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Fulltext The In Vitro and In Vivo Anticancer Properties of Moringa oleifera

Khor KZ, Lim V, Moses EJ, Abdul Samad N

Evid Based Complement Alternat Med, 2018;2018:1071243.
PMID: 30538753 DOI: 10.1155/2018/1071243

Moringa oleifera, a fast-growing deciduous tree that is widely cultivated in tropical and subtropical regions of the world, is well known for its abundant uses. The tree is a source of food, shelter, and traditional medicine for many people, especially in developing countries. Many studies have been conducted to evaluate the various claims of traditional medicine practitioners that the moringa tree can improve health and treat various diseases. The tree has a high nutritional profile, especially the nutrient rich leaves. Some reports also support the use of parts of the tree to reduce blood sugar and cholesterol levels. These attractive properties have led researchers to look for other novel uses for the moringa tree, especially as a source of anticancer drugs. Researchers have tested extracts from various parts of the moringa tree both in vitro and in vivo on several types of cancers with varying success. This review explores the state of current research on the anticancer properties of M. oleifera.
Fulltext Endoscopic ultrasound-guided hepaticogastrostomy using a partially covered metal stent in patients with malignant biliary obstruction after failed Endoscopic retrograde cholangiopancreatography

Emmanuel J, Omar H, See LT

JGH Open, 2020 Dec;4(6):1059-1064.
PMID: 33319037 DOI: 10.1002/jgh3.12386

BACKGROUND AND AIM: The advent of endoscopic ultrasound-guided biliary drainage (EUS-BD) has provided an inimitable alternative for gaining biliary access in patients who fail conventional endoscopic drainage. The antimigratory features of the partially covered metal stent (PCMS), namely, the flange head and uncovered portion of the stent, makes it a valuable option in patients undergoing EUS-guided hepaticogastrostomy (EUS-HGS). The aim of the study is to evaluate the clinical outcome of EUS-BD via the hepaticogastrostomy approach using PCMS in patients with malignant biliary obstruction after failed ERCP.
METHODS: This is a single-center retrospective observational study of patients with malignant biliary obstruction undergoing EUS-HGS after failed ERCP between January 2018 and May 2019. The end-point of the study was to assess the technical and clinical success rate, as well as the stent- and procedure-related complications.
RESULTS: There were 20 subjects in this study. The average age was 71.8 ± 7.6 years. Most patients were male, 16 (80%). Inaccessible papillae was the most common indication for this procedure, 16 (80%). Technical success was achieved in all patients. The average procedural time was 39.9 ± 1.3 min. Mean preprocedural bilirubin levels were 348.6 ± 28.8 and subsequently decreased to 108.94 ± 37.1 μmol/L at 2 weeks postprocedure. The clinical success rate was 95% (19/20), with one patient requiring percutaneous transhepatic biliary drainage (PTBD). There were no stent- or procedure-related complications reported in this study.
CONCLUSION: EUS-HGS with PCMS is a feasible, effective, and safe alternative for biliary decompression in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).
Fulltext Endoscopic ultrasound-guided colo-colostomy in a case of acute large bowel obstruction

Emmanuel J, Kollanthavelu S, Henry F, See LT

Endosc Int Open, 2021 Mar;9(3):E289-E291.
PMID: 33655023 DOI: 10.1055/a-1336-2213

Bowel obstruction is one of the most common surgical emergencies and a major cause of morbidity and mortality. Standard supportive measures must be instituted as soon as the diagnosis is confirmed. Anastomotic strictures are a benign etiology of intestinal obstruction, occurring in up to 22 % of patients following colorectal resection. Traditionally, endoscopic balloon dilation (EBD) has been the intervention of choice in such cases; however, it may not be feasible in all settings. We report a novel application of the AXIOS stent and electrocautery-enhanced delivery system (Boston Scientific, Marlborough, Massachusetts, United States) to create a colo-colostomy to bypass a sigmoid colon stricture in a 51-year-old woman who presented with acute intestinal obstruction. Despite stent dislodgment during the procedure, the preexisting tract allowed us to improvise our technique with a second LAMS placement. The patient was discharged well 48 hours after the procedure. However, 4 months later, she required a session of EBD following a presentation for fecal impaction. She is currently asymptomatic and being followed up regularly as an outpatient.
Fulltext Homozygous Southeast Asian Ovalocytosis in five live-born neonates

Lavinya AA, Razali RA, Razak MA, Mohamed R, Moses EJ, Soundararajan M, et al.

Haematologica, 2021 06 01;106(6):1758-1761.
PMID: 33179475 DOI: 10.3324/haematol.2020.268581

Not available.
A RUNX1/ETO-SKP2-CDKN1B axis regulates expression of telomerase in t (8;21) acute myeloid leukemia

Moses EJ, Azlan A, Khor KZ, Mot YY, Mohamed S, Seeni A, et al.

Cell Mol Life Sci, 2023 Feb 23;80(3):70.
PMID: 36820913 DOI: 10.1007/s00018-023-04713-y

The fusion oncoprotein RUNX1/ETO which results from the chromosomal translocation t (8;21) in acute myeloid leukemia (AML) is an essential driver of leukemic maintenance. We have previously shown that RUNX1/ETO knockdown impairs expression of the protein component of telomerase, TERT. However, the underlying molecular mechanism of how RUNX1/ETO controls TERT expression has not been fully elucidated. Here we show that RUNX1/ETO binds to an intergenic region 18 kb upstream of the TERT transcriptional start site and to a site located in intron 6 of TERT. Loss of RUNX1/ETO binding precedes inhibition of TERT expression. Repression of TERT expression is also dependent on the destabilization of the E3 ubiquitin ligase SKP2 and the resultant accumulation of the cell cycle inhibitor CDKN1B, that are both associated with RUNX1/ETO knockdown. Increased CDKN1B protein levels ultimately diminished TERT transcription with E2F1/Rb involvement. Collectively, our results show that RUNX1/ETO controls TERT expression directly by binding to its locus and indirectly via a SKP2-CDKN1B-E2F1/Rb axis.
First toddler mesenteric lymphatic malformation in Malaysia - A case report

Soh CH, Emmanuel J, Rahizan MI, Azmi MA, Thillainayagam SD, Nurdaliza MB, et al.

Med J Malaysia, 2022 Jan;77(1):104-106.
PMID: 35087006

This is the first reported case of a mesenteric lymphatic malformation in a toddler in Malaysia. It is a rare benign condition with incidence of 1 in 250,000 populations. Our patient presented to us at 2 years 11months old complaining of abdominal distension for 6 months without obstructive symptoms. Clinically there was a vague soft central abdominal mass. CT abdomen done revealed a large multiloculated intraperitoneal mesentery cystic mass within the central abdomen extending to pelvis. A semi-emergency laparotomy was performed. Intra-operatively the multiloculated mesenteric cyst measured 20cm x 30cm, adherent to the small bowel beginning at 12cm from duodeno-jejunal junction. Resection of the mesenteric cyst with adherent small bowel and primary anastomosis was done. Histopathological examination revealed multiple large lymphatic channels of various sizes in the mucosa and submucosa. Our patient has no signs of recurrence and remains symptom-free after 1 year since his surgery. Surgery with clear margins of resection is the recommended gold standard based on available literature. Type of surgical resection required will depend on the type of mesenteric lymphatic malformation. An awareness of this rare pathology is required to ensure proper management is given to these patients.
Fulltext EUS-guided laser lithotripsy for pancreatic duct stones after failed conventional pancreatic endotherapy

Emmanuel J, Hsin DCC, Bt Wan Abdullah WZA, See LT

Endosc Int Open, 2024 Jan;12(1):E135-E138.
PMID: 38304353 DOI: 10.1055/a-2187-7263

The central dogma of pain in patients with chronic pancreatitis revolves around the pathophysiology of ductal hypertension owing to stones that obstruct the pancreatic duct. Conventional modalities available to decompress the pancreatic duct are occasionally limited by failed selective pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography. We describe a novel endoscopic approach of EUS-guided laser lithotripsy to assist in pancreatic duct (PD) stone fragmentation in two symptomatic patients with underlying chronic pancreatitis who had failed PD cannulation and extracorporeal shock wave lithotripsy (ESWL). In both cases, a 365-micrometer LightTrail TracTip Holmium laser fiber was advanced within a 19G endoscopic ultrasound aspiration needle (Expect Slimline (SL), Boston Scientific, Marlborough, Massachusetts, United States) under endoscopic ultrasound (EUS) guidance to fragment the PD stones. There were no procedure-related complications encountered and follow-up after 1 month of the procedure revealed significant reduction in abdominal pain scores. To the best of our knowledge, these are the first reported cases of EUS-guided laser lithotripsy performed for PD stones. Our approach of performing laser lithotripsy under EUS guidance obviates the need for an ESWL procedure; however, it is technically more challenging and requires precision to avoid injury to the pancreas. Further prospective studies are required to evaluate the safety and efficacy of this novel approach and its applicability as either a rescue procedure or in tandem with conventional pancreatic endotherapy modalities.
Comparing Number and relevance Of false activations between two Artificial Intelligence CADe SystEms: the NOISE study

Spadaccini M, Hassan C, Alfarone L, Da Rio L, Maselli R, Carrara S, et al.

Gastrointest Endosc, 2022 Jan 04.
PMID: 34995639 DOI: 10.1016/j.gie.2021.12.031

BACKGROUND AND AIMS: Artificial Intelligence (AI) has been shown to be effective in polyp detection, and multiple computer-aided detection (CADe) system have been developed. False positive (FP) activation emerged as a possible way to benchmark CADe performances in clinical practice. The aim of this study is to validate a previously developed classification of FP comparing the performances of different brands of approved CADe systems.
METHODS: We compared 2 different consecutive video libraries (40 video per arm) collected at Humanitas Research Hospital with 2 different CADe system brands (CADe A and CADe B). For each video, the number of CADe false activations, the cause and the time spent by the endoscopist to examine the area erroneously highlighted were reported. The FP activations were classified according to the previously developed classification of false positives (the NOISE classification) according to their cause and relevance.
RESULTS: A total of 1021 FP activations were registered across the 40 videos of the Group A (25.5±12.2 FPs per colonoscopy). A comparable number of FPs were identified in the Group B (n=1028, mean:25.7±13.2 FPs per colonoscopy) (p 0.53). Among them, 22.9±9.9 (89.8%, Group A), and 22.1±10.0 (86.0%, Group B) were due to artifacts from bowel wall. Conversely, 2.6±1.9 (10.2%) and 3.5±2.1 (14%) were caused by bowel content (p 0.45). Within the Group A each false activation required 0.2±0.9 seconds, with 1.6±1.0 (6.3%) FPs requiring additional time for endoscopic assessment. Comparable results were reported within the Group B with 0.2±0.8 seconds spent per false activation and 1.8±1.2 FPs per colonoscopy requiring additional inspection.
CONCLUSION: The use of a standardized nomenclature permitted to provide comparable results with either of the 2 recently approved CADe systems.