Clinical Assessment Limitation in Extragastrointestinal Stromal Tumour of Rectovaginal Septum Diagnosis: A Case Report

@#Extragastrointestinal tumour of rectovaginal septum (rvGIST) is a rare malignancy that affects rectovaginal septum. We present a case of rvGIST that was initially managed as cervical eGIST based on clinical assessment. A 66-yearold woman presented with postmenopausal bleeding and constipation. Bimanual pelvic examination revealed an irregular mass occupying the vagina. CT thorax, abdomen and pelvis showed a 9.2 x 10.0 x 14.0 cm pelvic mass arising from cervix, extending superiorly to involve the uterus. The patient proceeded to undergo total abdominal hysterectomy, bilateral salpingo-oophorectomy, enucleation of rectovaginal septum mass, rectosigmoidectomy and permanent colostomy. Intraoperatively, there was a 9 x 7 cm mass arising from rectovaginal septum. Histopathological examination of surgical specimen revealed spindle cell tumour diffusely positive for CD34, CD117 and DOG1. The final diagnosis was rvGIST. In conclusion, the diagnosis of rvGIST require a combination of clinical assessment with intraoperative finding and histological assessment of the surgical specimen.

Linezolid-resistant Enterococcus casseliflavus and Enterococcus gallinarum isolated from poultry farms in Kelantan, Malaysia

Aims@#Linezolid has become a decisive therapy in treating infections with vancomycin-resistant Enterococcus (VRE). Currently, the emergence of linezolid-resistant Enterococcus further complicates the therapeutic options and leads to global health threat not only in hospital setting but in the community. The study aimed at antimicrobial pattern of Enterococcus isolated from 6 poultry farms in Kelantan, Malaysia.@*Methodology and results@#Between February and December 2019, 300 broiler cloacal swab sample (Gallus gallus domesticus) were collected and screened for linezolid-resistant enterococci (LRE) using a standard biochemical and antimicrobial susceptibility tests. Among all the samples, 32.3% (n=97/300) grew Enterococcus, 71.1% (n=69/97) of it were identified Enterococcus casseliflavus by molecular identification, whilst remaining isolates 28.9% (n=28/97) were further identified as Enterococcus gallinarum by 16S rRNA sequencing. None of the isolates were found to exhibit high-level resistance to vancomycin. However, 3/97 (3.1%) were exhibit resistance to high-level gentamicin based on Kirby-Bauer disk diffusion test. Whereas 48/97 (49.5%) of isolates were observed to be resistant to ampicillin, 28/97 (28.9%) were resistant to penicillin. Surprisingly, among the two strains isolated, 18.6% (n=18/97) of it were resistant to linezolid. Isolates showed resistance to linezolid by disk diffusion test were verified by VITEK-2 automated system (bioMérieux, USA) with MIC ≥8 µg/mL. All antimicrobial susceptibility test and minimal inhibitory concentration (MIC) results were interpreted according to Clinical and Laboratory Standard Institute (CLSI). @*Conclusion, significance and impact of study@#In conclusion, this study has reported the prevalence of linezolid resistant Enterococcus (LRE) in highly intrinsic antibiotic resistant of E. casseliflavus and E. gallinarum in Malaysia poultry farms, alongside with the truancy of vanA strains. The emergence of LRE strains is an alarming problem to the animal husbandry and healthcare setting worldwide. This could lead to potentially untreatable and life-threatening enterococcal infections. Even more worrying is the spread of LRE to geographical regions where these strains were previously unreported, which may pose a global health threat. Antimicrobial surveillance in poultry husbandry is thus, dimly necessary to prevent wide spread of multidrug-resistant bacteria.

Synthesis of molecularly imprinted polymers of vanillic acid and extraction of vanillic acid from spiked blood serum

Vanillic acid (4-hydroxy-3-methoxybenzoic acid) is a phenolic acid found in many plant extracts. It is used as aflavoring and scent agent and produces a pleasant, creamy odor. It is widely used in many applications for therapeuticpurposes to flavoring agent. Molecularly imprinted polymers of vanillic acid were synthesized by precipitationpolymerization with a noncovalent approach for the extraction from blood serum. Three different imprinted polymershave been synthesized with varying molar ratio of monomer. The synthesized polymer particles were characterizedusing Fourier-transform infrared spectroscopy and scanning electron microscopy. The extraction efficiency of highlyselected imprinted polymer of vanillic acid from spiked blood serum was about 80%.

Experiences of Left-Handed Undergraduates in a Dental Faculty in Malaysia

@#Work environment in dentistry benefits the right-handed dental practitioners. This situation requires the left-handers to work in an adjusted position causing them discomfort and inconvenience. The aim of this study was to explore the experiences of the identified left-handed undergraduate dental students in Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM) in performing dental procedures. The first phase of the study was to determine handedness of the students using the Edinburgh Handedness Inventory Questionnaire that was distributed to all the dental students. This was followed by a qualitative study using the phenomenology approach. Semi-structured interviews were conducted on left-handed students to determine their perceptions on left-handedness in performing dental procedures. The number of students interviewed was based on attainment of the saturation point. The interview was recorded and transcribed verbatim. The transcripts were analysed through coding, categorising and grouping responses into themes. Prevalence of left-handedness in this faculty was 7%. The participants were not aware of the right-handed situation when they enrolled in the faculty. This situation gave rise to psychological impact such as anxiety and stress. Although some participants were able to use their right hand for certain procedures, the dominant hand continued to be their preference. The difficulties encountered when using the non-dominant hand were grip-strength, angulation and positioning of the instruments. Dental procedures in periodontology (such as scaling, root debridement) and oral surgery (tooth extraction, incision and suturing) were found to be very challenging. They experienced muscle fatigue, reduced precision and prolonged time to complete the dental procedures. They felt that they should be given more time to adapt using the right hand under the tutelage of left-handed faculty members. Left-handed dental students faced difficulties in adapting to the right-handed situation and affect their effectiveness and efficiency. Specific activities need to be designed for left-handers to adapt to the situation under the guidance of left-handed faculty members.

Sleep quality and OPRM1 polymorphisms: a cross-sectional study among opioid-naive individuals

ABSTRACT O sistema opioidérgico envolve a regulação do sono e da vigília. É possível, portanto, que os polimorfismos genéticos no OPRM1 influenciem na qualidade do sono. Este estudo investigou a associação de polimorfismos do OPRM1 com a qualidade subjetiva do sono entre indivíduos sem tratamento prévio com opióides. Este estudo observacional de corte transversal envolveu 161 homens que nunca haviam se tornado opióides (média de idade = 27,74 anos; variação: 18 a 63 anos). A qualidade subjetiva do sono foi avaliada com a versão traduzida e validada em malaio do Índice de Qualidade do Sono de Pittsburgh (PSQI). O DNA foi extraído do sangue total e submetido à reação em cadeia da polimerase (PCR) para dois polimorfismos OPRM1 (118A> G e IVS2 + 691G> C). Sujeitos combinados com 118A e IVS2 + 691Galelos (haplótipo AC) apresentaram escores significativamente mais baixos do PSQI [média (DP) = 4,29 (1,76)] em comparação àqueles sem o haplótipo [4,99 (2,50)] (p = 0,004). Por outro lado, os indivíduos com genótipo heterozigótico combinado (GC / AG diplotipo) apresentaram escores significativamente mais altos do PSQI em comparação àqueles sem o diplótipo [6,04 (2,48) vs 4,54 (2,22), p = 0,004]. Em indivíduos sem tratamento prévio com opiáceos, o haplótipo AC e o diplótipo GC / AG para os polimorfismos 118A> G e IVS2 + 691G> C do OPRM1 estão associados a uma melhor e pior qualidade do sono, respectivamente.

Role of oxidative stress in opiate withdrawal and dependence: Exploring the potential use of honey.

Opiate dependence and withdrawal is a worldwide public health problem and give a significant burden to society. In exploring the problems of opiate dependence and withdrawal, oxidative stress in thought to be involved in the mechanism of the development of dependence and tolerance to morphine. Therefore, there is possibility that antioxidant has the role to reduce the oxidative stress leading to opiate dependence and withdrawal. In this mini review we describe the evidence of relationship between oxidative stress and opiate dependence. We also describe the evidence of honey which has been claimed to have high antioxidant properties and its promising potential to reduce oxidative stress in opiates dependence and tolerance individuals.

Analgesic effect of honey bioactive compounds and its role in reducing morphine tolerance.

Honey has been used as a supplement nutrient in human for centuries. It exerts antibacterial, anticancer, anti-inflammatory properties as well as analgesic activity. But not many studies have been done to analyze effect of honey on morphine tolerance. Hence, this review is targeting on analgesic effect of honey bioactive compounds and their potential in morphine tolerance study.

Phoenix dactylifera Linn as a potential novel anti-oxidant in treating major opioid toxicity.

The use of opioids has gain popularity in the field of medicine especially in treating chronic terminally ill patients. Unfortunately, several adverse effects in relation to its use have been reported. Literature search on the adversity of opioids in treating pain, its paradoxical hyperalgesic effects and susceptibility to addiction were conducted using Pubmed, Embase and Google Scholar without species limitation. This brief article focuses on the corresponding neuro-protective, hepato-protective, anti-inflammatory, ulcero-protective and nephron-protective functions of (Phoenix dactylifera L) to elaborate on evidences, mechanisms, modulatory and pharmacological significance to counteract adverse effects of opioid treatment and provide insight on the underlying mechanisms of addiction.

Reviews on Calcium Mediated Secondary Messengers in Chronic Opioids Exposure/Addiction.

Addiction and withdrawal are problems disturbing the health of the individual and also causes difficulties for society, raising the rates of divorce, unemployment and government spending on legal and medical systems. Opioids show an important pharmacological effect in the treatment of pain, with extremely addictive potential. Chronic opioid exposure is known to produce the complex behaviors of tolerance and dependence, a state exposed by opioid abstinence leading to withdrawal syndrome, as well as oxidative stress. Studies show that calcium mediated secondary messengers play a crucial role in the mechanism of addictive process and oxidative stress induced by chronic opioid usage. Calcium/calmodulin-dependent protein kinase II (CaMKII), is a major calcium regulated signal transducer that controls many neuronal systems and play important role in neuronal plasticity and can act as a key and direct promoting opioid tolerance and dependence and identifying such a direct mechanism may be useful for designing a pharmacology treatment for these conditions, recent studies, has been shown that calcium channels antagonist can be used in the treatment of withdrawal syndrome. Chronic opioid exposure associated with tolerance, dependence withdrawal syndrome and oxidative stress. Studies has shown that calcium mediated secondary messengers involved in the genesis of these conditions, better understanding of biological mechanisms underlie reduction in neuronal cell excitability could help in the identification of pharmacological targets for treatment.

Hb lepore/β0-thalassaemia with α+-thalassaemia interactions, a potential diagnostic pitfall

Haemoglobin (Hb) Lepore is a variant Hb consisting of two α-globin and two δβ-globin chains. In a heterozygote, it is associated with clinical findings of thalassaemia minor, but interactions with other haemoglobinopathies can lead to various clinical phenotypes and pose diagnostic challenges. We reported a pair of siblings from a Malay family, who presented with pallor and hepatosplenomegaly at the ages of 21 months and 14 months old. The red cell indices and peripheral blood smears of both patients showed features of thalassaemia intermedia. Other laboratory investigations of the patients showed conflicting results. However, laboratory investigation results of the parents had led to a presumptive diagnosis of compound heterozygote Hb Lepore/β-thalassaemia and co-inheritance α+-thalassaemia (-α3.7). Hb Lepore has rarely been detected in Southeast Asian countries, particularly in Malaysia. These two cases highlight the importance of family studies for accurate diagnosis, hence appropriate clinical management and genetic counseling.

Hb Lepore/β0-Thalassaemia With α+-Thalassaemia Interactions, A Potential Diagnostic Pitfall

Haemoglobin (Hb) Lepore is a variant Hb consisting of two α-globin and two δβ-globin chains. In a heterozygote, it is associated with clinical findings of thalassaemia minor, but interactions with other haemoglobinopathies can lead to various clinical phenotypes and pose diagnostic challenges. We reported a pair of siblings from a Malay family, who presented with pallor and hepatosplenomegaly at the ages of 21 months and 14 months old. The red cell indices and peripheral blood smears of both patients showed features of thalassaemia intermedia. Other laboratory investigations of the patients showed conflicting results. However, laboratory investigation results of the parents had led to a presumptive diagnosis of compound heterozygote Hb Lepore/β-thalassaemia and co-inheritance α+-thalassaemia (-α3.7). Hb Lepore has rarely been detected in Southeast Asian countries, particularly in Malaysia. These two cases highlight the importance of family studies for accurate diagnosis, hence appropriate clinical management and genetic counseling.

Reviews of herbal and their secondary metabolites in the treatment of ulcerative colitis and peptic ulcer.

Peptic ulcer is a disease of the Gastro-intestinal tract (GIT), which includes both gastric and duodenal ulcers. The occurrence of peptic ulcer disease has been attributed to the imbalance between aggressive factors like acid, pepsin, and Helicobacter infection on one hand and the local mucosa defenses like bicarbonate and mucus secretion and prostaglandins synthesis on the other hand. The most serious complications of peptic ulcer disease include hemorrhage, perforation, penetration, and gastric outlet obstruction. Ulcerative colitis is a form of inflammatory bowel disease (IBD). It is a form of colitis, a disease of the colon that includes characteristic ulcers, or open sores. IBD is often confused with irritable bowel syndrome. Ulcerative colitis is associated with a general inflammatory process that affects many parts of the body. Sometimes these associated extra-intestinal symptoms are the initial signs of the disease, such as painful arthritic knees in a teenager and may be seen in adults also. Several classes of pharmacological agents have proved to be effective in the management of the acid peptic disorders viz., antacids, acid suppressive agents, anticholinergic, cytoprotective agents, etc. A widespread search has been launched to identify new anti-ulcer therapies from natural sources to replace currently used drugs of doubtful efficacy and safety. Herbs, medicinal plants, spices, vegetables and crude drug substances are considered to be a potential source to control various diseases including gastric ulcer and ulcerative colitis. In the scientific literature, a large number of medicinal plants and their secondary metabolites with anti-ulcer potential have been reported. As the gastro protective effect can be linked to different mechanisms, once demonstrated the activity, the extracts and more appropriately the active compounds should be assessed for action mechanisms to elucidate their mode of action. Besides, new action mechanisms may be discovered.

Preference of teaching and learning methods in a new medical school of Malaysia.

Teaching and learning are the two sides of a coin. Henceforth, there is a strong correlation between the methods used in delivering the information by the lecturers and the assimilation of that knowledge by the students. MBBS programme of FPSK, UniSZA, is divided into two phases, preclinical (Year I and II) and clinical (Year III, IV and V) phases. The main teaching and learning methods for preclinical phase include lecture, tutorial, practical, problem based learning (PBL) and early clinical exposure (ECE). This cross-sectional study was conducted in July 2013 in UniSZA, Malaysia. 50 respondents from preclinical phase were randomly selected from total 117 students to answers the questionnaire. The questionnaire was developed with extensive literature review and pretested and validated. The questionnaire has been divided into 5 sections. The data were analysed using the SPSS 17.0. This study showed that 36 (72%) out of 50 respondents chose lecture as the most preferred teaching and learning method. Five (10%) out of 50 respondents preferred tutorial and 3 (6%) out of 50 respondents preferred PBL, practical and ECE respectively. None of the respondents chose Computer Assisted Learning (CAL) as a preferred method. Probably learning guideline of CAL is not clear that make the session the most unpreferred. Majority of the students in preclinical phase preferred lecturer/teacher-centred learning session to acquire knowledge in a medical school.

An application of moderately T2-weighted 3D TSE-FS pulse sequence to MRI myelography in investigation of patient with cervical spondylotic radiculopathy.

Conventional MRI and MRI-myelography studies were classified as positive when morphological alterations noted correlated with clinical presentations. This study was to analyse the usefulness of MRI myelography of the cervical spine using technique of moderate T2-weighted Three Dimensional Turbo Spin Echo-Fat Sequence pulse sequence in identifying nerve root compression in patients with cervical spondylotic radiculopathy. MRI myelogram detected less nerve root compression 5% but conventional MRI 8%. Clinical findings were significantly associated with imaging findings in both imaging techniques (p<0.001). MRI myelogram overreported 45 and conventional MRI over-reported 80 nerve roots compression when correlated with clinical presentation (p<0.001). There was 50% alteration on conventional MRI when viewed together with MRI myelogram. There was significant difference with nerve root compression and clinical findings between MRI myelogram and conventional MRI (p<0.001). MRI myelogram underestimated the number of nerve roots compressed but it altered the interpretation of conventional MRI in 5% cases when viewed together. The addition of MRI myelogram increased the number of positive nerve roots. MRI myelogram is a useful adjunct to conventional axial and sagittal imaging in the investigation of cervical spondylotic radiculopathy.

The Role of Computed Tomography (CT) Scan in Assessment of the Parametrial Involvement in Early Stage Cervical Carcinoma

This retrospective study is aimed at evaluating the role of CT scan in predicting parametrium involvement in early stage of cervical carcinoma. It was conducted in a Gynaecologic Oncology Centre, Hospital Alor Star from January 2004 till December 2008. All patients with operable stage I and II cervical cancer had pelvic CT scan for evaluation of parametrium involvement before undergoing radical hysterectomy and pelvic lymphadenectomy. Parametrial streakiness or presence of infiltration suggested local invasion. Following radical hysterectomy, the specimens sent for histological confirmation and the correlation between the CT scan finding and the histopathology result was studied. The result revealed a total of 104 patients with operable stage cervical carcinoma had pelvic CT scan. The sensitivity and the specificity of CT scan in assessing parametrial involvement was 33.3% and 84.8%, respectively. In conclusion, CT scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer. Hence, routine preoperative pelvic CT scan has a limited role in assessing parametrial involvement in early stage cervical carcinoma.

Uterine Sex Cord Tumour- Management Dilemma

Uterine sex cord tumour is a very rare tumour with uncertain management strategies and prognosis. A 61-year-old, nulliparous, who was not on hormone replacement therapy, presented with first episode of postmenopausal bleeding. A transvaginal scan revealed an enlarged uterus with thick endometrial lining and features of multiple degenerated fibroid. Endometrial biopsy was negative for malignancy. Computed tomography of the abdomen and pelvis confirmed the mass, with atrophic ovaries and incidental finding of bilateral hydronephrosis requiring stentings. Otherwise, there were no pelvic lymph nodes enlargement. Our impression was a uterine sarcoma and we decided for total abdominal hysterectomy with bilateral salpingooophorectomy. Surprisingly, the histology report confirmed uterine sex cord tumour. There are less cases of recurrence and there is no general consensus on the management. However, we decided for adjuvant chemotherapy (BEP regime) as the malignant cells infiltrated more than half of myometrial thickness, with good outcome.