IIUM Medical Journal Malaysia (IMJM)
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Plasma Haptoglobin as A Potential Biomarker for Coronary Artery Disease in Young Hypertensive Adults
Get PDFINTRODUCTION: Uncontrolled hypertension is one of the recognized risk factors for coronary artery disease (CAD) in young adults, commonly underestimated owing to the young age. A novel biomarker to improve CAD risk assessment and hypertension management should be identified for this cohort. Thus, we had conducted a study to investigate plasma concentration and the role of haptoglobin in young hypertensive adults in the establishment of premature acute myocardial infarction (AMI). MATERIALS AND METHODS: A total of 120 male adults aged between 18 to 45 years enrolled into this cross-sectional study, divided into control, hypertensive, and acute myocardial infarction (AMI) groups. Blood samples were collected from all subjects, plasma concentrations of haptoglobin measured using enzyme-linked immunosorbent assays, and other CAD risk factors including high sensitivity C-reactive protein (hs-CRP) levels were analyzed. RESULTS: Plasma concentration of haptoglobin in the AMI group was the highest compared to hypertensive and control group (290.63±99.90 vs. 208.47±112.93 vs. 170.02±108.11 ng/ml, p<0.006). There was a significant association between AMI and plasma haptoglobin concentration in hypertensive subjects independent of other known CAD risk factors (OR: 0.985, 95% CI 0.973-0.997, p=0.017). There was positive correlation between plasma haptoglobin and hs-CRP (r=0.0370, p<0.001). CONCLUSION: Plasma haptoglobin is a potential biomarker to identify young hypertensive adults who are at risk of developing CAD
Evaluation of Tumour-Associated Macrophages and Colony-Stimulating Factor-1 Expression in Invasive Breast Carcinoma and Their Association with Prognostic Parameters
Get PDFINTRODUCTION: Recent breast cancer research has focused on tumour microenvironment (TME). Tumour-associated macrophages (TAMs) are the key players in TME as they provide pro-tumorigenic milieu for tumour progression and metastasis. These macrophages are primarily regulated by colony-stimulating factor-1 (CSF-1) secreted by breast cancer cells. This study investigated the association of localization of TAMs infiltration within breast carcinoma and CSF-1 expression by cancer cells with the pathological prognostic parameters. MATERIALS AND METHODS: TAMs were assessed in 128 cases of invasive breast carcinoma by CD163 immunohistochemical expression. The median TAM density in both the tumour nest and tumour stroma was utilized to classify TAMs into categories of low and high infiltration. The cancer cells were immunostained with anti-CSF-1 antibody and the staining intensity was evaluated as low or high expression. RESULTS: High nest and stromal TAMs were associated with higher tumour grades (p=0.005 and p=0.0001, respectively) whereas only high stromal TAMs showed significant association with negative oestrogen and progesterone receptors status (p=0.001 and 0.001, respectively); and triple-negative subtype (p=0.002). High CSF-1 expression was significantly associated with high stromal TAMs (p=0.031). High CSF-1 expression was associated with tumour grade and positive HER2 status (p=0.008 and 0.007, respectively). CONCLUSION: TAMs in tumour nest and stroma showed varying degrees of association with the clinicopathological parameters. High CSF-1 expression was associated with unfavourable prognostic parameters. Therefore, the evaluation of TAMs and CSF-1 expressions could potentially serve as prognostic markers and cellular targets for novel treatment modality in invasive breast cancers
Updates in Microglial Research with Respect to Brain Cancer
Get PDFMicroglia resides in the microenvironment of the central nervous system (CNS) and is thought to play a key role in the development and progression of brain cancer. This is because it was shown that microglia comprised a large portion of the total brain tumour mass. Besides, the origin of microglia cells in brain tumours is worth understanding as it is important to distinguish the resident macrophages from the circulating macrophages when discussing the pathology of brain tumours. Activated microgliosis has been linked to increased inflammatory mediators like cytokines, growth factors, matrix metalloproteinases (MMPs) and many more, which would facilitate tumourigenesis. Brain tumour cells also proliferate under the influence of signalling pathways, such as the toll-like receptor 2 signals. Vascular endothelial growth factor (VEGF) which is an angiogenic factor aids in the growth of tumour cells. Brain cancer cells rely on suppressing the effector arm of immune system to evade attacks by downregulating major histocompatibility complexes (MHC) class II molecules and inducing the conversion of microglia to an immunosuppressive phenotype. Glioblastoma stem cells (GSCs) that give rise to brain cancers communicate with microglia cells, which determines their growth and invasion potential. Understanding the molecular interactions of brain cancer and microglia cells would help unlock novel treatments via means of immunotherapy, immunosuppressants and utilising microglia cells to deliver nanoparticle drugs to effectively target and treat brain cancer
Translation and Validation of the Malay Version of Modified Vaccine Hesitancy Scale (MVHS-M) for Assessment of Parental Vaccine Hesitancy
Get PDFINTRODUCTION: Parental hesitancy towards routine childhood vaccines has been recognized as one of the public health threats. Since the uptake of child vaccination remains inconsistent, there is a need for a reliable and validated tool to measure this phenomenon. MATERIALS AND METHODS: A cross-sectional study was conducted at government health clinics in Kelantan between April 2023 to July 2023. A permission to use the original version of Modified Vaccine Hesitancy Scale (MVHS) was obtained and translated into the Malay version (MVHS-M) based on established guidelines. Parents who have at least one child aged 7 years or less were recruited by using systematic random sampling to validate the MVHS-M. A confirmatory factor analysis (CFA) was used to confirm the latent domain, while reliability was measured by composite reliability and test-retest. The data were analysed using IBM SPSS Version 26 and Mplus version 8. RESULTS: A total of 270 parents who fulfilled the study criteria were selected and completed the survey. The CFA showed a good fit index: RMSEA = 0.057 (90% CI 0.031, 0.082), CFI = 0.970, TLI = 0.957, and SRMR = 0.031. The composite reliability for the domain "lack of confidence" was 0.93 (95% CI 0.91, 0.94), while the domain "risk" showed a reliability of 0.74 (95% CI 0.69, 0.79). The test-retest reliability, as measured by the Intra-class Correlation Coefficient (ICC), was 0.77 (95% CI 0.59, 0.87), indicating good stability. CONCLUSION: MVHS-M is a valid and reliable tool that will be useful in identifying parental vaccine hesitancy in Malaysia
Seroprevalence of Neonatal Herpes Simplex Virus Infection at A Tertiary Teaching Hospital in Malaysia
Get PDFINTRODUCTION: Neonatal herpes simplex virus (HSV) infection is generally infrequent, despite being a life-threatening illness. Knowledge of its prevalence is limited in Malaysia since most cases are asymptomatic infections and only limited routine neonatal HSV screening is conducted. This study therefore provides a comprehensive investigation of the seroprevalence of HSV-1 and HSV-2 in neonates. MATERIALS AND METHODS: Serological screening for HSV-1 IgG and HSV-2 IgG antibody tests using the Electrochemiluminescence assay was performed on serum samples of 215 neonates delivered from January until December 2022 at Hospital Universiti Sains Malaysia. RESULTS: Of the neonates, 54.4% were found to be HSV-1 positive, while 4.2% were HSV-2 positive. All the HSV-2 neonates were co-infected with HSV-1. Newborns aged 0–10 days were the most infected group by HSV-1 (92.3%) and HSV-2 (55.6%). The most reported clinical presentation was small gestational age (SGA) (60%). Microcephaly and macrocephaly were observed in one neonate each. The clinical presentations of reactive HSV-1 and HSV-2 cases revealed the presence of fever with rash in both cases. CONCLUSION: The high seroprevalence of HSV-1 is alarming. It is hoped that these data will support the advocacy of screening women for HSV before or during pregnancy as a precautionary approach to reducing the risk of vertical transmission
Post-traumatic, Depression, Anxiety, and Stress Symptoms among Malaysian Firefighters
Get PDFINTRODUCTION: Emergency responders, including firefighters are frequently exposed to life-threatening situations in their daily lives causing an increased risk for occupational stress, anxiety, depression and post-traumatic stress symptoms (PTSS). Hence, this study aimed to determine the prevalence, and correlation of PTSS with stress, anxiety, and depression among Malaysian firefighters. MATERIALS AND METHODS: A cross-sectional study was conducted among firefighters stationed in 20 fire and rescue stations in Penang, Malaysia using self-administered online survey through a purposive sampling. Information collected were sociodemographic data, measurement of severity of PTSS via Post-Traumatic Checklist-5 (PCL-5), and assessment of depression, anxiety, and stress via Depression, Anxiety, and Stress Scale (DASS-21). A descriptive analysis and Pearson's correlation coefficient analyses were employed in study analysis. RESULTS: Out of 562 firefighters participated in the study, the prevalence of PTSS, stress, anxiety, and depression was 5.0%, 2.1%, 13.0%, and 8.5%, respectively. Among those with PTSS, 28.6%, 78.6%, and 67.9% suffered from stress, anxiety, and depression, respectively. Hence, anxiety was highly coexisted with PTSS. There was significant positive correlation between PTSS score and the score of stress (r=0.656, P< 0.001), anxiety (r=0.699, P< 0.001), and depression (r=0.700, P< 0.001). CONCLUSION: Our study findings suggested that stress, anxiety, and depression can co-occur with PTSS. Hence, firefighters should have regular mental health assessments as the concurrent effect of multiple medical conditions may require comprehensive treatment to address the various aspects of each condition
Physicochemical and Sensory Attributes of Trihoney Blend (Trigona sp., Apis mellifera, and Apis dorsata) for Enhanced Antioxidant Optimization using Response Surface Methodology (RSM)
Get PDFINTRODUCTION: The therapeutic applications of honey products have been extensively studied, but the various combination of honeys as a high-antioxidant product has not been explored. This study aimed to develop an optimized three honey formulation (Trihoney) with maximal antioxidant potency and physicochemical characteristics, as well as favourable among panellists. MATERIALS AND METHODS: The three types of honey studied are; i) Trigona sp. honey (TH), ii) Apis mellifera honey (MH), and iii) Apis dorsata honey (DH). Response surface methodology (RSM) was employed to design optimal Trihoney formulation for i) total phenolic content (TPC), ii) ferric-reducing ability of plasma (FRAP), and iii) 2,2’-diphenyl-1 picrylhydrazyl (DPPH) radical scavenging activity. Proximate and nutrient analyses, such as moisture, protein, fibre, carbohydrate, sugar, and gross energy were also conducted. Additionally, sensory evaluation was carried out to support the findings. RESULTS: Based on RSM, three optimal Trihoney formulation were developed; i) Trihoney 1 (MH15:DH10:TH45), ii) Trihoney 2 (MH15:DH10:TH25), and iii) Trihoney 3 (MH15:DH10:TH15). Trihoney 1 was the most promising formulation, exhibiting the highest TPC (0.50 mg/GAE/g), remarkable values of FRAP (230.85 AAE/g) and DPPH (86.32%). Physicochemical and sugar analysis indicated that all values complied with permitted quality standards. MH received the highest overall acceptability scores based on sensory evaluation. CONCLUSION: These findings warrant further extensive investigation of Trihoney formulation in animal studies to support its efficacy as a valuable food supplement
Peritoneal Tuberculosis Mimicking Ovarian Malignancy
Get PDFPeritoneal tuberculosis is an uncommon site of extrapulmonary infection caused by Mycobacterium tuberculosis (TB). It occurs mostly in immunocompromised patients such as malignancy, elderly or renal failure patients. We present a case of pelvic TB which appear to mimic an ovarian malignancy with acute onset of ascites. A 59 years old, para 3 presented with 2 weeks history of abdominal ascites with ovarian tumour. Ovarian cancer was suspected. Total abdominal bilateral salpingo-oophorectomy was performed. Histo pathology confirmed TB. She was started with an-TB therapy, she was improved after 2 weeks of therapy and she is well until now. Peritoneal TB is a rare condition which can mimick ovarian malignancy or peritoneal malignancy, especially in patient without pulmonary manifestation and negative TB investigations. This will cause dilemma in diagnosis hence delay in management.
Surgical outcome of Acoustic Neuroma Surgery in a Malaysian Tertiary Hospital
Get PDFINTRODUCTION: Acoustic neuroma (AN) or vestibular schwannoma, is a benign, slow-growing tumour that arises from the Schwann cell of the vestibular branch of the vestibulocochlear nerve. Treatment options are mainly conservative or surgical excision. The aim of this study is to describe the clinical characteristics of AN and the surgical outcomes in a Malaysian tertiary hospital. MATERIALS AND METHOD: Records of 73 patients who were diagnosed with AN from January 2008 until December 2019 were retrieved. All patients were analyzed for demographic data and clinical characteristics. In all 52 patients underwent AN surgery and had normal preoperative facial nerve function. A descriptive analysis was used for the surgical outcomes of each patient. RESULTS: The median age of patients was 51.5 (15.8 SD). Hearing levels pre-operatively were severe to profound in 74.0% of the patients, followed by moderate to severe in 15.1%, mild to moderate in 6.8%, and mild hearing loss in 2.7%. Retrosigmoid (48.1%) was the most common surgical approach used, followed by translabyrinthine (44.2%) and middle cranial fossa (MCF) (7.7%). The translabyrinthine approach is associated with the least incidence of facial nerve paresis postoperatively (21.2%) when compared to the retrosigmoid and middle cranial fossa approaches (40.4%). However, there was no significant association between surgical approaches and facial nerve outcome (p=0.07). CONCLUSION: AN surgery is a safe procedure, regardless of the surgical approach used. There was a significant relationship between tumour size and facial nerve outcome
A Systematic Review on Multiple Purpose Solution of Contact Lens Ingredients: Benefits and Risks
Get PDFSince the past decades, the prevalence of microbial keratitis (MK) has risen notably among contact lens (CL) wearers. The main contributor to this infection is the use of an inefficient CL disinfecting solution. This paper highlights a systematic review of articles from journals on the multipurpose solution (MPS) of CL ingredients available currently in the market. This review emphasizes the compositions of MPS to evaluate their effectiveness and risks to lens wearers. A search for original articles published was conducted through Scopus, PubMed, and Google Scholar databases, focusing on the keywords contact lens ingredients and preservatives, MPS, polyquaternium, biguanides, and MK. A thorough review was conducted to extract the data on the subjects from the generated searches.The review revealed that hydrogen peroxide (H2O2), polyhexamethylene biguanide (PHMB), povidone-iodine (P-I), and polyquaternium-1 (PQ-1) are the preferred MPS formulations in the current industry of CLs. These chemical ingredients are effective against causative agents of keratitis for faster disinfection and lower risks of microbial infections in CL users. Thus, proper hygienic practices must follow the guidance from the respective product manufacturers to prevent harmful risks of ocular diseases