Thyroid function status evaluation in patient post-radiotherapy for nasopharyngeal carcinoma: A retrospective study

INTRODUCTION

Nasopharyngeal carcinoma (NPC) is among the most common malignancy in Malaysia. Radiationinduced hypothyroidism has been reported in other countries. However, in Malaysia, no studies were ever done to determine the effect of radiation on hypothyroidism. The objective of this study is to evaluate the practice of taking thyroid function test (TFT) and determine hypothyroidism post-radiation in patients with NPC.

MATERIALS AND METHODS

A retrospective study on the symptoms and results of TFT according to the dosage of intensity-modulated radiotherapy (IMRT) given to patients with NPC. Data were traced and analysed.

RESULTS

A total of 78 patients were identified. All patients received IMRT with 33-35 fractions of radiotherapy (RT) with total dosage of 66-70 Gray given. Not all patients had their thyroid function status measured routinely. Twelve patients did have symptoms of hypothyroidism. TFT were obtained in this group but the results were normal. No correlation was found between RT and hypothyroidism.

CONCLUSION

There was no correlation between IMRT and the development of hypothyroidism. A prospective study with better control of inclusion and exclusion criteria, and longer follow-up period with TFT, is needed to demonstrate the consistency of these findings.

The Mediating Effect of Job Satisfaction on Employee Loyalty: A Case Study of a Developer Company in Malaysia

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Influence of Graphene Oxide on the Ethanol Permeability and Ionic Conductivity of QPVA-Based Membrane in Passive Alkaline Direct Ethanol Fuel Cells

Passive alkaline-direct ethanol fuel cells (alkaline-DEFCs) appear to be suitable for producing sustainable energy for portable devices. However, ethanol crossover is a major challenge for passive alkaline-DEFC systems. This study investigated the performance of a crosslinked quaternized poly (vinyl alcohol)/graphene oxide (QPVA/GO) composite membrane to reduce ethanol permeability, leading in enhancement of passive alkaline-DEFC performance. The chemical and physical structure, morphology, ethanol uptake and permeability, ion exchange capacity, water uptake, and ionic conductivity of the composite membranes were characterized and measured to evaluate their applicability in fuel cells. The transport properties of the membrane were affected by GO loading, with an optimal loading of 15 wt.% and doped with 1 M of KOH showing the lowest ethanol permeability (1.49 × 10^-7 cm² s^-1 and 3.65 × 10^-7 cm² s^-1 at 30 °C and 60 °C, respectively) and the highest ionic conductivity (1.74 × 10^-2 S cm^-1 and 6.24 × 10^-2 S cm^-1 at 30 °C and 60 °C, respectively). In the passive alkaline-DEFCs, the maximum power density was 9.1 mW cm^-2, which is higher than commercial Nafion 117/KOH (7.68 mW cm^-2) at 30 °C with a 2 M ethanol + 2 M KOH solution. For the 60 °C, the maximum power density of composite membrane achieved was 11.4 mW cm^-2.

Periodic vicissitudes of different concentrations of a developed prototype killed S. aureus mastitis vaccine on immune modulators, mediators and immunoglobulins in cows

Mastitis is the inflammation of the mammary gland due to microbial infiltration causing a reduced mammary function. This study aims at developing a vaccine using Malaysian local isolate of Staphylococcus aureus and evaluating serum amyloid A, Interleukin-10, IgM and IgG responses periodically. Four bacterin concentrations (10⁶, 10⁷, 10⁸ and 10⁹ cfu/ml of the local isolate of S. aureus) were adjuvanted with aluminium potassium sulphate. Thirty cows grouped into 4 treatment groups (G-) were vaccinated (2 ml) intramuscularly, with a fifth G-A as control. The mean concentration (MC) of serum amyloid A (SAA) was significantly different (sig-d) (p ˂ 0.05) in G-D at 0 h post vaccination (PV), 3 h PV, 24 h PV, weeks 1, 2, 3 and 4 PV (6-, 15-, 5-, 12-, 11-, 4- and 11-fold increased (FI) respectively). The MC of serum amyloid A was also sig-d in G-E at 0 h PV, weeks 1, 2 and 4 PV (3, 8, 5 and 8 FI respectively). The MC of IL-10 was sig-d in G-D and C at 3 h PV and week 2 PV (5 and 2 FI respectively). The IgM MC was sig-d in G-B and C at 3 h PV (5 and 6 FI respectively), at 24 h PV (5 and 9 FI respectively), at week 3 PV(2 and 2 FI respectively) and week 4 PV (3 and 4 FI respectively). The MC of IgG was sig-d in G-E at 0 h, 3 h and week 3 PV(5, 6 and 2 FI respectively) and in G-D at weeks 1-4 (3, 3, 3 and 5 FI respectively). In conclusion, elevated levels of SAA, IgG and IL-10 in G-D(10⁸) informed our choice of best dosage which can be used to evoke immunity in cows.

Clinical responses in cows vaccinated with a developed prototype killed Staphylococcus aureus mastitis vaccine

Mastitis is an inflammatory condition of the udder that occurs as a result of the release of leucocytes into the udder in a response to bacterial invasion. The major causes of mastitis are an array of gram positive and negative bacteria, however, algae, virus, fungi, mechanical or thermal injury to the gland have also been identified as possible causes. Mastitis vaccines are yet to be developed using Malaysian local isolate of bacteria. The objective of the present experimental trial was to develop a monovalent vaccine against mastitis using S. aureus of Malaysian isolate and to evaluate the clinical responses such as temperature, respiratory rates and heart rates in vaccinated cows. S. aureus is a major causative bacteria in clinical and subclinical types of mastitis in cows. Four concentrations of the bacterin (10⁶, 10⁷, 10⁸ and 10⁹ cfu/ml of the local isolate of S. aureus) were prepared using Aluminium potassium sulfate adjuvant. Thirty cows were grouped into four treatment groups (B, C, D and E) with a fifth group as control (A). These groups were vaccinated intramuscularly(IM) with the prepared monovalent vaccine and its influence on the vital signs were intermittently measured. The mean of rectal temperature was significantly different (p˂ 0.05) at 0hr Post Vaccination [1]" in groups D and E (39.5 ± 0.15 °C and 39.4 ± 0.15 °C respectively) and at 3 h PV in groups C, D and E (39.8 ± 0.14 °C, 39.9 ± 0.14 °C and 40.3 ± 0.14 °C respectively) compared to the control group. This indicated a sharp increased rectal temperatures between 0hr and 3 h PV in groups C, D and E which later declined at 24 h PV. The mean of rectal temperature of group E was significantly different (p˂ 0.05) at weeks 1 and 2 PV (39.87 ± 0.19 °C and 39.80 ± 0.18 °C respectively) compared to the control group. The mean of heart rate was significantly different (p˂ 0.05) at week 1 PV in groups D and E (83.0 ± 3.8 beats/minute and 80.0 ± 3.8 °C respectively) compared to control. A trending decrease was however observed in heart rates of group E from weeks through 4 PV and in group D from weeks 1 through 3 PV. The mean of respiratory rates was significantly different (p˂ 0.05) at week 3 PV in group B and D (31.0 ± 1.2 breaths/minute and 28.0 ± 1.2 breaths/minute) compared to control. In conclusion, this study highlights responses of these vital signs due to vaccination against S. aureus causing mastitis in cows. To the best of our knowledge the findings of this study adds value to the shallow literature on vital signs alterations in cows vaccinated against mastitis as elevated levels of temperature and heart rates of group D and E indicated obvious response.

Analysis of Problems Posed in Problem Based Learning Cases: Nature, Sequence of Discloser and Connectivity with Learning Issues

Background: Problems posed in problem based learning (PBL) cases used during pre-clinical teaching-framework are typically a set of descriptions of events in need of explanations and resolution. The objectives of this study were to analyze the problems in PBL cases aimed to suggest areas for improvement.Methods: It was a review of cases used in PBL in undergraduate medical curriculum at UKM Medical Centre. Problems in PBL cases were labeled as ‘Triggers’ and ‘Patient Information Sheets’ which were disclosed as prescribed in structured facilitators’ guide. Six of the 10 PBL cases used in semester-1, session 2013-2014 were selected randomly for analysis.Results: Problems in 50% cases were overloaded and in 50% cases sequences of problem-disclosure were disorderly-labeled, though the flow of descriptions were alright. Averagely, 82% faculty-intended learning issues prescribed in facilitators’ guide were connected with problems. Unconnected learning issues were the result of faculty directed teacher-centered approach of guidance, while important learning issues that could have been derived against problems were un-identified.Conclusion: Connectivity of average 82% faculty-intended learning issues with problems reflect as good quality of PBL problems in UKM Medical Centre. However, problem disclosers in disorderly-labeled fashion, unconnected and unidentified issues against some problems in spite of conducting a good numbers of faculty development workshops, raised the issue of needs of further research on standard of training workshops. Educational leaders should give due importance on professionalism and needs of high-quality training for faculty to enhance PBL skills either by utilizing and mobilizing existing properly trained faculty or by hiring appropriate trained faculty.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.417-423

Microwave bio-sensor based on symmetrical split ring resonator with spurline filters for therapeutic goods detection

A novel symmetrical split ring resonator (SSRR) based microwave sensor with spurline filters for detecting and characterizing the properties of solid materials has been developed. Due to the weak perturbation in the interaction of material under test (MUT) and planar microwave sensor, spurline filters were embedded to the SSRR microwave sensor which effectively enhanced Q-factor with suppressing the undesired harmonic frequency. The spurline filter structures force the presented sensor to resonate at a fundamental frequency of 2.2 GHz with the capabilities of suppressing rejected harmonic frequency and miniaturization in circuit size. A wide bandwidth rejection is achieved by using double spurlines filters with high Q-factor achievement (up to 652.94) compared to single spurline filter. The new SSRR sensor with spurline filters displayed desired properties such as high sensitivity, accuracy, and performance with a 1.3% typical percentage error in the measurement results. Furthermore, the sensor has been successfully applied for detecting and characterizing solid materials (such as Roger 5880, Roger 4350, and FR4) and evidently demonstrated that it can suppress the harmonic frequency effectively. This novel design with harmonic suppression is useful for various applications such as food industry (meat, fruit, vegetables), biological medicine (derived from proteins and other substances produced by the body), and Therapeutic goods (antiseptics, vitamins, anti-psychotics, and other medicines).

Changes in blood pressure, vascular reactivity and inflammatory biomarkers following consumption of heated corn oil

Consumption of corn oil for cooking purpose is gaining popularity. The present study examined the effect of heated corn oil on blood pressure and its possible mechanism in experimental rats. Thirty male Sprague-Dawley rats were randomly divided into 5 groups and were fed with the following diets, Group I was fed with basal diet only; whereas group II,III,IV and V were fed with basal diet fortified with 15% (w/w) either fresh, once-heated, five-times-heated or ten-times-heated corn oil, respectively for 16 weeks. Body weight, blood pressure were measured at baseline and weekly interval for 16 weeks. Inflammatory biomarkers which included soluble intracellular adhesion molecules (sICAM), soluble vascular adhesion molecules (sVCAM) and C reactive protein (CRP), were measured at baseline and the end of 16 weeks. The rats were sacrificed and thoracic aorta was taken for measurement of vascular reactivity. There was significant increase in the blood pressure in the groups fed with heated once, five-times (5HCO) and ten-times-heated corn oil (10-HCO) compared to the control. The increase in the blood pressure was associated with an increase in CRP, sICAM and sVCAM, reduction in vasodilatation response to acetylcholine and greater vasoconstriction response to phenylephrine. The results suggest that repeatedly heated corn oil causes elevation in blood pressure, vascular inflammation which impairs vascular reactivity thereby predisposing to hypertension. There is a need to educate people not to consume corn oil in a heated state.

Molecular analysis of fragile X syndrome (FXS) among Malaysian patients with developmental disability

Fragile X syndrome (FXS) is a neurodevelopmental disorder commonly found worldwide, caused by the silencing of fragile X mental retardation 1 (FMR1) gene on the X-chromosome. Most of the patients lost FMR1 function due to an expansion of cytosine-guanine-guanine (CGG) repeat at the 5' untranslated region (5'UTR) of the gene. The purpose of this study is to identify the prevalence of FXS and characterize the FMR1 gene CGG repeats distribution among children with developmental disability in Malaysia. Genomic DNA of 2201 samples from different ethnicities (Malays, Chinese, Indian and others) of both genders were PCR-amplified from peripheral blood leukocytes based on specific primers at 5'UTR of FMR1 gene. Full mutations and mosaics were successfully identified by triple methylation specific PCR (ms-PCR) and subsequently verified with FragilEase kit. The findings revealed for the first time the prevalence of FXS full mutation in children with developmental disability in Malaysia was 3.5%, a slightly higher figure as compared to other countries. Molecular investigation also identified 0.2% and 0.4% probands have permutation and intermediate alleles, respectively. The CGG repeats length observation showed 95% of patients had normal alleles within 11 to 44 CGG repeats; with 29 repeats found most common among Malays and Indians while 28 repeats were most common among Chinese. In conclusion, this is the first report of prevalence and characterisation of CGG repeats that reflects genetic variability among Malaysian ethnic grouping.

Duplication 17p11.2 (Potocki-Lupski Syndrome) in a child with developmental delay

Potocki-Lupski syndrome (PTLS), also known as duplication 17p11.2 syndrome, trisomy 17p11.2 or dup(17)(p11.2p11.2) syndrome, is a developmental disorder and a rare contiguous gene syndrome affecting 1 in 20,000 live births. Among the key features of such patients are autism spectrum disorder, learning disabilities, developmental delay, attention-deficit disorder, infantile hypotonia and cardiovascular abnormalities. Previous studies using microarray identified variations in the size and extent of the duplicated region of chromosome 17p11.2. However, there are a few genes which are considered as candidates for PTLS which include RAI1, SREBF1, DRG2, LLGL1, SHMT1 and ZFP179. In this report, we investigated a case of a 3-year-old girl who has developmental delay. Her chromosome analysis showed a normal karyotype (46,XX). Analysis using array CGH (4X44 K, Agilent USA) identified an ~4.2 Mb de novo duplication in chromosome 17p11.2. The result was confirmed by fluorescence in situ hybridization (FISH) using probes in the critical PTLS region. This report demonstrates the importance of microarray and FISH in the diagnosis of PTLS.

ASPP2 deficiency causes features of 1q41q42 microdeletion syndrome

Chromosomal abnormalities are implicated in a substantial number of human developmental syndromes, but for many such disorders little is known about the causative genes. The recently described 1q41q42 microdeletion syndrome is characterized by characteristic dysmorphic features, intellectual disability and brain morphological abnormalities, but the precise genetic basis for these abnormalities remains unknown. Here, our detailed analysis of the genetic abnormalities of 1q41q42 microdeletion cases identified TP53BP2, which encodes apoptosis-stimulating protein of p53 2 (ASPP2), as a candidate gene for brain abnormalities. Consistent with this, Trp53bp2-deficient mice show dilation of lateral ventricles resembling the phenotype of 1q41q42 microdeletion patients. Trp53bp2 deficiency causes 100% neonatal lethality in the C57BL/6 background associated with a high incidence of neural tube defects and a range of developmental abnormalities such as congenital heart defects, coloboma, microphthalmia, urogenital and craniofacial abnormalities. Interestingly, abnormalities show a high degree of overlap with 1q41q42 microdeletion-associated abnormalities. These findings identify TP53BP2 as a strong candidate causative gene for central nervous system (CNS) defects in 1q41q42 microdeletion syndrome, and open new avenues for investigation of the mechanisms underlying CNS abnormalities.

Mesenchymal stromal cells for cartilage repair in osteoarthritis

Treatment for articular cartilage damage is quite challenging as it shows limited repair and regeneration following injury. Non-operative and classical surgical techniques are inefficient in restoring normal anatomy and function of cartilage in osteoarthritis (OA). Thus, investigating new and effective strategies for OA are necessary to establish feasible therapeutic solutions. The emergence of the new discipline of regenerative medicine, having cell-based therapy as its primary focus, may enable us to achieve repair and restore the damaged articular cartilage. This review describes progress and development of employing mesenchymal stromal cell (MSC)-based therapy as a promising alternative for OA treatment. The objective of this review is to first, discuss how in vitro MSC chondrogenic differentiation mimics in vivo embryonic cartilage development, secondly, to describe various chondrogenic differentiation strategies followed by pre-clinical and clinical studies demonstrating their feasibility and efficacy. However, several challenges need to be tackled before this research can be translated to the clinics. In particular, better understanding of the post-transplanted cell behaviour and learning to enhance their potency in the disease microenvironment is essential. Final objective is to underscore the importance of isolation, storage, cell shipment, route of administration, optimum dosage and control batch to batch variations to realise the full potential of MSCs in OA clinical trials.

P16INK4a: a potential diagnostic adjunct for prediction of high-grade cervical lesions in liquid-based cytology: with HPV testing and histological correlation

Human papillomavirus (HPV) is a necessary cause of cervical cancer and its precursors. Increased expression of high-risk hrHPV viral oncogenes in abnormal cells might increase the expression of p16INK4a. We aimed to determine the role of p16INK4a in detecting hrHPV-transformed epithelial cells in liquid-based cervical cytology, and compared the results with hrHPV DNA testing by realtime polymerase chain reaction (RT-PCR). Fifty-seven cytological samples were tested for p16INK4a immunomarker and hrHPV DNA. Test performance of both tests was determined by comparing sensitivity, specificity and predictive values using available histological follow-up data as gold standard. Of 57 samples, 36 (63.2%) showed immunoreactivity for p16INK4a and 43 (75.4%) were hrHPV-infected. A fairly low concordance rate (k = 0.504) between p16INK4a immunolabelling and hrHPV DNA status was noted. For prediction of cervical intraepithelial neoplasia (CIN) II and worse lesions, p16INK4a had a sensitivity and specificity of 93.5% and 60%; whereas hrHPV DNA testing had a sensitivity and specificity of 100% and 20%. Dual testing by combining p16INK4a and hrHPV showed sensitivity and specificity of 100% and 33.3%. In conclusion, p16INK4a is useful in predicting severity of the cytological abnormalities. Although p16INK4a is more specific but less sensitive than hrHPV in detecting high-grade cervical lesions, a combination of both tests failed to demonstrate significant improvement in diagnostic sensitivity, specificity and predictive value. Larger-scale prospective studies are required to assess further whether this biomarker should be routinely used as primary screening tool independently or in combination with hrHPV testing to improve diagnostic accuracy in cervical cytology.

Patient-derived glioblastoma cells show significant heterogeneity in treatment responses to the inhibitor-of-apoptosis-protein antagonist birinapant

Background:

Resistance to temozolomide (TMZ) greatly limits chemotherapeutic effectiveness in glioblastoma (GBM). Here we analysed the ability of the Inhibitor-of-apoptosis-protein (IAP) antagonist birinapant to enhance treatment responses to TMZ in both commercially available and patient-derived GBM cells.

Methods:

Responses to TMZ and birinapant were analysed in a panel of commercial and patient-derived GBM cell lines using colorimetric viability assays, flow cytometry, morphological analysis and protein expression profiling of pro- and antiapoptotic proteins. Responses in vivo were analysed in an orthotopic xenograft GBM model.

Results:

Single-agent treatment experiments categorised GBM cells into TMZ-sensitive cells, birinapant-sensitive cells, and cells that were insensitive to either treatment. Combination treatment allowed sensitisation to therapy in only a subset of resistant GBM cells. Cell death analysis identified three principal response patterns: Type A cells that readily activated caspase-8 and cell death in response to TMZ while addition of birinapant further sensitised the cells to TMZ-induced cell death; Type B cells that readily activated caspase-8 and cell death in response to birinapant but did not show further sensitisation with TMZ; and Type C cells that showed no significant cell death or moderately enhanced cell death in the combined treatment paradigm. Furthermore, in vivo, a Type C patient-derived cell line that was TMZ-insensitive in vitro and showed a strong sensitivity to TMZ and TMZ plus birinapant treatments.

Conclusions:

Our results demonstrate remarkable differences in responses of patient-derived GBM cells to birinapant single and combination treatments, and suggest that therapeutic responses in vivo may be greatly affected by the tumour microenvironment.

Antibiograms, Resistance Genes, Class I Integrons and PFGE profiles of Zoonotic Salmonella in Malaysia

Salmonella infections occur worldwide, in both developed and developing countries, and a major contributor to morbidity and economic costs. A total of 32 Salmonella isolates isolated from dogs (n=15/162), cats (n=1/126) and snakes (n=16/42) in the Klang valley, Peninsular Malaysia during 2012-2013, were used in this study and 6 serovars were identified. The isolates were then characterized for their susceptibility to commonly used antimicrobial agents using the standard disk diffusion method. The presence of relevant resistance genes and class 1 integrons were investigated by using PCR. Pulsed-field gel electrophoresis (PFGE) was carried out to determine the genetic diversity of these Salmonella strains. Higher resistance rates were observed for tetracycline (40.6%), nalidixic acid (21.9%), sulphamethazole-trimethoprim (18.7%), ampicillin (18.7%) followed by chloramphenicol (15.6%), streptomycin (6.25%), enrofloxacin (12.5%), cephalexin (6.25%), cephalothin (6.25%) and amoxicillin-clavulanic acid (3.12%). Nine percent (3/32) presented a single type of resistance, 6% (2/32) showed resistance to two classes of antimicrobials and 34% (11/32) were multidrugresistant (MDR) (resistant to 3 or more antimicrobials). Analysis of the carriage of resistance genes in the isolates revealed that seven (blaTEM-1, strA, strB, sulII, dfrhI, tetA, and cmlA) out of 10 resistance genes were present. Classes 1 integrons were present in 68.75% (11/16) of the resistance strains. PFGE analysis showed that the strains were very diverse and certain PFGE pattern clusters correlated well with antimicrobial resistance phenotypes. In conclusion, high rates of multidrug resistance were found among the dogs Salmonella strains.

Case-control investigation on the risk factors of melioidosis in small ruminant farms in Peninsular Malaysia

AIMS

Epidemiology of melioidosis is poorly understood because its occurrence is influenced by complex interaction of environmental, climatic, physicochemical and host factors. We investigated the potential risk factors for the exposure to Burkholderia pseudomallei in small ruminants' farms in Peninsular Malaysia.

METHODS AND RESULTS

Melioidosis-positive (n = 33) and negative (n = 27) farms were selected and visited for interviews and environmental samples collection. The characteristics and putative disease risk factors were compared between the case and the control farms using Chi-square test and logistic regression analysis. The multivariable logistic regression analysis showed that the odds of melioidosis were significantly higher in farms that had bush clearing around farms (odds ratio (OR) = 6.61, 95% confidence interval (CI) = 1.12-38.84, P = 0.037), in farms with B. pseudomallei present in the soil (OR = 6.23, 95% CI = 1.03-37.68, P = 0.046), in farms that have other animal species present (OR = 7.96, 95% CI = 1.14-55.99, P = 0.037) and in farms that had flooding or waterlogging conditions (OR = 11.95, 95% CI = 1.39-102.6, P = 0.024) when compared to the odds of the disease in farms that did not have the above conditions. The odds of the disease in farms that treated their soils with lime were significantly lower (OR = 0.028, 95% CI = 0.003-0.29, P = 0.003) compared to the odds in those that did not.

CONCLUSIONS

The risk factors for the exposure to B. pseudomallei highlighted above may have contributed to the occurrence of melioidosis in animals in the study farms.

SIGNIFICANCE AND IMPACT OF THE STUDY

Information from the study may be helpful in planning control measures against melioidosis and have improved understanding of the epidemiology of the disease in livestock farms.

Social support and self-care activities among the elderly patients with diabetes in Kelantan

INTRODUCTION

Diabetes is common among the elderly and can significantly affect their lives including the issues related with social support and diabetic self-care activities.

OBJECTIVES

The objective of this study was to examine the social support and self-care activities among the elderly patients with diabetes.

METHODS

A survey involving 200 patients was conducted from March 2013 to May 2013 in three hospitals in Kelantan. Data were obtained through self-administered questionnaires and clinical characteristics were acquired from the patients' records.

RESULTS

The scores for social support (mean = 19.26; SD = 2.63) and self-care activities (mean = 14.83; SD = 4.92) were moderate. Higher social support was associated with high levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS) level, the duration of diabetes and a decrease in body mass index (BMI) (p<0.05). It was observed that the patients with low educational, Hb1Ac and FBS level, with other chronic diseases and who have had diabetes for some time had low self-care activities (p<0.05). There was a significant negative relationship between an increase in social support and decrease in self-care activity (p<0.05).

CONCLUSION

Healthcare providers, family and friends have to strengthen their relationship with the elderly patients with diabetes to provide more social support and promote the compliance with diabetic self-care activities to improve clinical outcomes.

The use of Piper sarmentosum leaves aqueous extract (Kadukmy™) as antihypertensive agent in spontaneous hypertensive rats

BACKGROUND

The National Health and Morbidity Survey in 2011 estimated that 35.1% (5.7 million) of Malaysian adults aged 18 and older suffer from hypertension. Hypertension is still treated by conventional medicine despite its exact aetiology being unknown. Studies showed that oxidative stress and low availability of nitric oxide (NO) causes an increase in vascular wall tension and increase blood pressure. Piper sarmentosum (PS) a traditional Malay herbal plant is well known for its high antioxidant content. Antioxidant is useful in improving cardiovascular diseases particularly hypertension. Thus, it is beneficial to determine the effect of PS leaves aqueous extract (Kadukmy™) on the blood pressure, NO level, oxidative stress markers and serum cholesterol level of the Spontaneous Hypertensive Rats (SHR).

METHODS

Rats were devided into five groups consisting of three treatment groups and two control groups. Baseline blood investigations were done before and following commencement of treatment. Spontaneous hypertensive rats were treated for 28 consecutive days and the blood pressure was measured weekly.

RESULTS

Kadukmy™ administration showed a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) (P < 0.05), increased serum NO level (P < 0.05), reduced serum malondialdehyde (MDA) level (P < 0.05) and reduction of serum total cholesterol level in groups treated with Kadukmy-1™.

CONCLUSIONS

The result of the present study revealed that Kadukmy™ exerts its antioxidant activity to reduce oxidative stress damage, increase NO production and able to reduce blood pressure and cholesterol level.

Abdominal wall reconstruction after resection of an enterocutaneous fistula with an island pedicled anterolateral thigh perforator flap. Case report

Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.

Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein

OBJECTIVE

To determine the association between carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) with future cardiovascular disease (CVD) risk, and to assess whether high sensitivity C-reactive protein (hs-CRP) is an important mediator towards these vascular changes, among young men.

METHODS

This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWVCF and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score (FRS) and age adjusted FRS (A-FRS). Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 (SPSS Inc., Chicago, IL, USA).

RESULTS

The mean age of the subjects was 27.09 (95% confidence intervals [CI] 26.39-27.79) years old. Those with ≥2 risk factors had significantly higher AI [10.09 (95% CI: 9.06-11.12) versus 6.56 (95% CI: 5.54-7.57) (p=0.001), but not PWVCF 7.45 (95% CI: 7.29-7.61) m/s versus 7.29 (95% CI: 7.06-7.51) m/s, (p=0.90) when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS (p=0.0001).

CONCLUSION

To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP.