Glaucoma, recognized as optic neuropathy is the second largest cause of blindness worldwide. The disease is characterized by progressive loss of retinal ganglion cells and visual field defects. The pathophysiological factors involved in the onset and progression of glaucoma are not fully understood. However, it is now well accepted that elevated intraocular pressure is not the only causative factor. The pathophysiology of glaucoma involves multiple factors that interact in a highly complex manner to favor development of glaucomatous optic neuropathy. As the knowledge of molecular mechanisms involved is expanding, more and more therapeutic targets are being recognized for the development of safe and effective pharmacotherapy of glaucoma. Although at present the intraocular pressure lowering drugs are still the first line of treatment, the prospect of introducing neuroprotective therapies that can directly protect and perhaps stimulate regeneration of dying and dead retinal ganglion cells, shows considerable promise. This review presents recent developments in the pathophysiology and pharmacotherapy of glaucoma.
Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.
Coarctation of the aorta is a congenital anomaly presented by the combination of upper body hypertension and weak or absent femoral pulses. Increased morbidity and shortened life span of infants born with coarctation suggest that the malformation should be treated early in life. Surgical intervention has been recognized as the gold standard of treatment for children born with this defect. Unfortunately, studies in many institutions have shown that the diagnosis of coarctation of the aorta is often missed. As a consequence, many patients with coarctation of the aorta are not detected until adult life. Long-term follow-up of adult patients following surgical intervention for coarctation of the aorta reveals ongoing risks; hence, less invasive endovascular therapy becomes an alternative approach. Literature’s review was performed to compare the results of endovascular therapy (stenting and angioplasty) with surgical techniques to repair adult with coarctation of the aorta. The immediate improvement in hypertension and the morbidity were similar. Although stenting can be expected to show superiority to balloon angioplasty alone, that was not apparent when comparing these two endovascular approaches. The morbidity, mortality, and repeat intervention rates were just as high for stenting as they were for angioplasty or for a combination of both modalities. The majority of surgical complications were minor (i.e., vasculitis, bleeding), whereas the majority of endovascular complications could be considered more severe (i.e., dissection, traumatic aneurysm, stroke). Surgical therapy was associated with a very low risk of restenosis and recurrence, whereas endovascular therapy had a much higher incidence of restenosis and the need for repeat interventions. In conclusion, surgical therapy is superior compared to other modes of interventional therapy for adult with coarctation of the aorta, and it shall remain as current mode of therapy for adult with coarctation of the aorta.
The brain is considered the most eloquent organ in the human body as its activities impacts on all other systems. Though protected physically (in a bony covering), physiologically through the blood-CSF barrier (from invading organisms and toxins) and hemodynamically through the phenomenon of cerebral autoregulation; the brain is open to insults of various kinds which can critically damage this structure. Intracellular Ca++ accumulation, excessive activation of excitatory amino acid receptors, lipid peroxidation and free radical releaserelated damage are but a few of the pathological processes that occur at the neuronal level leading to damage. The mechanism by which the brain can be provided protection when it is in a compromised state or likely to be compromised is known as cerebral protection. There are various modalities of pharmacologic (use of barbiturates, etomidate, isoflurane, steroids, Ca++, corticosteroids etc) and non-pharmacologic therapies (hypothermia, hyperventilation, induced hypotension, electrophysiologic monitoring, endovascular management etc) available for cerebral protection which finds place in the armamentarium of clinicians managing the critically injured brain. Our knowledge of the functioning of the brain at the molecular level and the various biochemico-pathological processes that are set into motion during critical states continues to evolve. This review article attempts to explain present understanding of the biochemical and pathological processes involved in neuronal damage while also looking at current available therapies (pharmacologic & nonpharmacologic) being utilized in different clinical settings.
Negative pressure if applied in topical manner to a wound surface has been reported to enhance wound healing due to increase in local blood flow, reduction of tissue oedema, and by stimulating angiogenesis. An air-tight film covering the wound is connected by suction tube to a control unit by which negative pressure is applied to the surface of the wound in the range of 80-125 mm Hg. This method has been called negative pressure wound therapy (NPWT) or vacuum assisted closure (VAC). It has been recommended for virtually all kinds of complex wounds. The duration of the therapy varies from several days to several months. This technology promotes formation of granulation tissue, enhances healing of diabetic foot, and significantly reduces the size of the acute and chronic wounds and ulcers. It lowers the morbidity of Fournier’s gangrene, ensures better healing of lower limb wounds and ulcer of ischemic origin, and can serve as temporary wound cover when no closure technique is available. The limitations to using NPWT are presence of dead tissue, exposed vital structures, untreated osteomyelitis, unexplored fistulae and malignant wounds. The cost of the equipment may constitute another factor in limiting the use of this new technology. In conclusion the NPWT under certain circumstances is more effective than other available local wound treatments.
The term Developing Nations has to be used with caution as it had traditionally included a wide array of countries outside the developed world of North America, Western Europe and Japan (and a few other countries such as Australia and South Africa). The characteristics which defined these “emerging markets” were a Gross National Product (GNP) per capita which was below that of the developed economies, the potential for market growth and an environment with continued economic and political instability. However, as many of these countries have grown at different rates and have economic and other drivers which are very different and disparate, definitions of this sector have become more fragmented. (Copied from article).
MeSH terms: Australia; Developing Countries; Europe; Japan; North America; South Africa; Biological Processes; Economic Development; Gross Domestic Product
The consequence of postoperative infections associated with orthopaedic or biomaterial-associated implants is devastating to both the patients and the surgeons. Bacterial microcolonies adhere to the surface of implants, forming biofilms and then detaching part of itself into free-floating planktonic forms may be the cause of recurrent and persistent infections. These bacteria are very resistant towards antibiotics and require a higher drug concentration than usual in order to eradicate them. Quorem-sensing is regarded as one mechanism of communication or integration between these microorganisms in the biofilm and may even be in the transfer of resistant genes. Disruption of this pathway is regarded as one method of inhibiting its growth and formation. Implant design, technique and stability of fixation as well as the surface characteristics, the material and its biocompatibility may also influence bacterial adhesion. It has been suggested that multi-prong strategies such as prevention and disruption of biofilm formation, parenteral antibiotics, use of antibiotic-impregnated construction materials and altering the intrinsic properties of the implant surface may help to eradicate this menace.
This review places emphasis on the food and water borne protozoal diseases like, cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis which are endemic in many parts of the world. The article addresses cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis. Cryptosporidium and Giardia are widespread in the environment and major outbreaks have occurred as a result of contaminated drinking water. Cyclospora has significance in the preparation and consumption of fresh food that have not received heat treatment. Toxoplasma gondii, transmission occur through contaminated water, unpasteurised milk and also the consumption of raw meat, which has been regarded as a major route of transmission to humans .These parasitic protozoa do not multiply in foods, but they may survive in or on moist foods for months especially in cool and damp environment. Their ecology makes control of these parasites difficult. Transmission, clinical manifestations, outbreaks, public health surveillance and control measures that are used for those diseases will be reviewed in this article.
MeSH terms: Animals; Cryptosporidiosis; Cryptosporidium; Disease Outbreaks; Ecology; Giardia; Giardiasis; Hot Temperature; Humans; Meat; Milk; Parasites; Toxoplasma; Toxoplasmosis; Water Pollution; Cyclospora; Cyclosporiasis; Drinking Water; Public Health Surveillance
The various shortcomings involving issues related to managing patients with mental health are compared to those with physical health which are mainly attributed to attitude, misconception and stigma attached to mental health. There is a strong need to have a comprehensive collective efforts and a paradigm shift on how to deal with these critical issues especially in the area of Primary care for mentally ill.
MeSH terms: Attitude; Humans; Mental Health; Primary Health Care; Review; Mentally Ill Persons; Social Stigma
No vaccination is available to provide doctors with the immunity from errors and mistakes. Humans make mistakes everyday and eventually doctors will make mistakes or errors during their practice. Therefore, knowing how to handle the mistakes is crucial in improving patient safety and management. Disclosure of errors can be argued to play a significant role in respecting the patients’ rights and interest. We need to know that in a doctor-patient relationship, trust and vulnerability exist. If errors occur and doctors try to keep patients away from the truth, patients may no longer maintain their trust and this could lead to a negative turn in the relationship. Moreover, if errors are disclosed, doctors then may face a legal and ethical dilemma on whether to apologize for the errors made. This issue of apology has created debates among health professionals and lawyers in searching for the best answer. Apology can be a powerful tool to reconcile relationships but at the same time can also be a tool of deception.
Basal stem rot disease caused by the basidiomycete fungus, Ganoderma boninense is the most serious disease of oil palm in Malaysia. The disease can be identified by dry rotting of internal parts of the stem with fruiting bodies or basidiomata of the fungus occurring at the oil palm stem base. The stem lesion allows the basal stem rot disease to be distinguished from the other root diseases
(Turner, 1981).
The blood of the Painted Storks (Mycteria leucocephala) and the Milky Storks (M. cinerea) from Malaysia were collected
invasively from the breeding site. The blood was dropped on to FTA® cards and stored at room temperature. DNA was isolated from
the FTA® cards through a modification of the Wizard DNA Purification kit (Promega) procedure and PCR was performed with 11 pairs
of microsatellite primers of the American Wood Stork (M. americana). The collection of a drop of blood onto the card is superior to the
usual practice of collecting about five ml of blood into a vacuum tube as it causes fewer traumas to these sensitive birds. Moreover, this
collection procedure can be adopted for use in various wild animal species which are usually found in the remote areas of Malaysia as
the sample collection cards can be transported back to the laboratory at room temperature. Our procedure allows the typing of several
molecular genetic markers from just a drop of blood collected in the field and stored at room temperature alleviating the need for storage
in expensive deep freezers or liquid nitrogen tanks.
Termitomyces are delicious edible mushrooms found in Africa and South-East Asia including Malaysia. These mushrooms were found to grow symbiotically with termites around termite nests. Numerous efforts have been made worldwide to develop a cultivation method for these mushrooms. Unfortunately, none of those attempts were successful. The main obstacles encountered were the difficulty to identify and isolate pure termitomyces culture. The problem became prevalent as the culture gets contaminated by other fungi. Termitomyces can easily be identified by its mushroom fruiting body eventually but certainly not at the mycelium and hyphea stages. In this study a simple PCR-based genetic marker detection method for confirmation of termitomyces at any culture stage was developed. Using this method, four distinctive PCR assays
were developed using specific PCR primers designed based on the DNA sequence of the termitomyces mushroom. The PCR results showed that the PCR assays using intact termitomyces
DNA as template was not suitable for this purpose. However, PCR using BamHI and EcoRI predigested termitomyces DNA as template showed identical polymorphism pattern for both
termitomyces mushroom DNA and termitomyces culture DNA. Thus, the method reported here can be used for the identific.
This paper reports on a preliminary genetic investigation of two commercially cultured oyster species, white and black scar oysters, Crassostrea belcheri and C. iredalei, respectively. A total
of 68 individuals from three different areas in Malaysia namely a C. belcheri sample from Semporna (Sabah) and two populations of C. iredalei from Trai (Sabah) and Setiu (Terengganu) were
collected and analysed based on sequence analysis of cytochrome oxidase subunit I (COI). Alignment of COI gene was done using Alignment Explorer/CLUSTAL in Mega4.1. Genetic distances
within and between populations were calculated using Kimura 2-parameter. Phylogenetic dendograms were generated by Neighbour-Joining (NJ) and Maximum Parsimony (MP) methods.
The ingroup taxa were divided into two main clusters separating C. iredalei and C. belcheri with 99% bootstrap value. The two C. iredalei populations were homogeneous suggesting high
connectivity in the South China Sea for this species. The common central haplotype in the minimum spanning networks programme is believed to be the ancestral variant for the two species. The
findings from this study provides important baseline data for the aquaculture, management and monitoring of cultured populations of the oyster species.
Spinal muscular atrophy (SMA), a leading genetic cause of death in childhood, is caused by deletion of the SMN1 gene, located at chromosome 5q13. The molecular pathogenesis, which results in motor neuron degeneration within the anterior horn of spinal cord, is a focus of debate among scientists. The unique nature of the duplicative 5q chromosomal region provides considerable yet challenging opportunity for disease correction as well as complication in performing molecular diagnosis and understanding the molecular pathogenesis. This article reviewed recent findings in the molecular pathogenesis of SMA as well as the research advances in the molecular diagnosis and therapeutic approaches.
MeSH terms: Cause of Death; Motor Neurons; Muscular Atrophy, Spinal; Nerve Degeneration; Chromosome Structures
The world’s biodiversity is not distributed uniformly throughout the globe. Some areas such as the tropical rainforests, seas and coral reefs teem with the varieties of life whereas others such as some deserts and polar regions are almost devoid of them (Gaston, 2000). Malaysia, with her tropical jungles and seas, is rich with biodiversity. She is fortunate to have had eminent pioneers such as Ridley (1967), Corner (1972), Soepadmo (1972) and Whitmore (1983) to study her flora and Medway (1968) and Lim (1991) to study her fauna taxonomy. Other pioneers in Malaysian biology included Berry, Dhaliwal and Mohsin. These pioneers are then ably followed by workers such as Latiff, Kiew, Go, Khoo, Davidson, Saberi, Omar, Jambari, Idris, Zekri, Teo, Marziah, Tan, Mukherjee, Shapor, Yusoff, Azmi and many others studying the various subdisciplines of biology. In addition to the more obvious large plants and animals, microorganisms and aquatic organisms had not been neglected either. Workers such as Nawawi, Verghese, Ho and Faridah are known
for their work on fungi while Fatimah, Phang, Japar and Anton had studied algae, seaweeds, diatoms and seagrasses. However, some of these workers have now either retired or are soon going to attain retirement age and the worrying part is that there are not many younger
workers keen to pursue research in taxonomy and biosystematics, a prerequisite to further studies in ecology, genetics, biotechnology which in turn are prerequisites for rational conservation, management and sustainable utilization of our rich biological resources. With each passing day species are becoming extinct sometimes without us even knowing that they had ever existed. Even in a developed country such as the USA, one third of her plant and animal species are at risk of extinction (McCann, 2000). Hence, taxonomic and biosystematic studies of our plants, animals and microbes whether terrestrial or aquatic, freshwater and marine, should be priority areas. So should studies on their reproductive biology, life cycles, physiology, feeding habits, migration patterns, predators and their sensitivities to environmental changes.
Avian Influenza viruses belonging to the Orthomyxoviridae family are enveloped viruses with segmented negative sense RNA genome surrounded by a helical symmetry capsid. Influenza viruses, especially the highly pathogenic avian influenza virus (HPAI) such as H5 or H7 subtype are the most important pathogens for the poultry industry in recent times. The haemagglutinin protein and neuraminidase, serves as the target for the immune response of the host. Due to recurrent genetic reassortments between avian and human influenza viruses, global pandemics may emerge and the naive human immunity could not withstand pressure by the novel hybrid virus. The emergence of genetic engineering technology provided the industry with new methods of manufacturing diagnostics tools and vaccines. After extraction of RNA from the cell culture of strain influenza A/Chicken/Malaysia/2004(H5N1) of AIV, the viral RNA was converted to cDNA by a specific primer. The cDNA was amplified by the polymerase chain reaction (PCR) and analyzed
by agarose gel electrophoresis. The intact PCR product of full length haemagglutinin gene was cloned in TO POTM TA Cloning vector. The full-length HA-encoding gene of H5N1 AIV was subcloned into a pPICZA vector. After successful ligation, the constructed plasmid was transformed into E.coli.Top10, Plasmid DNA from transformed bacteria was extracted in white colony and positive clones were confirmed by restriction digestion with Sacl and Not1 restriction enzymes, colony PCR screening and nucleotide sequencing. Construction of a recombinant pPICZA/H5HA plasmid containing the full length haemagglutinin gene was achieved as a first step
towards the expression in Pichia pastoris.
MeSH terms: Animals; Capsid; Chickens; Electrophoresis, Agar Gel; Escherichia coli; Influenza in Birds; Genetic Engineering; Genetic Vectors; Hemagglutinins; Humans; Influenza, Human; Influenza Vaccines; Ligation; Neuraminidase; Influenza A virus; Pichia; Plasmids; Poultry; RNA, Viral; Polymerase Chain Reaction; DNA Primers; DNA, Complementary; Influenza A Virus, H5N1 Subtype; Pandemics
This paper describes the first reported attempt to isolate DNA sequences containing repeat motifs in Eurycoma longifolia and Orthosiphon stamineus. A library enriched for genomic repeat motifs was developed using novel oligonucleotides designed with inosine residues incorporated at predetermined positions. A total of eight and twelve specific molecular markers were developed for O. stamineus and E. longifolia respectively. These markers have a potential application in estimating population diversity levels and QTL mapping in these two medicinal plants, which are widely used in the Malaysian herbal industry.
This is a case of a 65 year old lady who presented with Cushing’s syndrome secondary to ingestion of a complementary and alternative medicine that has been adulterated with exogenous glucocorticoids. In a clinical consultation, it is important to include assessment of complementary and alternative medicine use for a comprehensive care.
MeSH terms: Complementary Therapies; Comprehensive Health Care; Cushing Syndrome; Glucocorticoids; Humans; Malaysia; Referral and Consultation
To describe the management of mild conduct problems in an adolescent at the primary care level. A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.
MeSH terms: Problem Behavior; Adolescent; Anger; Counseling; Female; Humans; Parents; Physicians, Family; Primary Health Care; Students; Parenting