Host induced control of pathogens involves, but not limited to, withholding of essential transition metals as well as releasing the metals at a toxic level. Zinc is one of these transition elements that plays critical role in controlling the pathogens in that manner – a key mediator in nutritional immunity. A number of subcellular and molecular mecha-nisms such as transport and storage proteins are known to maintain Zn homeostasis and scuffle with the pathogens. Pathogenic bacteria also use a number of mechanisms to combat the scuffle and fight for the right amount of Zn for their survival and growth. From the host perspective, a “delicate” balance of Zn must be maintained for immune surveillance while making the level of Zn either to starve or to intoxicate the pathogens. Metallothionein (MT), a group of low molecular weight proteins, is well known for its Zn transport and storage ability and is expected to play an important role in that nutritional immunity. Zn homeostasis by MT to fight oral pathogens is not unexpected too. Periodontitis and dental caries are two most common oral diseases which are linked to the pathogenic carnival of opportunistic bacteria. Can those culprits be exterminated through nutritional immunity using MT? Or could it be - those human hosts who become the easy prey of those pathogens lack inducible expression of MT in their oral tissues? The synthesis or degradation of MT in response to invading pathogens in oral tissues, the human-MT medi-ated Zn homeostasis in response to infectious insult in oral tissues are evident. Nonetheless, the cross talk between MT and Zn in oral nutritional immunity is largely unknown.
Introduction: This study aims to quantify the concentrations of Cu, Cr, Zn, Ni, Pb, As and Cd in paddy soil and water and assess their potential dermal health risk to the farmers at Kampung Sawah Sempadan, Malaysia. Methods: 72 water samples and 72 soil samples were collected and analysed using inductively coupled plasma mass spectrometry (ICP-MS). 117 respondents were interviewed using a questionnaire to obtain the exposure information for dermal health risk assessments. Results: All elements in water did not exceed the recommended concentration by Malaysia National Water Quality Standard (NWQS) and Food and Agriculture Organization (FAO). Nevertheless, the maxi- mum concentration of As (31.49 mg/kg) in paddy soil exceeded the Dutch Target Value for soil protection (29 mg/ kg). There was no significant chronic non-carcinogenic health risk for farmers working in the paddy soil and water (HQ
Rhinocerebral mucormycosis is a potentially fatal and progressive angioinvasive fungal infection. It is classically described in patients with uncontrolled diabetes mellitus and hematological malignancies. This report describes a case of progressive rhinocerebral mucormycosis in a patient with poorly controlled diabetes who was on prolonged prednisolone therapy for autoimmune kidney disease. The patient, who was a female, presented to hospital with headache, orbital pain and nasal bridge swelling. Black eschar on nasal mucosae was present on admission. Later, she was started on intravenous fluconazole for the diagnosis of fungal sinusitis. Subsequently, she developed intra- cerebral haemorrhage complicated with transtentorial herniation. Diagnosis of rhinocerebral mucormycosis was later observed by a laboratory finding and the treatment was changed to intravenous amphotericin B. However, the patient succumbed to her illness on the 6th day of hospitalisation. This report discusses the risk factors associated with rhinocerebral mucormycosis as well as the underlying pathogenesis. This report will also highlight the importance of early diagnosis and appropriate treatment for mucormycosis to improve prognosis in patients.
Although the precise etiology of Glioblastoma multiforme (GBM, WHO grade IV) remains unknown, its progression
is believed to be driven by the accumulation of multiple genetic alterations. Here, we report a case of a patient who
developed GBM, and associated with dual alterations, particularly 4977-bp deletion in mtDNA (mtDNA4977) and
p.Arg132His (R132H) mutation in IDH1. A 35-year old Malaysian woman patient who primary diagnosed with astrocytoma WHO grade I and subsequently after four years developed a GBM, was detected with a mtDNA4977. This
deletion appears to be a sporadic mutation. Additionally, analysis of patient’s tumor tissue also found to harbor a heterozygous IDH1 R132H mutation. This represents the first case report of coexisting mtDNA4977 together with IDH1
R132H mutation in a Malaysian patient of GBM. The findings of dual alterations could be of therapeutic benefit if
these alterations were justified to be contributing to GBM growth and aggressiveness.
Congenital cataract is a major cause of preventable blindness in children. It can be either hereditary or non-hereditary. In this case series, we present three cases of congenital cataract with a strong family history. The grandparents
and parents of these patients had cataract diagnosed in late childhood whilst the patients in this case series were
diagnosed with congenital cataract earlier. There was no history of consanguineous marriage in any of the families.
These cases show that, in the presence of a strong family history, a child will present with congenital cataract earlier
in their life. Hence, babies from such families should be screened at birth and at regular intervals within the first
year of life to enable early diagnosis and subsequent surgical intervention to reduce the incidence and burden of
amblyopia.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS
Introduction: Gestational Diabetes Mellitus (GDM) imposes a risk for both mother and child. Worldwide, it was estimated that GDM affects 1% to 28% of antenatal mothers. Previous studies revealed that prevalence of GDM ranged from 18.3% and 24.9% in Malaysia. This study was conducted with the aim of determining the prevalence of GDM among pregnant women and their sociodemographic characteristics in Tuaran District, Sabah State, Malaysia.
Methods: A cross sectional study was done in four Maternal and Child Health (MCH) Clinics at Tuaran, Tamparuli, Tenghilan and Kiulu in Tuaran District which included all pregnant mothers at gestational period of 24 weeks and above who attended these clinics from May 2018 to June 2018. Convenient sampling method was used. Secondary data was obtained from antenatal book records and primary data was collected by interview method using pretest-ed questionnaire. A total of 195 pregnant women participated in the study.
Results: The overall GDM prevalence among pregnant women who attended MCH clinics for antenatal care in Tuaran District was 28.2%, (95% CI: 22.0%-35.1%, n=55). Distribution of GDM cases were 34.5%, 34.5%, 18.2% and 12.7% for MCH Tuaran, Teng-hilan, Tamparuli and Kiulu respectively. Sociodemographic characteristics showed that majority of GDM was less than 35 years old of age (63.6%), multipara (60%), Kadazan/Dusun ethnicity (58.2%), attained secondary schools’ education and above (91%) and earning > RM1000 per month (65.5%). Percentage according to potential risk factors were 25%, 21% and 20% for history of abortion, family history of diabetes mellitus and previous history of GDM respectively.
Conclusion: Prevalence of GDM among pregnant women in Tuaran District was quite alarming. Further studies should be conducted about GDM and its determining factors for effective planning in strengthening GDM prevention and control programs.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected. Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3rd-5th September 2019
Introduction: Rice is classified as waxy, very low, low, intermediate and high based on its amylose content (AC). Most people prefer to consume intermediate AC rice because of its texture which tends to appear in between low (moist and sticky) and high (dry and less tender). Although rice with high AC appears dry and less tender, it usually possesses a low glycemic index (GI) i.e. a slower increase in blood glucose level after the consumption of food. Consequently, people with diabetes are recommended to eat low and intermediate GI foods. Although, rice is generally categorised as a high GI staple food there are some exceptions to it. For example, the premium Basmati aromatic rice possesses a low GI and is recommended for diabetic patients. The study aimed to identify Sabah’s traditional rice germplasm with low GI via AC that may be used as a replacement to commercial rice varieties.
Methods: A total of 110 traditional rice samples were obtained from rice fields located in the Tuaran and Kota Belud districts of Sabah. The AC in each sample was determined via I:KI method (ISO AACC-6647).
Results: We found that 46 (41.8%), 51 (46.4%), 7 (6.4%) and 6 (5.5%) Sabah’s traditional rice samples possess high, intermediate, low and very low AC, respectively. The intermediate AC type is predominant in Sabah’s traditional rice germplasm as it is the preferred rice texture by the general population. We have identified 46 rice germplasm with high AC type (i.e. with low GI value). The AC content in these is comparable to the Basmati rice and may be suitable candidates for diabetic patients.
Conclusion: The present study showed Sabah’s traditional rice germplasm has the potential to be promoted as a low GI rice cultivar based on AC for diabetic patients in order to prevent spikes in blood glucose levels while still enjoying the staple food
Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.
The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present
with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal
neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness.
Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully
performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may
cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good
long-term outcome.
Introduction: Coated archwires improve aesthetics during orthodontic treatment. However, little is known regarding
their clinical benefit. This randomised controlled trial (RCT) compared the tooth alignment (TA), coating loss (CL),
colour change (∆E*), and patient perception of coated archwires with their controls. Details of ∆E* and perception were reported in the second part of the articles. Methods: This RCT was done at three centres. Participants
were randomised to receive one of four treatment interventions using 0.014” superelastic coated nickel-titanium
archwires from Orthocare, RMO, G&H, and conventional uncoated 3M Unitek® archwires. These archwires were
ligated during bonding and collected after eighth week and questionnaires were distributed to participants in the
experimental groups only. After removal, TA and CL were measured using Little’s Irregularity Index and Autodesk®
AutoCAD® software, respectively. At the time of this preliminary reporting, 84 participants had completed the trial. Two archwires fractured and were excluded. Therefore, 166 archwires (n = 166) were analysed. Results: Only
non-extraction cases showed statistically significant differences in TA change between all groups (p = 0.005) and
RMO showed significantly lowest mean of TA (1.5 mm). RMO and Orthocare showed significant TA change in the
upper and lower arches (p = 0.037, 0.048). CL was found to be insignificant for both extraction and non-extraction
cases (p >0.05). Comparison between upper and lower arches revealed no significant difference in TA and CL in all
groups (p >0.05). Conclusion: From this preliminary analysis, Orthocare provides better TA in non-extraction cases
despite highest percentage of coating loss.
Introduction: Unsafe blood products cause transfusion-transmissible infections. A good knowledge and perception about blood safety issues is crucial to ensure safe blood supply. The objective is to develop and validate a question- naire about the knowledge and perception among blood donors on blood safety issues. Method: A cross-sectional study was conducted among 130 blood donors who attended the National Blood Centre, Kuala Lumpur in April and May 2018. The questionnaire was developed in the Malay language after extensive literature search. The self-admin- istrated questionnaire consisted 39 items which required around 20 minutes to complete. The validation involved content validity, construct validity using exploratory factor analysis and reliability using test-retest analysis in IBM SPSS statistics. The same group of respondents was retested after two weeks using the same questionnaire. Results: Content validity was established through multidisciplinary expert meeting and two content reviewers. The factors loadings of all questionnaires were more than 0.40. Knowledge questions were divided into three domains; percep- tion questions were divided into four domains. The intraclass correlation (ICC) values of the test-retest were more than 0.80 for the three knowledge domains and more than 0.60 for the four perception domains. The third domain of the perception section which consisted two questions had the lowest ICC value of 0.686 (95% CI 0.583-0.767). One of the questions was restructured to improve clarity. Conclusions: The questionnaire on knowledge and perception on blood safety issues has good validity and reliability, with appropriate items which warranted its utilization among blood donors.
Introduction: Laboratory turnaround time (LTAT) is considered a reliable indicator of the quality and efficiency of a laboratory’s service. LTAT achievement, particularly of urgent tests, remains unsatisfactory and challenging in many clinical laboratories especially in tertiary health care centres with high workload and restricted resources. The unresolved issue of unsatisfactory urgent renal profile (RP) LTAT below the standard performance goal prompted our interest to improve laboratory’s handling of urgent test request. We thus implemented the Lean principle in the management of urgent test requests using urgent RP as the test model. Methods: The implementation of laboratory Lean involved 4 steps process; (1) Development of burning platform for change (2) Identification of waste (3) Plan- ning and implementation of control measures (4) Measuring, monitoring, and sustaining the improvement. Urgent RP LTAT and the percentage of the request met the time requirement determined based on the data extracted from laboratory information system (LIS) before and after the implementation of Lean was compared to assess the effec- tiveness. Results: Urgent RP LTAT after the implementation of Lean was reduced i.e 35 min (before) vs 31 min (after), with the percentage of LTAT met the time requirement was significantly increased above the set target i.e 82.8% (before) to 93.5% (after) with P-value = 0.001. Conclusion: Implementation of innovation using Lean management has significantly improved urgent RP LTAT achievement, thus optimised urgent test management in our Chemical Pathology laboratory. Lean is a strongly recommended strategy to improve urgent test LTAT especially in laboratories with restricted resources.
Introduction: The study is introducing a laboratory technique to sustain the longevity of Heterotrigona itama sting- less bees collected from the farm in order to facilitate future health research on Kelulut honey. Methods: The worker bees were held in laboratory at 26 ± 2 oC, 57 ± 8 % relative humidity (RH) and 12:12 hours (light:dark period) in a cup covered with meshed cloth and installed with an inverted-wick system consists of a drinking straw with the bottom end loosely plugged with cotton wool. The artificial diet was pipetted into the straw to wet the cotton wool. The bees were divided into five diet groups, namely a) unfed - control, b) distilled water, c) purified tap water, d) non-carbonated isotonic drink or e) 5% honey solution. Feeding activity and survival of worker bees were observed daily. Results: The worker bees are seen to frequent and lick the cotton wool wetted with artificial diets. Comparison between the artificial diets, Kaplan-Meier statistical analysis showed that the 5% honey solution and non-carbonated isotonic drink have significantly (P < 0.05) extended the longevity of the worker bees with 50% survival probability at least 8 days. When the similar holding and feeding technique used for the bees from commercial farms, the 50% survival probability was extended to 14 days. Conclusion: The inverted-wick system with the use of 5% honey solu- tion or isotonic drink as the artificial diet is capable to hold the H. itama worker bees at least for a week with survival above 50% for laboratory experiments.
Introduction: The purpose of this study was to determine the usefulness of SPECT-CT in differentiating metastatic and degenerative disease of the spine. Methods: Twenty-eight patients aged 50 years and above diagnosed with various cancers were referred for whole body (WB) planar bone scintigraphy. Those with a maximum three foci of tracer up- take in the spine were selected for the study. SPECT-CT of these areas of uptake was performed and the lesions were classified as degenerative, indeterminate or metastasis. A repeat study (WB planar bone scintigraphy and SPECT-CT) was performed between 3 to 12 months later. These areas of uptake were reassessed and compared with the first WB planar bone scintigraphy and SPECT-CT. The second SPECT-CT was used as the standard for the diagnosis. Results: Thirty-seven lesions in 28 patients were assessed. The sensitivity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 75%, 62.5% and 75% respectively. The specificity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 86%, 93%, 90% respectively. There was 2.7% of ‘indeterminate lesion’ in the first WB planar bone scintigraphy, 5.4% in the second WB planar bone scintigraphy, and 5.4% in the first SPECT-CT. The indeterminate lesions were resolved in the second SPECT-CT. Conclusion: SPECT- CT is useful in differentiating degenerative disease from metastatic lesions in the spine.
Introduction: Melatonin (MEL) loaded alginate-chitosan/beta-tricalcium phosphate (Alg-CH/β-TCP) composite hy- drogel has been formulated as a scaffold for bone regeneration. MEL in the scaffold was anticipated to accelerate bone regeneration. The objective of this study is to observe signs of systemic toxicity and physical changes on surface defected bone for bone regenerative performance of the composite. Methods: The proximal-medial metaphyseal cortex of the left tibia of New Zealand white rabbit was the surgical site of the defect. A total of nine rabbits were randomly allocated to three groups; Group I; implanted with MEL loaded Alg-CH/β-TCP, Group II; Alg-CH/β-TCP and Group III defects were sham control. The rabbits were daily observed to determine systemic toxicity effects by composites. The physical changes to implanted site were observed using digital x-ray radiography and computerized tomography at weeks 0, 2, 4, 6 and 8 of post-implantation. Results: There were no clinical signs of systemic toxicity for all groups of rabbits. Digital radiography did not show adverse effects to the bone. Computerized tomography showed reduction in the area size and depth volume of the implantation site, but accelerated regeneration within the 8 weeks was not significantly different (P
Introduction: Various phantom with varied materials has been proposed to replace the human body. Besides, there is always a demand to use the local material as a phantom material, which is readily available and inexpensive. Wood is usually preferred because it is multifunction, environmentally friendly, low in toxic, inexpensive, as well as easy to use and prepare. Previous studies have found that Rhizophora spp. is a suitable natural source material and has been suggested due to its comparable dosimetric properties to commercial phantom. Methods: In this study, fabricated Rhizophora spp. particleboards phantom was opted as a solid-equivalent phantom medium at low energy photon beams using Gafchromic film x-ray quality assurance 2 (XRQA2). Additionally, the characteristics of XRQA2 film in the diagnostic energy range were generated. Results: Interestingly, the density of the fabricated Rhizophora spp particleboards was observed to have the same density with the water equivalent material (ρ= 1.00 g.cm-3) and has shown to have loosened agreement with PDD of water phantom at approximately 25% of the dose error. Also, further analysis using XRQA 2 film showed that energy was independent at different ranges. Conclusion: The analysis of fabricated Rhizophora spp particleboards undertaken here has extended our knowledge of the possibility of man- ufacturing cost-effective water equivalent phantom by using binder-less particleboard from Rhizophora spp. There- fore, a definite need for smaller interspacing particles should be considered to elevate the potential of Rhizophora spp particle boards as water equivalent materials.
Introduction: Cancer is one of the main causes of mortality globally and the incidence has been rising over the years. Studies have shown that miRNAs have the potential as cancer biomarkers. The miR-130a has been reported to be upregulated in several types of cancer, which indicate the important roles of miR-130a in cancer development and metastasis. The aim of this study is to identify potential target genes and to predict the regulatory function of miR- 130a-3p and 5p in cancer. Methods: Three bioinformatics platforms namely miRWalk, the Database for annotations, visualization and integrated discovery (DAVID) Gene Functional Classification Tool and miRanda-miRSVR analysis tools were used to identify possible interaction between miR-130a and its target. Protein-protein interaction (PPI) network for the predicted target genes was then constructed. Results: The analyses have identified nine predicted target genes for miR-130a-3p (RAPGEF4, SOS2, NRP1, RPS6KB1, MET, IL15, ACVR1, RYR2 and ITPR1), and ten for miR-130a-5p (BCL11A, SPOPL, NLK, PPARGC1A, POU4F2, CPEB4, ST18, RSBN1L, ELF5 and ARID4B), that might
play an important role in the development of cancer. Findings from this report suggest that miR-130a may involves in controlling cancer related genes; MET, ACVR1 and BCL11A. miR-130a-3p may regulates MET which involves in apoptosis and metastasis, and ACVR1 which involves in metastasis and angiogenesis. miR-130a-5p may regulates BCL11A which involves in apoptosis, proliferation and tumorigenesis. Conclusion: This study has highlighted the molecular interaction of miR-130a with associated genes and pathways, suggesting therapeutic potential of miR- 130a as personalised targeted therapy for cancer.
Nasopharyngeal carcinoma is a commonly encountered malignancy in endemic regions of the world namely South
East Asia, China and Hong Kong. In Malaysia, the ethnic Chinese population is particularly at risk due to genetic
susceptibilities and environmental exposure to carcinogenic agents. We herein report a case of nasopharyngeal carcinoma in a middle-aged man of Malay ethnicity who presented with nasal blockage and neck nodes. The biopsy of
the nasopharyngeal mass came back as papillary variant of nasopharyngeal carcinoma. The commonly reported histopathological types are the keratinizing and non-keratinizing types, and rarely the basaloid type. In this case report,
we aim to highlight one of the rare variants of the non-keratinizing nasopharyngeal carcinoma. When diagnosing the
non-keratinizing type, appreciation of the different morphological variants is crucial not only to help aid in procuring
an acurrate histopathologic diagnosis, but also to help in subsequent treatment plan.
A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs
and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate
Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and
clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthroscopy and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms
pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material
from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication
Introduction: Tuberculosis (TB) is one of the utmost serious infectious diseases worldwide. The emergence of multi- drug resistance demands the development of better or new putative drug targets for tuberculosis. Recent studies sug- gest Mycobacterium tuberculosis cytochrome P450 enzymes as promising drug targets and azole drugs as potential inhibitors. Methods: Various computational tools, like Expasy Protparam, Swiss model, RaptorX and Phyre2 were used to analyze 12 Mycobacterium tuberculosis P450 enzymes and determine their three-dimensional structure. The structural validation was done through a Ramachandran plot using RAMPAGE server. The docking of P450 enzymes with azole drugs was done with autodock ver 4.2.6. Results: Based on sub-cellular localization prediction using CEL- LO tool, P450 enzymes CYP123A1, CYP132A1, CYP135A1, CYP136A1, CYP140A1, and CYP143A1 were predicted to be in the cytoplasm. Through structure assessment by Ramachandran plot, the best homology modelled proteins were docked with azole drugs like clotrimazole, croconazole, econazole, fluconazole, itraconazole, itraconazole, ketaconazole and micronazole by using autodock. By docking method it is identified that ketaconazole drug has a high affinity towards most of the mycobacterium P450 enzymes followed by the itrconazole drug. CYP123A1 enzyme is preferable as a drug target due to high binding affinity towards ketoconazole followed by CYP135A1, CYP140A1 enzymes. Conclusion: This study would help in identifying putative novel drug targets in Mycobacterium tuberculosis, which can lead to promising candidates for the optimization and development of novel anti-mycobac- terial agents.