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1.  Multiple Sclerosis in Malaysia: Demographics, Clinical Features, and Neuroimaging Characteristics 
Background. Multiple sclerosis (MS) is an uncommon disease in multiracial Malaysia. Diagnosing patients with idiopathic inflammatory demyelinating diseases has been greatly aided by the evolution in diagnostic criterion, the identification of new biomarkers, and improved accessibility to neuroimaging in the country. Objectives. To investigate the spectrum of multiple sclerosis in Malaysia. Methods. Retrospective analysis with longitudinal follow-up of patients referred to a single tertiary medical center with neurology services in Malaysia. Results. Out of 245 patients with idiopathic inflammatory demyelinating disease, 104 patients had multiple sclerosis. Female to male ratio was 5 : 1. Mean age at onset was 28.6 ± 9.9 years. The Malays were the predominant racial group affected followed by the Chinese, Indians, and other indigenous groups. Subgroup analysis revealed more Chinese having neuromyelitis optica and its spectrum disorders rather than multiple sclerosis. Positive family history was reported in 5%. Optic neuritis and myelitis were the commonest presentations at onset of disease, and relapsing remitting course was the commonest disease pattern observed. Oligoclonal band positivity was 57.6%. At disease onset, 61.5% and 66.4% fulfilled the 2005 and 2010 McDonald's criteria for dissemination in space. Mean cord lesion length was 1.86 ± 1.65 vertebral segments in the relapsing remitting group as opposed to 6.25 ± 5.18 vertebral segments in patients with neuromyelitis optica and its spectrum disorders. Conclusion. The spectrum of multiple sclerosis in Malaysia has changed over the years. Further advancement in diagnostic criteria will no doubt continue to contribute to the evolution of this disease here.
PMCID: PMC3888747  PMID: 24455266
2.  Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome 
Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
PMCID: PMC3957351  PMID: 24643401
necrotizing fasciitis; Lemierre syndrome; Fusobacterium necrophorum; Klebsiella pneumoniae
3.  Mesenchymal Chondrosarcoma: A Case Report 
Mesenchymal chondrosarcoma is a rare disease with poor prognosis. Treatment including wide or radical excision is very important. Radiotherapy and chemotherapy are additional treatment options, but no conclusive results for their efficacy have been shown until date. Imaging modalities can give important clues for diagnosis and management planning. Angioembolization before surgery could be useful as prophylaxis to control intraoperative bleeding, increasing the likelihood of complete resection.
PMCID: PMC3743986  PMID: 23966829
mesenchymal chondrosarcoma; extraskeletal; therapeutic embolization
4.  Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications 
To report our early experience in image-guided chemoport insertions by interventional radiologists.
Materials and Methods:
This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy.
The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit.
Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.
PMCID: PMC3777320  PMID: 24082475
Central venous catheterization; complications; interventional radiology; vascular access ports
5.  Percutaneous Catheter-Based Rheolytic Thrombectomy for Massive Pulmonary Embolism: A Case Report 
Pulmonary thromboembolism is a life-threatening cardiovascular condition. The mortality rate is high in its current management. Besides supportive treatments, systemic thrombolysis and surgical thrombectomy play important roles in the comprehensive management of pulmonary embolism (PE). The percutaneous catheter-based rheolytic thrombectomy is a promising alternative for management of massive pulmonary emboli, particularly, when patients have contraindication with systemic thrombolysis or are not suitable for surgery.
We present the case of a 36-year-old Somalian man who came to our center for a total knee replacement (TKR). Three days after TKR, he developed sudden shortness of breath and decreased oxygen saturation. Computed tomography of pulmonary arteriogram showed extensive thrombi within the main pulmonary trunk, right and left pulmonary arteries, bilateral ascending and bilateral descending pulmonary arteries in keeping with massive PE. Because the patient was contraindicated for systemic thrombolysis, percutaneous, catheter-based rheolytic thrombectomy was chosen as the alternative treatment. His clinical symptoms improved immediately post-treatment. In conclusion, catheter-based rheolytic thrombectomy can serve as an alternative treatment for massive PE with a good clinical outcome.
PMCID: PMC3744003  PMID: 23983581
thrombectomy; thrombolysis; pulmonary embolism
6.  In Situ Identification of CD44+/CD24− Cancer Cells in Primary Human Breast Carcinomas 
PLoS ONE  2012;7(9):e43110.
Breast cancer cells with the CD44+/CD24− phenotype have been reported to be tumourigenic due to their enhanced capacity for cancer development and their self-renewal potential. The identification of human tumourigenic breast cancer cells in surgical samples has recently received increased attention due to the implications for prognosis and treatment, although limitations exist in the interpretation of these studies. To better identify the CD44+/CD24− cells in routine surgical specimens, 56 primary breast carcinoma cases were analysed by immunofluorescence and confocal microscopy, and the results were compared using flow cytometry analysis to correlate the amount and distribution of the CD44+/CD24− population with clinicopathological features. Using these methods, we showed that the breast carcinoma cells displayed four distinct sub-populations based on the expression pattern of CD44 and CD24. The CD44+/CD24− cells were found in 91% of breast tumours and constituted an average of 6.12% (range, 0.11%–21.23%) of the tumour. A strong correlation was found between the percentage of CD44+/CD24− cells in primary tumours and distant metastasis development (p = 0.0001); in addition, there was an inverse significant association with ER and PGR status (p = 0.002 and p = 0.001, respectively). No relationship was evident with tumour size (T) and regional lymph node (N) status, differentiation grade, proliferative index or HER2 status. In a multivariate analysis, the percentage of CD44+/CD24− cancer cells was an independent factor related to metastasis development (p = 0.004). Our results indicate that confocal analysis of fluorescence-labelled breast cancer samples obtained at surgery is a reliable method to identify the CD44+/CD24− tumourigenic cell population, allowing for the stratification of breast cancer patients into two groups with substantially different relapse rates on the basis of CD44+/CD24− cell percentage.
PMCID: PMC3441535  PMID: 23028444
7.  Breast milk expression among formally employed women in urban and rural Malaysia: A qualitative study 
Many women are unable to practice exclusive breastfeeding because they are separated from their infants while working. Expressing their breast milk helps them to continue breastfeeding. This study explores the perception and experiences related to the feasibility, acceptability and safety of breast milk expression among formally employed women in Kelantan, Malaysia.
A qualitative method using in-depth interviews was conducted from December 2008 to December 2009 among Malay women from urban and rural areas. A snowball sampling method was used to recruit the informants, and the interviews, which were facilitated by an interview guide, were audio-recorded and transcribed verbatim. Thematic analysis was conducted, with construction of codes and themes from each interview.
Analysis of the interviews with 20 informants identified three themes related to breast milk expression. The themes were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressed breast milk. The informants who did not practice exclusive breastfeeding believed that expressing their breast milk was not feasible, commonly because they felt there were not enough facilities for them. They also had negative feelings such as embarrassment. The safety and hygiene of the expressed breast milk was also their main concern.
More practical and focused education, as well as provision of facilities, is needed for women to effectively and safely express and store their breast milk. The issue of inadequate milk production should be emphasized, especially by encouraging them to express their breast milk as a way to improve milk production.
PMCID: PMC3453522  PMID: 22929649
Breast milk expression; Pumping; Exclusive breastfeeding; Employed; In-depth interview
8.  Fatal mediastinal biopsy: How interventional radiology saves the day 
Annals of Thoracic Medicine  2012;7(2):107-109.
This was a case of a 35-year-old man with mediastinal mass requiring computed tomography (CT)-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA (n-Butyl cyanoacrylate) was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome.
PMCID: PMC3339201  PMID: 22558017
Biopsy; complications; computed tomography; guidance; mediastinum; therapeutic embolization
9.  Prevalence and Risk Factors of Intestinal Helminth Infection Among Rural Malay Children 
Soil-transmitted intestinal helminth infection is prevalent in rural communities of Malaysia. Risk factors contributing to helminth infections are largely unknown in the country.
To determine the prevalence and risk factors of intestinal helminth infections among children in Beris Lalang, a rural Muslim community of Malaysia.
Settings and Design
In this cross-sectional study, children aged 7-9 years were recruited during the mass Friday prayer at Beris Lalang mosque by trained imams (religious leaders). A standardized questionnaire was used to obtain information on socio-demographic profile, daily hygienic practices, and history of helminth infection.
Out of 79 samples, 29 (37%) were positive for helminthic ova, of which 24 were ova of Trichuris trichiura. Poor education of the mother (primary education or less) (P=0.015), eating raw salad (P=0.03), and no physical activities (P=0.03) were found independent risk factors for the child's helminth infections in univariate analysis. A higher proportion of children with helminth infections complained of tiredness and fatigue compared to those without such infections (36% vs. 12%, P=0.019). In a multivariate analysis of predictors of helminth infection, poor education of the mother (P=0.02) and eating raw salad (P=0.04) remained statistically significant, after controlling for several other potential risk factors.
T. trichiura was the most prevalent intestinal helminth infection in children in rural Malaysia. Risk factors of helminth infection included mother's poor education and eating raw salad and vegetables.
PMCID: PMC3326951  PMID: 22529621
Children; Intestinal helminth; Malaysia; Prevalence; Risk factors
10.  The Prevalence of Metabolic Syndrome According to Various Definitions and Hypertriglyceridemic-Waist in Malaysian Adults 
Metabolic syndrome can be diagnosed according to several different criteria such as the latest International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Program III (NCEP ATPIII), and World Health Organization (WHO). The objectives of this study were to determine the prevalence of metabolic syndrome and the concordance between the above mentioned definition, and hypertriglyceridemic-waist criteria.
This cross sectional study was done in Bachok, Malaysia and involved 298 respondents aged between 18 to 70 years. Multistage random sampling method was used to identify study locations while convenient random sampling method was applied to select individuals. Hypertriglyceridemic waist was defined from an internationally acceptable cut-off criterion. Kappa statistic (κ test) was used to determine the concordance between various definitions and hypertriglyceridemic-waist.
The prevalence of metabolic syndrome based on different definitions was 32.2% (IDF), 28.5% (NCEP ATP III) and 12.4% (modified WHO). The prevalence of hypertriglyceridemic-waist was 19.7% and based on the IDF criteria a total of 97.5% participants with hypertriglyceridemic-waist had metabolic syndrome. The IDF criteria showed the highest concordance with NCEP ATPIII criteria (κ = 0.63), followed by hypertriglyceridemic-waist criteria (κ = 0.62) and WHO criteria (κ = 0.26).
The prevalence of metabolic syndrome was highest using the IDF criteria compared to NCEP ATPIII, modified WHO and hypertriglyceridemic-waist. There was a good concordance of IDF criteria with NCEP ATP III and hypertriglyceridemic-waist criteria.
PMCID: PMC3237265  PMID: 22174962
Hypertriglyceridemic-waist; Metabolic syndrome; Malaysia
11.  The Vanishing Veins: Difficult Venous Access in a Patient Requiring Translumbar, Transhepatic, and Transcollateral Central Catheter Insertion 
Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.
PMCID: PMC3328940  PMID: 22589680
central nervous system neoplasms; child; oncology; recurrence; rhabdoid tumour; teratoma
12.  Y-Stent–Assisted Coil Embolisation of Wide-Necked Aneurysms Using a New Fully Retrievable and Detachable Intracranial Stent: Report of Two Cases 
Endovascular treatment of wide-necked aneurysms poses a challenge for the endovascular therapist. The Y-stent–assisted technique has been used for stent-assisted coil embolisation for wide-necked bifurcation aneurysms. This technique has been described for basilar tip aneurysms and middle cerebral artery bifurcation aneurysms using Neuroform and Enterprise stents. We report 2 cases of wide-necked bifurcation aneurysms that were treated with Y-stent–assisted coil embolisation using a new, fully retrievable and detachable intracranial stent (Solitaire AB™). We describe the advantages of a fully retrievable and detachable stent and its feasibility of forming a Y configuration.
PMCID: PMC3328942  PMID: 22589679
endovascular techniques; intracranial aneurysm; neurosurgery; stents; therapeutic embolisation
13.  DUSPs strike again 
Cell Cycle  2011;10(17):2827-2835.
PMCID: PMC3233488  PMID: 21869596
14.  Follice-Stimulating Hormone Receptor Forms Oligomers and Shows Evidence of Carboxyl-Terminal Proteolytic Processing 
Endocrinology  2007;148(5):1987-1995.
FSH receptor (FSHR), a member of the G protein-coupled receptor superfamily, is present in the plasma membrane of ovarian granulosa cells and testicular Sertoli cells. FSH regulates normal ovarian follicle development and spermatogenesis through FSHR. The extracellular domain of FSHR is a weakly associated homodimer in the recently solved crystal structure of FSH in complex with the extracellular domain of FSHR. However, there is currently no biochemical data that demonstrate that FSHR exists as a dimer or higher-order oligomer in cell membranes. A fluorescence resonance energy transfer assay was used to determine whether full-length native FSHR is an oligomer. FSHR-specific monoclonal antibody or Fab fragments, labeled with two different fluorophores, allowed the study of nontagged receptor in situ. Unoccupied FSHR exhibited strong fluorescence resonance energy transfer profiles in situ. Complementary coimmunoprecipitation experiments of myc- or FLAG-tagged FSHR indicated that FSHR forms oligomers early in receptor biosynthesis. No effect of FSH treatment was observed. Thus, immature forms of FSHR, not yet fully processed, were observed to coimmuno-precipitate. An unexpected observation was made that the C-terminal epitope tags are removed from FSHR before arrival at the cell surface. These results provide the first evidence for oligomers of full-length FSHR in situ and for C-terminal proteolytic processing of FSHR and that both events take place during biosynthesis. This may explain how heterozygous mutations in the FSHR gene that affect receptor trafficking may be ameliorated by oligomer formation.
PMCID: PMC3113408  PMID: 17272391
15.  Receptor Activator of NF-kB (RANK) Expression in Primary Tumors Associates with Bone Metastasis Occurrence in Breast Cancer Patients 
PLoS ONE  2011;6(4):e19234.
Receptor activator of NFkB (RANK), its ligand (RANKL) and the decoy receptor of RANKL (osteoprotegerin, OPG) play a pivotal role in bone remodeling by regulating osteoclasts formation and activity. RANKL stimulates migration of RANK-expressing tumor cells in vitro, conversely inhibited by OPG.
Materials and Methods
We examined mRNA expression levels of RANKL/RANK/OPG in a publicly available microarray dataset of 295 primary breast cancer patients. We next analyzed RANK expression by immunohistochemistry in an independent series of 93 primary breast cancer specimens and investigated a possible association with clinicopathological parameters, bone recurrence and survival.
Microarray analysis showed that lower RANK and high OPG mRNA levels correlate with longer overall survival (P = 0.0078 and 0.0335, respectively) and disease-free survival (P = 0.059 and 0.0402, respectively). Immunohistochemical analysis of RANK showed a positive correlation with the development of bone metastases (P = 0.023) and a shorter skeletal disease-free survival (SDFS, P = 0.037). Specifically, univariate analysis of survival showed that “RANK-negative” and “RANK-positive” patients had a SDFS of 105.7 months (95% CI: 73.9–124.4) and 58.9 months (95% CI: 34.7–68.5), respectively. RANK protein expression was also associated with accelerated bone metastasis formation in a multivariate analysis (P = 0.029).
This is the first demonstration of the role of RANK expression in primary tumors as a predictive marker of bone metastasis occurrence and SDFS in a large population of breast cancer patients.
PMCID: PMC3084800  PMID: 21559440
16.  Human equilibrative nucleoside transporter 1 and carcinoma of the ampulla of Vater: expression differences in tumour histotypes 
The human equilibrative nucleoside transporter 1 (hENT1) is the major means by which gemcitabine enters human cells; recent evidence exists that hENT1 is expressed in carcinoma of the ampulla of Vater and that it should be considered as a molecular prognostic marker for patients with resected ampullary cancer. Aim of the present study is to evaluate the variations of hENT1 expression in ampullary carcinomas and to correlate such variations with histological subtypes and clinicopathological parameters. Forty-one ampullary carcinomas were histologically classified into intestinal, pancreaticobiliary and unusual types. hENT1 and Ki67 expression were evaluated by immunohistochemistry, and apoptotic cells were identified by the terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate biotin nick end labelling (TUNEL) method. hENT1 overexpression was detected in 63.4% ampullary carcinomas. A significant difference in terms of hENT1 and Ki67 expression was found between intestinal vs. pancreaticobiliary types (P=0.03 and P=0.009 respectively). Moreover, a significant statistical positive correlation was found between apoptotic and proliferative Index (P=0.036), while no significant correlation was found between hENT1 and apoptosis. Our results on hENT1 expression suggest that classification of ampullary carcinoma by morphological subtypes may represent an additional tool in prospective clinical trials aimed at examining treatment efficacy; in addition, data obtained from Ki67 and TUNEL suggest a key role of hENT1 in tumour growth of ampullary carcinoma.
PMCID: PMC3167316  PMID: 20839414
human equilibrative nucleoside transporter 1; histotypes; vater ampulla; cancer; immunohistochemistry.
17.  Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis 
Massive haemoptysis is the most dreaded of all respiratory emergencies. Bronchial artery embolisation is known to be a safe and effective procedure in massive haemoptysis. Bronchial artery of anomalous origin presents a diagnostic challenge to interventional radiologists searching for the source of haemorrhage. Here, we report a case of massive haemoptysis secondary to a lung carcinoma with the bronchial artery originating directly from the right subclavian artery. This artery was not evident during the initial flush thoracic aortogram. The anomalous-origin bronchial artery was then embolised using 15% diluted glue with good results. An anomalous-origin bronchial artery should be suspected if the source of haemorrhage is not visualised in the normally expected bronchial artery location.
PMCID: PMC3216163  PMID: 22135550
bronchial arteries; glues; haemoptysis; therapeutic embolisation; medical sciences
18.  Reversible splenial lesion syndrome in neuroleptic malignant syndrome 
Reversible focal lesions in the splenium of the corpus callosum (SCC) or reversible splenial lesion syndrome are rare and little is known about their pathophysiology.
Case summary
The authors describe a case of a 65-year-old female who presented with fever, abnormal behaviour and mild hypernatremia. She was on neuropsychiatric treatment for bipolar disorder but denied any history of seizure. After an extensive workout to exclude infection, a clinical diagnosis of neuroleptic malignant syndrome (NMS) was made. Initial magnetic resonance imaging (MRI) of the brain showed a lesion in the SCC characterized by high-signal intensity on T2-weighted and FLAIR sequences with reduced signal intensity on T1-weighted sequence. Diffuse weighted imaging (DWI) showed restricted diffusion. There was no enhancement following Gadolinium administration. The follow-up MRI 8 weeks later showed complete resolution of the SCC lesion.
While the pathophysiology of reversible SCC lesions is still unclear, this case highlights the need to consider NMS in the differential diagnosis of reversible splenial lesion of the corpus callosum.
PMCID: PMC3097717  PMID: 21610992
corpus callosum; reversible splenial; neuroleptic malignant syndrome
19.  Superselective Embolisation in Acute Lower Gastrointestinal Haemorrhage: A Single Institution Experience 
Superselective embolisation has been recognised as integral in the management of lower gastrointestinal haemorrhage. It has also reduced the need for emergency surgery. The objective of this case series was to describe the lower gastrointestinal haemorrhage cases seen in our centre, its diagnosis and the role of superselective embolisation in patient management.
All patients who underwent superselective embolisation from January 2008 until April 2009 in our centre were analysed. Data were collected from the hospital electronic medical records.
Four patients (three males) with a mean age of 81 years were analysed. Multidetector computerised tomography and digital subtraction angiography were positive in all patients. Superselective embolisation with platinum microcoils was performed in all patients (n = 4). Technical success was achieved in all patients (100%).
Superselective embolisation in the treatment of lower gastrointestinal haemorrhage is safe and effective with a very high technical success rate.
PMCID: PMC3216130  PMID: 22135510
gastrointestinal haemorrhage; therapeutic embolisation; spiral computerised tomography; medical sciences
20.  Body Mass Index and Body Fat Status of Men Involved in Sports, Exercise, and Sedentary Activites 
A cross-sectional study was carried out in Kota Bharu on three groups of men with ages ranging from 18 to 44 years. The study groups included 83 athletes representing various types of sports and levels of participation (athlete group), 80 active men who exercised a minimum of 30 minutes per day at least 3 times per week (exercise group), and 80 inactive men (sedentary group). The objectives of the study were to compare the body mass indices (BMIs) and body fat statuses among the three groups with different physical activity levels. The height and weight of respondents were measured using the Seca weighing balance with height attachment. Skinfold thickness of biceps, triceps, subscapular regions, and suprailiac regions of each respondent were measured using Harpenden skinfold calipers. Percentage body fat was calculated as the sum of the four measurements of skinfold thickness. The results showed that the mean (± SD) BMIs in the athlete, exercise, and sedentary groups were 22.6 ± 2.9, 23.4 ± 3.5, and 24.3 ± 4.6 kg/m2, respectively. The combined prevalence of pre-obese (BMI 25.029.9) and obese (BMI ³ 30.0) subjects was 21.7% in the athlete group, 29.9% in the exercise group, and 47.5% in the sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower than in the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities, have lower BMIs and percentage body fat values compared to sedentary people. Therefore, to prevent obesity, all individuals are encouraged to perform regular physical activity, particularly sports activities.
PMCID: PMC3336165  PMID: 22589654
body fat; body mass index; obesity; physical activity; medical sciences
21.  Scalp Arteriovenous Malformation : A Case Report 
We report a rare case of Arteriovenous malformation (AVM) of the scalp in a 30 year-old Malay gentleman who presented with painless forehead swelling since birth. Magnetic Resonance Imaging (MRI) and cerebral angiogram performed and the findings are discussed.
PMCID: PMC3341908  PMID: 22570590
Scalp Arteriovenous Malformations; Subcutaneous Arteriovenous malformations; Radiological features
22.  Gender Difference in Safe and Unsafe Practice of Pesticide Handling in Tobacco Farmers of Malaysia 
To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice of personal attire tend to result in lower scores on use of personal protective equipment and personal protective clothing while personal hygiene practices result in lower score on safe work habit; and, (2) for male tobacco farmers, the lower scores on reading and following instruction on pesticide label and mixing pesticide and maintenance of pesticide sprayer in good condition suggests that they were not primarily involved in these activities. It is postulated that these differences in safe and unsafe practices of pesticide handling across gender is related to the choice of personal attire, personal hygiene practices and division of labour within farming households which in turn is influenced by prevailing sociocultural norms in the community.
PMCID: PMC3433957  PMID: 22973149
Gender difference; Safe and unsafe practice of pesticide handling; Tobacco farmers; Malaysia
23.  Biventricular Central Neurocytoma 
A case of biventricular neurocytoma is reported. A 36 year old Malay lady presented with headache of 8 months duration. Physical examination revealed signs of increase intracranial pressure. CT-scan and MRI showed tumour in both lateral ventricles. Patient underwent tumour debulking followed by adjuvant radiotherapy. The radiological appearances of central neurocytoma are discussed.
PMCID: PMC3438006  PMID: 22977388
Central neurocytoma; treatment; radiology
24.  The Use of Electronic Sensor in Hormone Analysis 
The development of antibody-based biosensor has grown steadily during recent years, and their use as a routine instrument in clinical application is not far from reality. This study has demonstrated the capability of conductometric sensor to quantitate human Follicle Stimulating Hormone (hFSH) from urine samples. The principles are adopted from Enzyme Linked Immunosorbent Assay (ELISA) technique. Self fabricated gold coated electrode was dipped in the microtiter well containing antibody-antigen complex. Substrate was added to the system to initiate a secondary reaction, which produced electroactive species and change the conductivity of the solution. The changes were proportional with the concentration of the hormone present. The results obtained correlate well with the conventional ELISA technique. Inter and intra assay variation (%CV) were under 6% and the lowest detection limit is 0.75 mIU/ml which was well under the physiological range of the hormone. This system offered advantages such as simplicity, reliability, minimal addition of reagents, freedom from turbidity and color problem, probability of miniaturizing the electrode thus minimizing the sample volume and the ability of on line data analysis. This study proved that Antigen-Antibody reaction via EIA could be detected electronically and it has a potential to be used as one of the measuring mode in clinical analysis.
PMCID: PMC3329744  PMID: 22589683
biosensor; immunossay; hFSH; antibody
25.  Role of PhoU in phosphate transport and alkaline phosphatase regulation. 
Journal of Bacteriology  1992;174(24):8057-8064.
The negative regulatory function of PhoU in alkaline phosphatase (AP) was suggested by the behavior of K10 phoU35 carrying a missense mutation whose product was detected by immunoblotting. To define more clearly the regulatory function of this protein for the synthesis of AP, we constructed a null mutation. The constitutive synthesis of AP in this phoU deletion strain confirmed the negative role of PhoU. However, the expression of the PhoU protein from an isopropyl-beta-D-thiogalactopyranoside-inducible promoter had no effect on the repression of AP synthesis. Furthermore, the involvement of PhoU in free-Pi uptake was demonstrated. These results provide evidence that PhoU participates in Pi transport and in the regulatory role of the phosphate-specific transport system.
PMCID: PMC207544  PMID: 1459954

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