and further medical procedures. Holistic care was prioritized during treatment and rehabilitation, including lifestyle changes, stress management techniques, and the significance of quitting smoking. This case emphasizes the necessity of careful post-COVID-19 treatment and comprehensive medical observation. The research highlights the significance of multidisciplinary cooperation in enhancing patient results and comprehending the intricate connection with esophageal cancer.
Method
In order to complete the case study, a 49-year-old male patient named X was interviewed online. During the interview, the patient described all of his symptoms, diagnosis, medical procedures, and problems from 2022.
Result
This case study demonstrates the intricate relationship between a 49-year-old Patient’s COVID-19 infection and the subsequent identification and management of esophageal cancer. Even after recovering from COVID-19, cancer was found as a result of enduring symptoms. Treatment included surgery, chemotherapy, and all-encompassing care; further attention was needed for postoperative problems. To manage health concerns after COVID-19, the study highlights the significance of careful medical observation, interdisciplinary collaboration, and attentive therapy.
Conclusion
In summary, even after the acute sickness has subsided, patients should continue to be closely watched for any potential problems that may arise from COVID-19 infection. This case emphasizes this necessity. This middle-aged patient’s complex journey serves as a reminder of the value of thorough medical examinations, and multidisciplinary teamwork among healthcare providers, and holistic care methods. Understanding the intricate relationship between COVID-19 and the later development and treatment of other illnesses, such as oesophageal cancer, enables medical professionals to better optimize patient outcomes and offer more efficient treatment plans in comparable situations
Influence of Confluent White Matter Hyperintensities on the Mechanics of Memory
Full text linkIntroduction:
Dementia affects approximately 55 million people worldwide and is characterised by cognitive function deterioration in areas like attention and memory. Given the high prevalence of dementia and its contribution to significant psychiatric morbidity globally, it is a critical health issue in geriatric care.
White matter hyperintensities (WMH) are associated with an increased risk of dementia and cognitive impairment. Confluent WMH (C-WMH), with larger WMH volumes, are associated with greater cognitive decline than non-confluent WMH (NC-WMH).
Presently, the pathogenesis of cognitive impairment due to WMH remains largely unknown. A better understanding of the type of memory loss in C-WMH would allow for earlier detection of individuals at risk of cognitive decline and opportunities for early interventions to slow down memory loss.
Objective:
To identify the stage(s) of memory (attention, encoding, and retrieval) affected in non-demented individuals with and without C-WMH in a Southeast Asian population.
Methods:
In this cross-sectional study, 496 non-demented adults were recruited from Singapore. Using magnetic resonance imaging, they were classified as either having C-WMH or NC-WMH based on the Staals’ criteria. Neuropsychological assessment tests were conducted to assess the global cognition scores and attention, encoding, and retrieval abilities of the subjects. A one-way ANCOVA with Bonferroni correction for age and years of education was performed.
Results:
Individuals with C-WMH had significantly lower global cognition scores and significantly worse encoding abilities (P=0.037) compared to those with NC-WMH. However, the attention (P=0.813) and retrieval abilities (P=0.215) were not significantly different in C-WMH & NC-WMH adults.
Conclusion:
C-WMH is associated with significantly poorer performances in encoding abilities, but not in attention and retrieval, even in adults without dementia. Understanding the specific stage of memory affected in C-WMH individuals could help guide cognitive training interventions for non-demented individuals with pre-existing WMH to reduce the future risk of cognitive decline
Today’s Choice, Future’s Voice: Decide End-Of-Life Care Plans in Advance
Full text linkBackground
Having a dignified end-of-life is a human right. However, elderly people with a terminal illness, such as cancer and severe dementia, are often unable to express their will. They may involuntarily receive futile life-sustaining treatments leading to unnecessary suffering.
Medical futility raises many problems. It prolongs patients’ painful dying process, exhausts families with considerable expenses and time, causes healthcare providers moral distress, and consumes substantial medical resources. It has been a serious issue in Taiwan, where people tend to avoid talking about death when they’re alive. The prevalence of prolonged ventilation here is 5.8 times that of in the U.S., and nearly 30% of national healthcare expenditures occur during the last 3~6 months of life.
To solve the problem, Patient Right to Autonomy Act was implemented in 2019. Adults can complete Advance Directive (AD) to refuse or accept certain treatments in specific conditions. However, many citizens are still unfamiliar with AD. Some even misunderstand it as euthanasia.
Objectives
The poster aims to encourage people to consider and complete ADs in advance, which may be the voice to state one’s choices in the future. By planning earlier, it’ll not only help individuals receive patient-centered cares but benefit society by minimizing medical futility
Artificial Intelligence Companionship Robots Improving Depressive Symptoms in Older Adults: A Systematic Review
Full text linkBackground
The global geriatric population is expected to double from 8.5% to 17% (2015-2050), warranting investigation of the health issues most pertinent to this population. A major issue is depression, which is debilitating but often overlooked, with an estimated global prevalence of 7% in older adults. Artificial Intelligence (AI) robot companions have emerged for use in geriatric care, but no recent systematic reviews have clarified their impact on depressive symptoms.
This review aims to explore the efficacy of AI robot companions in reducing depressive symptoms within the geriatric population.
MethodsWe conducted a systematic review, searching Medline, Embase and Cochrane databases for English-language studies published between January 1 2003 and May 4 2023, with participants >65 years old assessing AI companionship robots for depression. Titles and abstracts were screened by two independent reviewers. Included quantitative results were meta-analysed using a random effects model and qualitative results were subjected to thematic analysis. Assessments for risk of bias and publication bias were performed.
Results
From 641 results, 7 studies with quantitative results and 6 with qualitative results met the inclusion criteria. Meta-analysis showed AI robots had no statistically significant impact on depressive symptom scores (standardized mean difference = 0.21, 95% confidence interval [-0.10, 0.51]), but qualitative findings demonstrated favourable views towards robot companions, particularly in terms of participant-reported reductions in loneliness (5 of 6 qualitative studies) with use.
Conclusion
In the geriatric population, whilst quantitative data showed no significant difference between AI robots and standard care for depression, qualitative findings demonstrated potential for companionship robots to be considered for depression. However, validity and reliability of results were impacted by the lack of high-quality studies, with many limited by small sample sizes, and short study durations. Further investigation is recommended for more conclusive evidence due to the limitations of some studies
THE RELATION BETWEEN BONY NASOLACRIMAL CANAL AND PRIMARY ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION
Full text linkIntroduction
Epiphora is a medical condition caused by primary acquired nasolacrimal duct obstruction (PANDO). It is often diagnosed in patients over 70 years of age and is at least 4 times more common in females. As life expectancy increases, the prevalence of epiphora will continue to increase and significantly affect quality of life. We propose to explore the effect of narrower bony nasolacrimal canal (BNLC) morphology on PANDO.
Method
This study used a hospital-based, retrospective case-control design with 584 participants grouped into PANDO patients and the control group. Morphometry of the bony nasolacrimal canal was measured by CT scan. The diagnosis of PANDO was confirmed by a blockage on the lacrimal irrigation test. The analyses were performed using Stata version 11.2. Statistical significance was defined as p<0.05.
Results
The average age of PANDO patients was 63.1±11.3 years, while the average age of control patients was 62.9±12.6 years. The BNLC's minimum transverse diameter was 3.67±1.96 mm on the PANDO side, 3.98±2.01 mm on the non-PANDO side and 4.03±1.12 mm for the control group. The distal BNLC transverse diameter was 4.39±1.21mm for the PANDO side, 4.33±1.32 mm on the non-PANDO side and 5.11±1.25 mm for the control groups. The BNLC entrance transverse diameter was 4.36±1.59 mm on the PANDO side, 4.43±1.83 mm on the non-PANDO side and 4.69±1.61 mm in the control group.
Conclusions
A susceptibility for primary acquired nasolacrimal duct obstructions’ development may result from narrower bone nasolacrimal canal shape. We detected a narrow distal bony nasolacrimal transverse diameter for both the PANDO and non-PANDO sides in unilateral PANDO patients compared with the control group
Awareness about Abortion among the Students in Malaysia
Full text linkObjectives:
Malaysia’s law and regulation on abortion ties in closer to the Islamic beliefs which varies from western countries such as the United States. However, misinformation and anti-abortic myths are heavily propagated through channels such as family and friends. This research aims to investigate the students’ knowledge of abortion laws and to discern between the facts and myths concerning abortion.
Study design:
This was a cross-sectional study of English speaking students aged 18 and above in Malaysia. Data was collected and interpreted through online resources such as Google Forms, Google Sheet & Google Feedback. This investigative study focuses on primary questions catered towards abortion.
Results:
Based on the results of 195 students, majority (113/195; 57.9%) felt that it would be illegal for her to get an abortion if mother is healthy, while (112/195; 57.4%) felt that if her life, or was the result of rape, or was the result of incest, it would be legal for her to get an abortion. For three out of the assessed myths, students are unable to discern and remain uncertain. Most students (92/195; 47.2%) are personally against abortion and feels that the government should not prevent a woman from making the decision herself. While (85/195; 43.6%) believe that having an abortion is morally acceptable and should be made legal. The remaining (18/195; 9.2%) believes that abortion is morally wrong and should be made illegal.
Conclusions:
Malaysian students have a very minimal level of comprehension regarding the country’s abortion laws, all the while still remaining unclear of the misconception and facts of abortion.
Implications:
Present abortion policies and guidelines will remain redundant unless they are actively endorsed to HCPs and incorporated into legal medical facilities as well as incorporating sexual education into corricular activities, making it vital.
 
A Scoping Review on the Factors Influencing the General Acceptance of Southeast Asians Towards HPV Vaccination
Full text linkBackground: Southeast Asia is known to have one of the highest Human Papillomavirus (HPV) prevalence rates globally. HPV vaccination has been shown to be successful in the prevention of infection.
Objectives: This study aims to perform a scoping review of the factors influencing HPV acceptance in Southeast Asia, extract dominant themes, identify factors, describe subgroup representation, and suggest considerations in the creation of interventional and delivery strategies to increase vaccine uptake.
Methodology: PubMed was used to identify papers discussing vaccine acceptance, published from January 2009 to March 2020. After review, 41 studies were included in qualitative synthesis.
Findings: The following outcomes were measured in the included studies: knowledge of HPV, attitudes towards vaccination, factors influencing attitudes towards vaccination, and the effectiveness of interventions and strategies in increasing vaccine uptake. There was an overall level of low to moderate knowledge, with generally high vaccine acceptance. Literacy was found to have a direct relationship with uptake, although limited by one’s resources and capability to get vaccinated. Price was noted to be the most crucial factor behind accessibility. Among delivery strategies, school-based and national immunization programs were found to be the most effective.
Conclusion: Factors influencing attitudes towards vaccination include economic, personal, social, and cultural factors. Culturally-specific research and interventions that would better grasp the contexts of target communities are recommended.
Key words: vaccine acceptance, vaccine hesitancy, vaccine uptake, health literacy, HP
Characteristics and Trends of Heatstroke-Related Emergency Department Visits: A Multicentre Retrospective Study
Full text linkIntroduction:
With the rise in ambient temperature as a result of global climate change, multiple health concerns have been raised about the increased risk of developing heat-related illnesses. Heatstroke remains one of the most common and severe forms of thermal injury, and is of particular significance in the field of mountain and wilderness medicine.
Objective:
To examine the epidemiological pattern and trend of heatstroke patients.
Method:
This is a retrospective analysis of heatstroke-related emergency department (ED) visits using data extracted from the Clinical Data Analysis and Reporting System (CDARS) database. Visits were stratified by sex, age group, and residential districts, and the total and demographic-specific incidence were computed with respect to population data from the Census and Statistics Department.
Results:
Between 2016 and 2021, 1980 ED visits for heatstroke were recorded, resulting in an incidence of 4.44 visits per 100,000 per year (95% Confidence Interval [CI] = 4.25-4.64). 16 deaths were reported, yielding an overall mortality of 0.81%. While the annual incidence remained relatively constant from 2016 to 2020 (changes <10%), it increased considerably (+27.6%) in 2021. Rates of heatstroke-related visits also varied by sex, age, and residential area. There were significantly higher incidences in males (7.33 per 100,000; 95% CI = 6.97-7.71), adults aged 65-69 years (6.93 per 100,000; 95% CI = 5.99-8.02), and residents living in the following districts: Southern (7.84 per 100,000; 95% CI = 6.46-9.51), North (7.18 per 100,000; 95% CI = 5.96-8.64), and Islands (10.3 per 100,000; CI = 8.36-12.7).
Conclusion:
This study offered valuable insights into the local epidemiological pattern of heatstroke, revealing the recent rise in incidence and population at heightened risk (men, elderly, residents of Southern, North, and Islands districts)