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Oxidised cellulose in musculoskeletal oncology procedure: Does it reduce postoperative blood loss?

Singh VA, Ong BK, Yasin NF

Musculoskelet Surg, 2024 Dec;108(4):483-489.
PMID: 38848000 DOI: 10.1007/s12306-024-00840-2

BACKGROUND: Major musculoskeletal oncology procedures often result in perioperative bleeding. This exposes patients to allogeneic red blood cell transfusion and its potential complications, thus increasing the risk of surgical wound infection and prolonged hospital stay. This study aimed to investigate the efficacy of oxidised cellulose, a topical haemostatic agent, in reducing postoperative blood loss and its subsequent risks.
METHODS: In this randomised controlled trial, 40 patients undergoing major musculoskeletal oncology procedures were assigned to control and intervention groups. Oxidised cellulose was inserted into the surgical wound after the resection's conclusion before the wound's closure to reduce postoperative bleeding for patients in the intervention group. Postoperative closed suction drain system (Redivac TM) volume, drop in haemoglobin level, allogeneic red blood cell transfusion rate, duration of surgery, and length of hospital stay were compared between the two groups.
RESULTS: The postoperative Redivac volume (Control: 432 MLS vs. Intervention: 431.75 MLS), drop in haemoglobin level (Control: 3.12 g/dL vs. Intervention: 3.06 g/dL), duration of surgery (Control: 134 vs. Intervention: 156 min), and allogeneic red blood cell transfusion were lower in the intervention group (Control: 204 MLS vs. Intervention: 170 MLS), but they were not statistically significant (p > 0.05) (Control: 134 vs. Intervention: 156 min). Mean hospital stay was similar in both groups (Control: 5.45 days vs. Intervention: 5.85 days).
CONCLUSION: Oxidised cellulose use does not significantly affect postoperative blood loss, the rate of allogeneic blood transfusion, and hospital stay. However, we believe its use contributes positively but not considerably towards lower postoperative blood loss in musculoskeletal oncology surgeries.
Interventions to Improve Adherence to Medication on Multidrug-Resistant Tuberculosis Patients: A Scoping Review

Octaviani P, Ikawati Z, Yasin NM, Kristina SA, Kusuma IY

Med J Malaysia, 2024 Mar;79(2):212-221.
PMID: 38553929

INTRODUCTION: Inappropriate treatment and non-adherence use of anti-tuberculosis (TB) drugs trigger the spread of multidrug-resistant tuberculosis (MDR-TB) strains and causes an emerging public health threat worldwide. Therefore, non-adherence to MDR-TB treatment leading to prolonged medication period, increase incidence of adverse event and financial burden, thus it requires interventions to achieve a therapeutic outcome.
OBJECTIVE: This scoping review aims to provide an overview of interventions to improve the adherence level to medication of MDR-TB patients.
MATERIALS AND METHODS: A review of observational studies was conducted to discuss the accuracy, tolerability and ease of use of tonometers in measuring IOP in children with glaucoma. Three databases (PubMed, Web of Science, Scopus) were used in a scoping review. The data were synthesised using Rayyan AI. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review.
RESULTS: A total of 11 articles were included in this review to describe the various interventions in MDR-TB treatment adherence. Psychological counselling or education intervention was the most popular intervention, and it significantly increased adherence levels among MDR-TB patients. Increased adherence level patients also reported by interventions with Medication Event Reminder Monitor (MERM), Video Directly Observed Therapy (VDOT), 30-day recall and Visual Analogue Scale (VAS), Financial Support, mHealth Application and directly observed therapy, short course (DOTS) and DOTS-Plus programs. However, we found that Electronic Dose Monitoring (EDM) device intervention has less effect on MDR-TB patients' adherence.
CONCLUSION: The recovery of patients can be facilitated through MDR-TB treatment adherence interventions. It is acknowledged that the studies included in this review exhibit heterogeneity, with a majority showing significant improvement. Therefore, further study was required to investigate the specific on developing highly personalised interventions tailored to specific population or context, as well as to assess the cost-effectiveness of such interventions.
Fatty acid profile from immobilised Chlorella vulgaris cells in different matrices

Abu Sepian NR, Mat Yasin NH, Zainol N, Rushan NH, Ahmad AL

Environ Technol, 2019 Apr;40(9):1110-1117.
PMID: 29161985 DOI: 10.1080/09593330.2017.1408691

The immobilisation of Chlorella vulgaris 211/11B entrapped in combinations of natural matrices to simplify the harvesting process was demonstrated in this study. Three combinations of matrices composed of calcium alginate (CA) and sodium alginate (SA), sodium carboxymethyl cellulose (CMC) and SA, and mixed matrices (SA, CA, and CMC) were investigated. The number of cells grown for each immobilised matrix to microalgae volume ratios (0.2:1-1:1) were explored and compared with using SA solely as a control. The optimum volume ratios obtained were 1:1 for SA, 0.3:1 for CA and SA, 1:1 for CMC and SA, and 0.3:1 for mixed matrices. The immobilised microalgae of mixed matrices exhibited the highest number of cells with 1.72 × 109 cells/mL at day 10 and 30.43% of oil extraction yield followed by CA and SA (24.29%), CMC and SA (13.00%), and SA (6.71%). Combining SA, CA, and CMC had formed a suitable structure which improved the growth of C. vulgaris and increased the lipid production compared to the immobilisation using single matrix. Besides, the fatty acids profile of the oil extracted indicates a high potential for biodiesel production.
Family study of haemoglobin Arya in a Malaysian family

Nahanthiran S, Nik Mustapha NH, Yasin N, Idris FB, Md Noor SB

Malays J Pathol, 2024 Aug;46(2):315-320.
PMID: 39207009

INTRODUCTION: Thalassemia and haemoglobinopathies are relatively common among Malaysians. One of the rare haemoglobinopathies reported is Haemoglobin (Hb) Arya, which occurs due to substitution of aspartic acid at residue 47 of the alpha chain by asparagine. Here, we report the detection of Hb Arya in a Malaysian family, which was detected incidentally during family screening.
CASE REPORT: A 16 years-old girl, clinically asymptomatic was noted to have low mean corpuscular haemoglobin (MCV) with normal Hb level. Hb analysis using capillary electrophoresis (CE) showed reduced Hb A of 76.5%, Hb A2 of 1.6% with presence of small peak at Zone 1 likely A2'. There was also a small peak noted at Hb D zone and Hb S zones which quantified as 1.5% and 20% respectively. Supplementary test by high performance liquid chromatography (HPLC) showed a prominent peak at D-window (19.6%) and a small peak at S-window (0.6%). DNA analysis revealed a heterozygous state of α2 codon 47 Hb Arya mutation. Subsequent family study showed a similar mutation in the father and sister of the index case.
CONCLUSION: Very few reports are available up to date regarding Hb Arya. This report highlights the rare haemoglobinopathy in a Malay family in Malaysia that contributes to the growing literature of this rare haemoglobin variant.
Fulltext Gene Mutation Spectrum among Alpha-Thalassaemia Patients in Northeast Peninsular Malaysia

Vijian D, Wan Ab Rahman WS, Ponnuraj KT, Zulkafli Z, Bahar R, Yasin N, et al.

Diagnostics (Basel), 2023 Feb 27;13(5).
PMID: 36900038 DOI: 10.3390/diagnostics13050894

(1) Background: Alpha (α)-thalassaemia is a genetic disorder that affects 5% of the world population. Deletional or nondeletional mutations of one or both HBA1 and HBA2 on chromosome 16 will result in reduced production of α-globin chains, a component of haemoglobin (Hb) that is required for the formation of red blood cells (RBCs). This study aimed to determine the prevalence, haematological and molecular characterisations of α-thalassaemia. (2) Method: The parameters were based on full blood count, high-performance liquid chromatography and capillary electrophoresis. The molecular analysis involved gap-polymerase chain reaction (PCR), multiplex amplification refractory mutation system-PCR, multiplex ligation-dependent probe amplification and Sanger sequencing. (3) Results: With a total cohort of 131 patients, the prevalence of α-thalassaemia was 48.9%, leaving the remaining 51.1% with potentially undetected α gene mutations. The following genotypes were detected: -α3.7/αα (15.4%), -α4.2/αα (3.7%), --SEA/αα (7.4%), αCSα/αα (10.3%), αAdanaα/αα (0.7%), αQuong Szeα/αα (1.5%), -α3.7/-α3.7 (0.7%), αCSα/αCSα (0.7%), -α4.2/αCSα (0.7%), -SEA/αCSα (1.5%), -SEA/αQuong Szeα (0.7%), -α3.7/αAdanaα (0.7%), --SEA/-α3.7 (2.2%) and αCSα/αAdanaα (0.7%). Indicators such as Hb (p = 0.022), mean corpuscular volume (p = 0.009), mean corpuscular haemoglobin (p = 0.017), RBC (p = 0.038) and haematocrit (p = 0.058) showed significant changes among patients with deletional mutations, but not between patients with nondeletional mutations. (4) Conclusions: A wide range of haematological parameters was observed among patients, including those with the same genotype. Thus, a combination of molecular technologies and haematological parameters is necessary for the accurate detection of α-globin chain mutations.
A rare case of compound heterozygous Southeast Asian double α-globin gene deletion and Haemoglobin Quong Sze in a Malay proband

Vijian D, Wan Ab Rahman WS, Kannan TP, Zulkafli Z, Mohd Noor NH, Bahar R, et al.

Malays J Pathol, 2024 Aug;46(2):321-324.
PMID: 39207010

INTRODUCTION: Haemoglobin (Hb) Quong Sze is a non-deletional α-thalassaemia subtype that occurs due to missense mutation at codon 125 of the HBA2 gene. Interaction between Hb QS with Southeast Asian double α-globin gene deletion results in non-deletional HbH disease, which is more severe than deletional HbH.
CASE REPORT: A 3-month-old baby boy was presented with neonatal anaemia and mild hepatomegaly. Full blood count revealed severe hypochromic microcytic anaemia. There was an abundance of HbH inclusion bodies in his red blood cells. High-performance liquid chromatography showed a reduced HbA2 level with the presence of pre-run peak. Capillary electrophoresis showed the presence of HbH and Hb Barts. Molecular analysis found a common α0-thalassaemia (--SEA) in one allele and mutation in codon 125 in the other allele.
DISCUSSION: Non-deletional HbH disease due to a combination of deletional and non-deletional mutations may present with severe clinical manifestations than those with deletion mutations, which warrants accurate diagnosis using molecular techniques.
Rare coinheritance of hemoglobin vancleave with severe beta-thalassemia mutation in a patient with secondary erythrocytosis

Aziz NA, Musa NH, Mathews M, Rajenderan KT, Abdul Hamid FS, Hassan S, et al.

Hum Genome Var, 2024 Apr 23;11(1):19.
PMID: 38653961 DOI: 10.1038/s41439-024-00275-y

Hemoglobin (Hb) Vancleave (NM_000518.5:c.431 A > T; dbSNP: rs33918338) is an extremely rare structural hemoglobin variant worldwide, and studies are limited. This report describes the case of a 16-year-old male patient who presented with secondary erythrocytosis. The diagnosis of Hb Vancleave, in combination with codon 41/42 (-TTCT) (NM_000518.5:c.126_129del; dbSNP: rs80356821), was confirmed by direct sequencing. This report highlights the importance of sequencing in the differential diagnosis of beta-thalassemia syndrome in Malaysia.
Global Globin Network and adopting genomic variant database requirements for thalassemia

Halim-Fikri H, Zulkipli NN, Alauddin H, Bento C, Lederer CW, Kountouris P, et al.

Database (Oxford), 2024 Sep 04;2024.
PMID: 39231257 DOI: 10.1093/database/baae080

Thalassemia is one of the most prevalent monogenic disorders in low- and middle-income countries (LMICs). There are an estimated 270 million carriers of hemoglobinopathies (abnormal hemoglobins and/or thalassemia) worldwide, necessitating global methods and solutions for effective and optimal therapy. LMICs are disproportionately impacted by thalassemia, and due to disparities in genomics awareness and diagnostic resources, certain LMICs lag behind high-income countries (HICs). This spurred the establishment of the Global Globin Network (GGN) in 2015 at UNESCO, Paris, as a project-wide endeavor within the Human Variome Project (HVP). Primarily aimed at enhancing thalassemia clinical services, research, and genomic diagnostic capabilities with a focus on LMIC needs, GGN aims to foster data collection in a shared database by all affected nations, thus improving data sharing and thalassemia management. In this paper, we propose a minimum requirement for establishing a genomic database in thalassemia based on the HVP database guidelines. We suggest using an existing platform recommended by HVP, the Leiden Open Variation Database (LOVD) (https://www.lovd.nl/). Adoption of our proposed criteria will assist in improving or supplementing the existing databases, allowing for better-quality services for individuals with thalassemia. Database URL: https://www.lovd.nl/.