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@#Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.
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Objective To investigate the effects of Andrographis paniculata (Burm.f.) Wall. Ex Nees (A. paniculata) on expressions and activities of catalase, superoxide dismutase and alkylhydroperoxide reductase C in Staphylococcus aureus (S. aureus) with respect to its survival in vitro. Methods Antioxidative property of methanolic leaves extract of A. paniculata (0.06 mg/mL). Minimum inhibitory concentration (MIC) was determined by its ability to reduce hydrogen peroxide (H
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OBJECTIVE@#To investigate the effects of Andrographis paniculata (Burm.f.) Wall. Ex Nees (A. paniculata) on expressions and activities of catalase, superoxide dismutase and alkylhydroperoxide reductase C in Staphylococcus aureus (S. aureus) with respect to its survival in vitro.@*METHODS@#Antioxidative property of methanolic leaves extract of A. paniculata (0.06 mg/mL). Minimum inhibitory concentration (MIC) was determined by its ability to reduce hydrogen peroxide (HO) toxicity against S. aureus ATCC 25923 [(3.8 × 10) cfu/mL]. Effects of the extract on expressions of katA (encoding catalase), sodA and sodM [encoding superoxide dismutases (SODs)], and ahpC [encoding alkylhydroperoxide reductase C (AhpC)] in S. aureus were determined by RT-qPCR and corresponding enzyme activity assays were performed. Nitroblue tetrazolium reduction (NBT) assay was performed to determine effects of the extract on intracellular and extracellular levels of O in S. aureus.@*RESULTS@#Cells challenged with 7.5 mmol/L HO showed 0% survival in 30 min whereas 25% survived after treatment with the extract and HO. Cells that were treated with the extract alone had 43% survival in the same exposure period. Expressions of sodA and sodM genes in extract-treated cells were lowered 0.8-fold and 0.7-fold, respectively with decrease in total SOD activity of 26.8 U compared to untreated cells, 32.4 U (P < 0.05). In contrast, extract-treated S. aureus cells showed 3.3-fold increase in katA expression with corresponding increase in catalase activity of 1.828 U compared to untreated cells which was 1.248 U, (P < 0.05). More profoundly, ahpC expression was increased 61-fold in extract-treated cells, (P < 0.05) with corresponding increase in AhpC activity of 0.018 U compared to untreated cells, 0.012 U, (P < 0.05). Extract-treated cells had significantly lower intra- and extracellular O levels with absorbance readings (A) of 0.340 and 0.524 compared to untreated cells which were 0.516 and 0.928 (P < 0.05), respectively.@*CONCLUSIONS@#Taken together these results suggest that the low MIC of A. paniculata methanolic leaves extract (0.06 mg/mL) reduce HO toxicity and more importantly, was in itself effectively inhibitory against S. aureus. Further, our observations suggest that a probable mode of its inhibitory mechanism against S. aureus is by reducing total SOD activity through downregulation of sodA and sodM expressions.
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<p><b>OBJECTIVE</b>This study investigated the effects of allylpyrocatechol (APC), the major component in ethanolic extract of Piper betle, on key oxidative stress resistance enzymes important for the survival of Staphylococcus aureus, a major pathogen in the human host.</p><p><b>METHODS</b>Effects of APC on expressions of genes encoding catalase (katA), superoxide dismutases (SODs), including sodA and sodM, and alkyl hydroperoxide reductase (ahpC) in Saureus were quantitated by RT-qPCR in reference to gyrA and 16S rRNA. Corresponding activities of the enzymes were also investigated. The Livak analysis was performed for verification of gene-fold expression data. Effects of APC on intracellular and extracellular reactive oxygen species (ROS) levels were determined using the nitroblue tetrazolium (NBT) reduction assay.</p><p><b>RESULTS</b>APC-treated Saureus cells had higher sodA and sodM transcripts at 1.5-fold and 0.7-fold expressions respectively with corresponding increase in total SOD activity of 12.24 U/mL compared to untreated cells, 10.85 U/mL (P<0.05). Expression of ahpC was highest in APC-treated cells with 5.5-fold increased expression compared to untreated cells (P<0.05). Correspondingly, ahpC activity was higher in APC-treated cells at 0.672 (A) compared to untreated cells which was 0.394 (A). In contrast, katA expression was 1.48-fold and 0.33-fold lower respectively relative to gyrA and 16S rRNA. Further, APC-treated cells showed decreased catalase activity of 1.8 ×10(U/L or μmol/(min·L)) compared to untreated cells, which was 4.8 ×10U/L (P<0.05). Absorbance readings (A) for the NBT reduction assay were 0.709 and 0.695 respectively for untreated and treated cells, which indicated the presence of ROS. APC-treated Saureus cells had lower ROS levels both extracellularly and intracellularly, but larger amounts remained intracellularly compared to extracellular levels with absorbances of 0.457 and 0.137 respectively (P<0.05).</p><p><b>CONCLUSION</b>APC induced expressions of both sodA and sodM, resulting in increased total SOD activity in Saureus. Higher sodA expression indicated stress induced intracellularly involving O, presumably leading to higher intracellular pools of HO. A concommittant decrease in katA expression and catalase activity possibly induced ahpC expression, which was increased the highest in APC-treated cells. Our findings suggest that in the absence of catalase, cells are propelled to seek an alternate pathway involving ahpC to reduce stress invoked by Oand HO. Although APC reduced levels of ROS, significant amounts eluded its antioxidative action and remained intracellularly, which adds to oxidative stress in treated cells.</p>
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Objective: This case report highlights the abuse and dependence potential of Zolpidem and the risk of life-threatening withdrawal symptoms upon abrupt discontinuation. Method: We report a case of Zolpidem dependence which presented with withdrawal symptoms upon abrupt discontinuation. Results: A 32 year old male, who had abused non-benzodiazepine Zolpidem for 6 years presented to the accident and emergency unit with generalized seizures upon stopping Zolpidem ‘cold turkey’. He required admission to the neurology high dependency unit for stabilization of the seizures and was later managed by the addiction team where a tapering dose of benzodiazepine was prescribed. Conclusion: This case demonstrates that non-benzodiazepine agents can cause tolerance and dependence, and thus produce withdrawal symptoms upon discontinuation.
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Objective: This case report highlights the risk of Torsade de Pointes (TdP), a life threatening cardiac arrhythmia in a heroin dependent patient receiving methadone substitution therapy who was prescribed erythromycin for upper respiratory tract infection. Method: We report a case of a 35-year-old Malay man on methadone maintenance treatment who developed TdP possibly due to drug interaction between methadone and erythromycin. Results: The patient reported feeling unwell, chest pain and feeling dizzy after consuming 2 doses of erythromycin. ECG monitoring showed prolonged rate-corrected QT interval leading to TdP. The patient was admitted to the ward where the cardiac arrhythmia ceased following methadone discontinuation. This cardiac arrhythmia was most likely due to drug interaction between methadone and erythromycin (an enzyme inhibitor) which led to an increase in methadone concentration and potentiated the adverse effects. Conclusion: As methadone is a beneficial treatment for heroin dependent patients, the risk of cardiac arrhythmia is of great concern. To avoid complications of drug interaction, patients on methadone therapy should be advised to seek medical assessment before taking other drugs. As TdP is life threatening, it is thus important that physicians and psychiatrists involved in the treatment of heroin dependent patients on methadone substitution therapy be made aware of this risk.
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To evaluate the usefulness and validity of the exercise-induced T wave normalization for prediction and diagnosis of ischemic heart disease and to assess and quantify its correlation to autonomic dysfunction. A cohort study Department of Medicine, Farwania Hospital, Kuwait One hundred and twenty-one patients with history of exertional chest pain with inverted T wave in the resting ECG but without history of myocardial infarction and 67 patients with T wave inversion during exercise test were included in the study. All patients underwent treadmill exercise ECG test and stress thallium scintigraphy in the course of their management. Exercise induced T-wave There was no significant difference between patients from both groups as regards the resting heart rate, the time of the exercise test, peak heart rate, heart rate recovery after exercise and QT dispersion after exercise, [p = NS]. Predictive indices revealed that exercise induced T wave normalization is sensitive but not a specific indicator for prediction of ischemic heart disease, as the sensitivity was 71%, specificity = 49.2%, accuracy = 63.2%, positive predictive value = 74.4% and negative predictive value = 44.8%. A significant relation between age, smoking status, diabetes mellitus status and exercise induced T wave normalization [p < 0.05] was observed. Exercise induced T wave normalization is a sensitive but not specific marker of exercise induced myocardial ischemia and this may be due to autonomic dysfunction with impaired parasympathetic function and unopposed sympathetic action