IIUM Medical Journal Malaysia (IMJM)
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Anti-CCP Antibodies: an Emerging Marker for the Early Diagnosis of Rheumatoid Arthritis
Get PDFRheumatoid arthritis (RA) is a systemic disease affecting mainly joints. Since rheumatoid arthritis is a common and a world wide problem therefore accurate diagnosis of this disease is essential. In the past rheumatoid factor was considered as the only marker for diagnosing this disease; however rheumatoid factor is present in many other disorders and even in up to 15% of healthy population. For the detection of rheumatoid arthritis, over the years many auto antibodies have been reported such as anti perinuclear factor (APF) and anti keratin antibodies (AKA) but they were not specific and due to the tedious procedure used for their laboratory diagnosis, they could not become popular for the diagnosis of this disease. Recently anti-CCP antibodies have been reported and they are becoming popular due to their high sensitivity and specificity. It is hoped that in a couple of years time anti-CCP antibodies could be included in the ACR criteria for diagnosing RA
Polymorphisms of CYP1A1*4 and GST as Susceptibility and Prognostic Genes for Acute Myeloid Leukemia
Get PDFIntroduction: Associations between polymorphisms for genes encoding enzymes involved in biotransformation of xenobiotics and susceptibility to several cancers have been shown in several studies. The aim of the study is to investigate the influence of cytochromes P450 (CYP1A1*4) and Glutathione S-transferases (GSTs) (T1 and M1) gene polymorphisms in susceptibility to acute myeloid leukemia (AML) as well as their prognostic role for the treatment outcome in AML patients. Material and Methods: This study included 65 individuals classified as healthy controls and newly diagnosed AML patients. BMA and immunophenotyping assay by flowcytometry were done at D1 and D14 following treatment induction to assess the complete remission or non response to treatment in AML patients. The CYP1A1*4 and of GSTT1and GSTM1 genotypes were examined using polymerase chain reaction (PCR)-based methods. Results: A higher prevalence of the CYP1A1*4 (CA and AA) genotype was found in AML patients than in controls (37% vs 23.3%, OR =3.25, 95% CI. 1.01-10.46, p=0.05). GSTT1 null genotype were also more frequent in AML patients than in controls (58% vs 26.7%, OR = 3.79, 95% CI 1.11-12.87, p=0.03). The combination of GSTT1 null genotype and CYP1A1 *4 (AA) genotype further increased the risk of AML (OR =12.66, 95% CI 1.19-128.6, p=0.03. Conclusion: GSTT1 null genotype appears to modulate individual’s susceptibility of AML patients to treatment response, especially when combined with CYP1A1*4 (AA) genotype suggesting gene-gene interactions
An Unusual Presentation of a Thyroid Malignancy: A Case Report
Get PDFPatient with thyroid mass rarely presents in emergency situation. It is because the nature of the mass is that it usually increases slowly in size. Thus, any surgical intervention can be planned electively. The most common condition that necessitates urgent intervention, is upper airway compromise due to sudden rapid increase in size of the swelling. This can be due to intralesional bleeding or superimposed infection on the enlarged gland. We report a case of urgent completion thyroidectomy performed to a patient with fungating recurrent papillary carcinoma who present with bleeding from the mass externally
Primary Systemic Amyloidosis: a Case Report and Review of Clinical Features
Get PDFPrimary systemic amyloidosis is a rare disorder that has multisystemic manifestations. The diagnosis is very difficult because of non-specific clinical signs. We report a patient with primary systemic amyloidosis manifesting as peripheral neuropathy, nephrotic syndrome, gastrointestinal syndrome, orthostatic hypotension, pericardial fluid, weight loss and so on. Histopathological examination of kidney and sural nerve showed Congo red positive deposits. Primary systemic amyloidosis should be considered in any patient older than 40 years who has the following symptoms and signs: fatigue, weight loss, edema, paresthesias, muscle weakness, noninfectious diarrhea, skin and soft-tissue lesions, and the complications of nephrotic syndrome, congestive heart failure (not on an ischemic basis), peripheral neuropathy, or unexplained hepatomegaly. All patients need the diagnosis confirmed histologically by biopsy of an involved organ
Dextranomer/Hyaluronic Acid Copolymer (Dx/HA) Has no Effect on Bacterial Growth in Culture Media With or Without Antibiotic Discs
Get PDFIntroduction: Endoscopic treatment of vesicoureteral refl ux (VUR) by subureteral injection of biocompatible polymers is an established treatment option for refl ux. Dextranomer/hyaluronic acid copolymer(Dx/HA) has gained wide popularity for treating VUR. We decided to investigate the antibacterial activity of Dx/HA and its interaction with antibiotics in in-vitro conditions. Materials and Methods: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus mirabilis suspensions were inoculated into Mueller-Hinton agar media and 30 μl of Dx/HA was inoculated in 5 mm diameter pits and the plates were incubated at 37°C for 24 hours. At the end of the incubation period, inhibition zones around the discs were measured. Expansion of the inhibition zones towards the pits which contained Dx/HA was considered as synergism. Dx/ HA was inoculated into pits made in Mueller-Hinton agar medium without antibiotic discs but containing suspensions of bacteria. These media were incubated under the same circumstances and same measurements were done. All experimental procedures were performed twice. Increase in bacterial zone diameters for ≥ 5 mm was inoculated was regarded as signifi cant for each agent. Results: Dx/HA caused no difference in bacterial growth either with or without antibiotic discs as determined by inhibition zones in the culture media. Conclusion : Dx/ha will not contribute to UTI if it is used for the treatment of VUR in cases either with or without infection
Health-Related Quality of Life of COPD Patients Attending Outpatient Clinic at Institute of Respiratory Medicine, Kuala Lumpur, Malaysia
Get PDFIntroduction: This study measured the health-related quality of life (HRQoL) among COPD patients attending outpatient clinic at Institute of Respiratory Medicine, Kuala Lumpur. Materials and Methods: A crosssectional survey was conducted from November 2008 to January 2009 on 99 COPD patients. Subjects were interviewed through socio-demographic and health characteristics. The HRQoL was measured using the SF36v2 questionnaires. Results: Majority of the subjects were above 60 years (64.6%) with mean age of 64.10 ± 11.04 years, male (84.8%), Malays (49.5%), married (74.7%), primary educational level (57.6%), income level below RM1000 (39.4%), ex-smoker (64.6%), moderate COPD (40.4%), 1 to 5 years of illness (62.6%), presence of co-morbidities (65.7%) and satisfied with support from caregiver (48.5%). The total mean score for physical health component summary (PCS) was 41.64 ± 7.99 and mental health component summary (MCS) was 46.53 ± 13.21. Conclusion: There were significant differences in PCS for different educational level (p<0.05) and socio-economic status (p<0.01). The MCS were significantly different between ethnicity (p<0.05) and level of satisfaction with support from caregiver (p<0.01). This finding provides information that needed focus in healthcare services
Intraluminal Tubal Endometriosis Mimicking Hydrosalpinx: Report of an Unusual Case
Get PDFEndometriosis is an estrogen-dependent disease causing pelvic pain and infertility and there is still limited knowledge of the pathogenesis. Hydrosalpinx is commonly seen in a heterogeneous spectrum of pathologies of distal tubal occlusion. In general, collection of fluid in uterine tubes occur as the end stage of pyosalpinx or as the advenced stage of endometriosis with pelvic adhesion. In this report we present a very rarely seen case that is called intraluminal tubal endometriosis mimicking hydrosalpinx without pelvic adhesion in an infertile patient. The clinical features and the management of intraluminal tubal endometriosis case which is very rare cause of enlarged tuba uterina in an infertile patient discussed
Hepatic Adenomatosis: Diagnosis and Management Dilemma
Get PDFHepatic adenomatosis is a rare, benign tumour of the liver. It was first described by Flejou et al as multiple adenomas in an otherwise normal liver parenchyma. Although benign, it can present as a diagnostic challenge because the lesions can be difficult to distinguish from other hepatic tumours. Patients can be asymptomatic and the diagnosis may only be made incidentally. We describe the case of 40-year-old Malay lady who was incidentally found to have hepatomegaly. Radiological examinations revealed a complex left ovarian cyst with multiple liver lesions. Biopsy of the liver lesion showed features of hepatic adenomatosis. Literature review was done and the dilemma in managing her was discussed