Association of New Generation Anti-CCP Antibodies with Disease Severity and Functional Status in Rheumatoid Arthritis Patients

@#Introduction: Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies in patients with rheumatoid arthritis (RA) is associated with higher disease activity and lower functional ability. This study investigated the presence of the new generation of anti-CCP antibodies (anti-CCP2 IgG, anti-CCP2 IgA and anti-CCP3.1 IgG/IgA) and their association with disease severity and functional status of RA patients. Methods: A total of 46 RA patients and 40 healthy controls participated in this cross-sectional study that was conducted at the Rheumatology Clinic, Hospital Universiti Sains Malaysia. Blood samples were taken from all participants for anti-CCP2 IgG, anti-CCP2 IgA, and anti-CCP3.1 IgG/IgA analysis. Disease severity and functional status of RA patients were measured using the Disease Activity Score-28 (DAS28) and the modified Health Assessment Questionnaire (mHAQ) respectively. Results: Significantly higher proportion of RA patients were found with positive anti-CCP2 IgG (63.0%), anti-CCP2 IgA (37.0%), and anti-CCP3.1 IgG/IgA antibodies (63.0%) than the healthy controls. No significant association was found between anti-CCP antibodies status and mean DAS28 score of the RA patients. However, RA patients with negative anti-CCP2 IgG status had higher mean mHAQ score than patients with positive anti-CCP2 IgG status. Conclusion: Our study has demonstrated detection of the new generation anti-CCP antibodies in RA patients, supporting the use of autoantibodies in RA diagnosis. While no significant association was found between the presence of anti-CCP antibodies and disease severity of RA patients, the absence of anti-CCP2 IgG was associated with worse function and greater disability of the patients.

Cytogenomic Profiling of Chronic Lymphocytic Leukaemia Patients Using DNA Microarray

@#Introduction: Chronic lymphocytic leukaemia (CLL) is the most frequent adult leukaemia in the Western world. The clinical presentation varies greatly, from very indolent cases to those with aggressive and fast advancing disease. This variation has significant implications for clinical approaches, therapeutic tactics, and, ultimately, survival durations from diagnosis. Acquired chromosomal aberrations play a key role in CLL aetiology. Due to difficulty to obtain abnormal metaphases for analysis, few methods such as fluorescence in-situ hybridization (FISH) and multiplex ligation-dependent probe assay (MLPA) were employed to detect chromosomal aberration however the methods are limited to specific locus only. Thus, this study is aimed to detect the chromosomal aberrations using DNA microarray platform. Methods: In this retrospective study, DNA archive obtained from 7 CLL patients which collected at diagnosis and subjected to Affymetrix CytoScan® 750K single nucleotide polymorphism (SNP) array following the manufacture procedure. The raw data obtained were analysed using the Chromosome Analysis Suite (ChAS) software (Affymetrix) using annotations of genome version GRCh38 (hg38). Result: Out of 7 patients, 4 of them showing deletion of 13q while 3 of them showing deletion of 14q in various region . Some of the deleted loci were too small (0.42-0.6Mb) to be detected by conventional cytogenetic analysis (CCA). There was also the presence of additional chromosomal aberrations that could be missed by CCA, FISH, or MLPA due to cryptic deletion or duplication that was as small as 0.4MB in size. Conclusion: The present study showed that low resolution chromosomal aberration was able to be detected using DNA microarray platform in comparison to CCA, FISH and MLPA.

The Prevalence and Associated Risk Factors of Carpal Tunnel Syndrome among Private Dentists in Klang Valley, Malaysia: A Cross-sectional Study

@#Carpal Tunnel Syndrome (CTS) is a progressive entrapment neuropathy that is commonly associated with dentists. If left untreated, permanent nerve and muscle damage may occur. The purpose of this study is to determine prevalence of CTS among private dentists in Klang Valley, Malaysia and to further identify the associated risk factors for CTS symptoms. In-person interviews of 78 subjects obtained using the convenience sampling method were carried out. The Boston Carpal Tunnel Questionnaire (BCTQ) and clinical tests of Phalen and Tinel were used to examine signs and functional impact of CTS. The overall prevalence of CTS-related symptoms is 37.2%. Using BCTQ alone, 6.4% showed mild CTS symptoms through the level of functional state scoring (FSS) while 10.3% showed mild to moderate symptoms in the scale of the severity of symptoms (SSS). There is a significant correlation between the age of dentists and CTS symptoms (p = 0.007). The prevalence of CTS was more common in older dentists. Increasing age and working hours per week further enhance the risk of CTS. Findings from this study will serve as a useful baseline to establish further study in Klang Valley. Future work should examine the accounts underlying these risk factors for preventive measures.

Therapeutic effects of anthocyanin-rich Hibiscus sabdariffa L. extract on body mass index, lipid profile and fatty liver in obese-hypercholesterolaemic rat model

Background: Hibiscus sabdariffa L. or Roselle, is one of the most common flower plants cultivated worldwide. Traditionally, it is claimed to reduce weight and cholesterol level. The aim of this study was to evaluate the effects of anthocyanin-rich Roselle aqueous extract on the physical, biochemical and histological changes in obese-hypercholesterolaemic rat model.Methods: Thirty Sprague-Dawley male rats were divided into five groups (n=6 per group). Group 1 is normal control (NC) rat that was fed with normal diet. The remaining rats (Group 2-5) were fed with commercial high-fat diet (HFD) for 6 weeks to induce obese-hypercholesterolaemic (OH) rat. After induction, the OH rats were divided into 4 groups: OH-Untreated group, OH-ARTE; OH treated with 300 mg/kg Roselle aqueous (anthocyanin-rich) and 1% trifluoroacetic acid extract (ARTE), OH-Orlistat; OH treated with 37 mg/kg orlistat and OH-Atorvastatin; OH treated with 10 mg/kg atorvastatin. After the 3 weeks intervention period, all rats were sacrificed. Body mass index, lipid profile and liver enzymes were evaluated. The liver section was subjected to hematoxylin and eosin staining for histopathological evaluation.Results: This study showed that 3 weeks administration of ARTE significantly reduced BMI, improved levels of lipid profile and liver enzymes, and histopathological changes of liver when compared to OH-untreated rats. The results were also comparable to the standard drugs.Conclusions: This study suggested that Roselle extract constitutes an effective and safe alternate treatment for obesity and hyperlipidaemia.

Differential expression of circulating miRNAs in Parkinson’s disease patients: Potential early biomarker?

@#Background & Objective: Circulating microRNAs (miRNAs) expressions have been suggested as potential biomarkers for Parkinson’s Disease (PD). Identification of early biomarkers for PD is important and crucial as PD symptoms occur at a late stage. Hence, these biomarkers could be used in molecular diagnosis for early detection. We therefore examined and compared the expression of circulating miRNAs between PD patients and controls. We also compared the miRNAs expression between early-onset PD (EOPD) and late-onset PD (LOPD). Methods: RNA was extracted from the plasma of EOPD (onset age <50 years; n=14), LOPD (onset age < 60 years; n=14) and healthy controls (n=11). The miRNAs expression was determined using the Affymetrix GeneChip microarray. Differential analysis was performed using the R software. Significantly differentiated miRNAs were subsequently analyzed for functional enrichment and biological pathway using the FunRich v1.3 software based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. The Omics.net was used to determine the predicted target mRNAs of these miRNAs, and their interactions, based on the five most differentially expressed miRNAs. Results: In total, 273 miRNAs were upregulated in PD patients compared to controls. The most significant miRNAs were hsa-miR-301a-3p, 100-5p, 140-5p, 486-3p, 143-3p (fold change ranging from 11.2 – 32.0). A total of 140 circulating miRNAs were differentially expressed in EOPD compared to LOPD. Five of these miRNAs (one upregulated miRNA (hsa-miR-29b-3p) and four downregulated miRNAs (hsa-miR-297, 4462, 1909-5p and 346) belonged exclusively to the EOPD patients. The predicted gene targets of these miRNAs involved in dopaminergic synapse regulation, crucial to the pathogenesis of PD. Conclusion: Circulating miRNAs differ between PD patients and controls, and between EOPD and LOPD patients. A validation study with a larger and more diverse multi-ethnic population should be conducted to confirm our results.

Insecticide susceptibility status and resistance mechanism of Anopheles cracens Sallum and Peyton and Anopheles maculatus Theobald (Family: Culicidae) from knowlesi malaria endemic areas in Peninsular Malaysia

Objective: To assess the insecticide susceptibility status of Anopheles cracens (An. cracens) and Anopheles maculatus (An. maculatus) from knowlesi malaria endemic areas in Peninsular Malaysia towards DDT, malathion and deltamethrin and to determine the resistance mechanism involved. Methods: Adult and larval mosquitos were collected for surveillance. Susceptibility status of Anopheles was determined using the standard WHO adult bioassay, larval bioassay and biochemical enzyme assay. Results: WHO adult bioassay results indicated An. cracens collected from Kampung Sungai Ular, Pahang was resistant towards 4% DDT, while An. maculatus collected from Kampung Sokor, Kelantan and Kampung Sungai Lui, Selangor exhibited resistance towards 4% DDT. However, the enzyme activity profiles varied according to strains and species. The resistance ratio of larval bioassay, showed that all strains and species tested were susceptible to malathion and temephos. Conclusions: Since only a few anopheline strains exhibited low level of insecticide resistance towards malathion, DDT and temephos. These insecticides are still considered effective for vector control program towards An. cracens and An. maculatus.

Auditory Localization Performances in Subjects with Simulated Unilateral Conductive Hearing Loss

No abstract available.

Motivating Factors and Potential Deterrents for Blood Donation among Young Blood Donors in Kelantan, Malaysia

Abstract@# Introduction: Recruitment of potential blood donors from a younger age group is a good effort because they would be in good health and may have a long journey in blood donation. This study evaluated the motivating and deterring factors for donating blood among blood donors, who are students pursuing higher education. Methods: This was a cross-sectional study using a set of questionnaires, involving 391 students in Kota Bharu, Kelantan, Malaysia. The research tool was adapted and modified, as well as validated and pilot-tested to ensure its validity and reliability. Data were analysed using the SPSS and Stata software. Results: The most highly rated motivating factor for donating blood was to help others and to create a good practice (98%). The motivating factor of being interested in a blood donation campaign was highly rated by female respondents (87%) compared to male respondents (79.1%). The most highly rated deterring factor was the dislike for skipping a class to donate blood (30.9%), which was highly rated as a positive response by female blood donors (35.1%). There was a significant difference between the motivating factors (p = 0.043) and the deterring factors (p = 0.011), as seen between gender. Items that have the logo of the blood donation centre, such as T-shirts, towels, mugs or bags are rated as the most attractive incentive (87%). Conclusion: Altruism was the main reason for young blood donors choosing to donate blood. Social media usage should be considered when promoting blood donation campaigns to this age group.

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.

Anti-Cyclic Citrullinated Peptide Antibody and Periodontal Status in Rheumatoid Arthritis Patients

Objectives: Studies have shown that periodontal disease and Rheumatoid Arthritis [RA] shared similar pathogenesis. Anti-Cyclic Citrullinated Peptide anibodies [anti-CCP] has recently been used for diagnosis of RA. Thus, this study aimed to assess the levels of anti-CCP antibodies and periodontal status in RA patients

Methods: Forty four RA patients were included in this study. The blood samples were analysed for anti-CCP levels. Plaque Score [PS], Gingivitis Score [GS], Probing Pocket Depth [PPD] and Clinical Attachment Loss [CAL] were recorded for assessment of periodontal status. Relevant clinical information was obtained from medical records

Results: Mean anti-CCP level was 180.8 +/- 290.3 Unit/ml. The results showed that 27.3% patients had poor oral hygiene [PS >60%; mean anti-CCP 84.22 +/- 167.51 Unit/ml], 52.3% had generalized gingivitis [mean anti-CCP 145.07 +/- 269.17 Unit/ml], and 20.5% had mean CAL of >3mm [mean anti-CCP 56.81 +/- 119.02 Unit/ml]. None of patients presented with deep PPD > 4mm. The levels of anti-CCP showed no significant association with periodontal status [p=0.27]

Conclusion: Most RA patients were positive for anti-CCP antibodies and presented with generalized gingivitis. Oral hygiene education should be reinforced in RA patients to prevent further progression of periodontal disease. Nevertheless, studies with larger sample size should be carried out to obtain more conclusive findings

Awareness of Glycosylated Haemoglobin (HbA1c) Among Type 2 Diabetes Mellitus Patients in Hospital Putrajaya

The glycosylated haemoglobin (HbA1c) test is the most widely accepted laboratory test for evaluating long term glycaemic control. Patient’s understanding of HbA1c can lead to better glycaemic control. This study is aimed to determine the awareness and level of understanding of HbA1c among type 2 DM patients and its association with glycaemic control. A cross-sectional descriptive study among Type 2 DM patients undergoing routine follow up in an endocrine clinic of a tertiary centre in Malaysia. Patients were invited to answer a validated questionnaire which assessed their awareness and understanding of HbA1c. Their last HbA1c results were retrieved from the laboratory information system. A total of 92 participants were recruited. Fifty-six (60.9%) were aware of the term HbA1c. Fifty percent were categorised as having good HbA1c understanding, with age, monthly income and level of education being the factors associated with understanding. No significant association was noted between HbA1c understanding and glycaemic control, although more patients with good HbA1c understanding had achieved the target glycaemic control compared to those with poor understanding. The level of HbA1c awareness and understanding was acceptable. Factors associated with understanding were age, income and level of education. Continuing efforts however, must be made to improve patients understanding of their disease and clinical disease biomarkers.

Cognitive Profiles in Parkinson’s Disease and their Correlation with Dementia, Anxiety and Depression: A Preliminary Study

A cross-sectional study was carried out at a medical centre to determine the cognitive profiles of 30 Parkinson’s disease patients with age of 69.76 ± 7.39 years. Thirty-seven percent of the patients were found to be at risk for dementia. The scores on subscales of working memory and alternating verbal fluency were significantly lower in Parkinson’s disease patients who were older than 77 years old. The scores on a subtest of working memory on the Parkinson’s Disease Cognitive Rating Scale (PDCRS) were significantly lower in Parkinson’s disease patients with a duration of illness of more than 10 years. In cognitive measurement, the subtests of verbal memory, delayed free recall and verbal fluency on the PD¬CRS were significantly lower in patients with less than six years of education. The patients who had difficulty with sustained attention, working memory and movement had significant anxiety and depression symptoms. In conclusion, multiple patterns in cognitive profiles influence the quality of life of patients with Parkinson’s disease in multi-dimensional ways.

Hypertension and its association with the severity of chronic periodontitis: a preliminary study

Chronic periodontitis (CP) is an inflammatory disease of the supporting tissues of the teeth caused by specific microorganism. Hypertension is one of the major causes of cardiovascular disease whereas periodontitis has recently drawn increasing attention because of its potential relationship with cardiovascular disease. The objectives of this study were to determine the prevalence of the hypertension in CP patients as well as to evaluate the association between hypertension and severity of CP. One hundred and eighty five records of CP patients treated in Dental Clinic, Universiti Sains Malaysia Hospital (USM Hospital), Kelantan from 2010 until 2013 were retrieved and reviewed. The diagnosis of periodontal disease and the presence of hypertension were recorded. The severity of chronic periodontitis was classified into mild, moderate and severe according to the clinical attachment loss. The data was obtained and analyzed using SPSS version 20.0. Majority of the subjects were from Malay ethnic group (94.4%) at the age range between 41 and 61 years (67.8%). In conclusion, the prevalence of hypertension in chronic periodontitis patients was 12.2%. There was no significant association between hypertension and severity of CP (p=0.229).

Supplementation of eurycoma longifolia jack extract for 6 weeks does not affect urinary testosterone: epitestosterone ratio, liver and renal functions in male recreational athletes

Eurycoma longifolia Jack [ElJ] has been shown to elevate serum testosterone and increased muscle strength in humans. This study investigated the effects of Physta a standardized water extract of ElJ [400 mg/day for 6 weeks] on testosterone: epitestosterone [T:E] ratio, liver and renal functions in male recreational athletes. A total of 13 healthy male recreational athletes were recruited in this double blind, placebo-controlled, cross-over study. The participants were required to consume either 400 mg of ElJ or placebo daily for 6 weeks in the first supplementation regimen. Following a 3 week wash-out period, the participants were requested to consume the other supplement for another 6 weeks. Mid-stream urine samples and blood samples were collected prior to and after 6 weeks of supplementation with either ElJ or placebo. The urine samples were subsequently analyzed for T:E ratio while the blood samples were analyzed for liver and renal functions. T:E ratio was not significantly different following 6 weeks supplementation of either ElJ or placebo compared with their respective baseline values. Similarly, there were no significant changes in both the liver and renal functions tests following the supplementation of ElJ. Supplementation of ElJ i.e. Physta at a dosage of 400 mg/day for 6 weeks did not affect the urinary T:E ratio and hence will not breach any doping policies of the International Olympic Committee for administration of exogenous testosterone or its precursor. In addition, the supplementation of ElJ at this dosage and duration was safe as it did adversely affect the liver and renal functions

Type 2 diabetes mellitus patients with poor glycaemic control have lower quality of life scores as measured by the Short Form-36

<p><b>INTRODUCTION</b>This study aimed to compare the quality of life based on the Short Form-36 (SF-36) between two different groups of type 2 diabetes mellitus patients with glycaemic control: those with a glycosylated haemoglobin (HbA1c) level at or below 7.5 percent and those above 7.5 percent.</p><p><b>METHODS</b>In this cross-sectional study, a generic SF-36 questionnaire was self-administered to patients with type 2 diabetes mellitus. Based on the HbA1c level, the mean SF-36 scale scores were compared. The analysis of covariance was used to obtain the adjusted mean scores of the SF-36 scales while controlling for age and duration of type 2 diabetes mellitus.</p><p><b>RESULTS</b>150 patients with type 2 diabetes mellitus were analysed. There were 63 (42 percent) women and 87 (58 percent) men, and their mean HbA1c level was 8.9 percent (SD 2.4 percent). When comparing the two groups of patients with different HbA1c levels, the adjusted means of four scales: physical health functioning, general health, social functioning and mental health, differed significantly between the two. The SF-36 scale scores in type 2 diabetes mellitus patients were also lower than those of the SF-36 norms for the Malaysian population.</p><p><b>CONCLUSION</b>Type 2 diabetes mellitus patients with poor glycaemic control had lower mean SF-36 scores in physical functioning, general health, social functioning and mental health, and the SF-36 scores in these patients were also lower than the SF-36 norms of the Malaysian population.</p>

The reliability and validity of the Malay version of the 18-item audit of Diabetes Dependent Quality of Life (the Malay ADDQOL) questionnaire.

The objective of this study was to examine the reliability and validity of the Malay version of the 18-item Audit of Diabetes Dependent Quality of Life (the Malay ADDQOL). Patients with type 2 diabetes mellitus who fulfilled the inclusion criteria were systematically selected. The Malay ADDQOL linguistically validated from the 18-item English version ADDQOL was self-administered twice at a 1-week interval. Two hundred eighty-eight respondents were included in the study. Analysis involved checking the feasibility, floor and ceiling effects, internal consistency, test-retest reliability and factor analysis. Item means and standard deviations fulfilled the Likert scale assumptions. The Cronbach's alpha was 0.943 (lower bound of the 95% CI of 0.935) and the intraclass correlation coefficient was 0.81 (95% CI from 0.72 to 0.87). Exploratory one factor analysis showed factor loadings above 0.5 for all the 18 items. The Malay ADDQOL has acceptable linguistic validity. It is feasible, has excellent reliability, content, construct validity, and is recommended to be used among Malay-speaking diabetic patients.