Malaria is a major cause of mortality and morbidity globally. Great efforts have been made in the prevention and the elimination of malaria, especially in controlling the malaria vector, the mosquito. Another promising approach would be the development of malaria vaccines. Malaria vaccine studies can be focused on the pre-erythrocytic-stage antigens and the blood-stage antigens, and on the transmission blocking agents targeting the malaria gametocytes. The blood-stage antigens are the leading candidates in malaria vaccine development, as the blood-stage parasites are responsible for causing symptomatic malaria. Human acquired immunity largely targets on blood-stage antigens. This review focuses on one of the most extensively studied blood-stage antigen, the merozoite surface protein-1 (MSP-1), specifically on its evaluation and immunogenicity in rodents and primate models, and its safety and immunogenicity in human clinical trials.
Malaria Vaccines

Refractory dermal melasma is resistant to conventional treatment. Platelet rich plasma (PRP) may help to reduce the pigmentation of melasma. We present a case report on the clinical outcome of 2 patients with melasma, given PRP, as an adjunct therapy. PRP was administered at a monthly interval for 2 sessions in combination with a monthly Q-switched Nd Yag laser treatment and topical alpha arbutin application. A modified melasma area and severity index (MASI) was evaluated by two dermatologists who were blinded. At the follow up on the 3rd months, the MASI score was reduced by mean 33.5% for case 1 and 20% for case 2. There were no clinical complications for case 1. However recurrence of melasma was noted in case 2 by a worsening of the MASI score mean to 53% at the sixth months follow up. In conclusion, intradermal PRP injection as an adjunct to the conventional treatment of melasma presented with differing results in two cases.
Melasma

Tissue and Organ Procurement

The liver is an important organ of the human body, playing a major role in the metabolism and storage of nutrients, synthesis of protein and other nutrients, as well as detoxifying many metabolic by-products. The response of the foetal and newborn liver to external insult and injury is limited. This is because the ability of the closely interdependent structures of a developing liver of expressing in the face of a variety of insults is limited as well. Thus most infants with insults to the liver present as cholestatic jaundice with variable degree of pale stools, enlarged liver and conjugated hyperbilirubinaemia. Biliary atresia, an idiopathic condition characterized by progressive fibrosing obliteration of both intra- and extrahepatic bile ducts, is the most important cause of neonatal cholestasis worldwide, including Malaysia. It is also the most important indication for childhood liver transplantation the world over. Challenges facing infants with biliary atresia include a delay in the diagnosis and late surgery, leading to a poor outcome. This often results from a failure to recognise the potential serious nature of an infant with prolonged cholestatic jaundice and pale stools among health care professionals. (JUMMEC 2010; 13(2): 72-79)
Biliary Atresia

Since the outbreak of the novel influenza H1N1 in Mexico in April 2009, more than half a million cases have been recorded with close to 6000 deaths. In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant. It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). ICUs around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of six centres that have used Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy in patients having ARDS. ECMO has been instituted in many of these cases not only as a bridge to therapy but also to reduce further barotrauma in these patients. ECMO experiences regarding 2 patients at the University of Michigan, 7 in Canada, 68 patients at Leicester UK, 68 in Australia and New Zealand, 1 in Hong Kong and 2 in Singapore are described. (JUMMEC 2010; 13(2): 80-87)
Influenza, Human

Acupuncture is one of the oldest and most commonly used complementary medical procedures in the World. Although it is not free from side effects, its use is becoming increasingly popular. The aims of this study were to describe the demographic characteristics of acupuncture users in Riyadh, Saudi Arabia and their knowledge, attitude and experience regarding acupuncture, as well as to determine the common complaints for which patients seek help from acupuncture centers. A cross sectional study, which targeted patients who attended acupuncture centers in Riyadh city during the study’s period. Most of the study participants were 21-40 years of age and about two third of them were males. The most common complaints that lead to acupuncture visits were joint pain (22.4%) and headache (18.6%). Dissatisfaction with medical treatment and side effects of medications were the major reasons, which led patients to seek cure from acupuncture therapy. About 65% of the patients heard of acupuncture from their families and friends. Pain sensation from needle puncture was the most noticed side effect (15.8%). Twenty-two patients completed treatment during the study period and out of those, twenty one patients claimed that they were successfully treated. The practice of acupuncture in Saudi Arabia is not well established. Pain seems to be the most common symptom that guides patients to attend acupuncture centers. There is need for education related to the appropriate use of acupuncture in Saudi Arabia. (JUMMEC 2010; 13(2): 93-101)
Acupuncture

Massive haemoptysis can occur in lung abscess. Massive haemoptysis itself may be life threatening due to asphyxiation or respiratory failure secondary to acute large airway obstruction by blood clots. Prompt removal of the obstructing blood clots save life. We describe a case of lung abscess causing massive haemoptysis resulting in acute airway obstruction which required rigid bronchoscopy to remove the huge blood clot. (JUMMEC2010; 13(2): 107-110)
Bronchoscopy

Pelvic lipomatosis is a rare disease of unknown cause, characterised by overgrowth of benign mature fat cells commonly located in the perivesical and perirectal spaces. The disease is rare amongst Asian population and has a wide range of presenting symptoms varying from lower urinary tract symptoms to bowel symptoms. However, this disease can be easily diagnosed based on certain characteristic radiological imaging techniques. We report a case of pelvic lipomatosis in an asymptomatic Chinese gentleman, who presented with classical radiological features of pelvic lipomatosis but provided us with challenging therapeutic scenario. (JUMMEC 2010; 13(2): 111-114)

We conducted a multi-institutional case study to identify the issues associated with the adoption of information and communication technology (ICT) in five private care hospitals in the Kingdom of Saudi Arabia. We conducted interviews with 37 respondents primarily comprising IT professionals. We found that there were three determinants of behavioural intentions in this case study: organisation objectives, facilitating conditions and social influence where there are no effects of performance expectancy or effort expectancy. In all five cases, none of the moderators (age, gender, experience and voluntariness) in the original united theory of acceptance and use of technology model were considered critically important by IT professionals. In the present paper, all qualitative elements such as themes, patterns and overarching in the data were analysed to reach a conclusion. In addition, the various perspectives of using ICT are discussed.
Medical Informatics

Tendon is a dense connective tissue that connects muscle to bone. Tendon can adapt to mechanical forces passing across it, through a reciprocal relationship between its cellular components (tenocytes and tenoblasts) and the extracellular matrix (ECM). In early development, the formation of scleraxis-expressing tendon progenitor population in the sclerotome is induced by a fibroblast growth factor signal secreted by the myotome. Tendon injury has been defined as a loss of cells or ECM caused by trauma. It represents a failure of cells and matrix adaptation to mechanical loading. Injury initiates attempts of tendon to repair itself, which has been defined as replacement of damaged or lost cells and ECM by new cells or new matrices. Tendon healing generally consists of four different phases: the inflammatory, proliferation, differentiation and remodelling phases. Clinically, tendons are repaired with a variety of surgical techniques, which show various degrees of success. In order to improve the conventional tendon repair methods, current tendon tissue engineering aims to investigate a repair method which can restore tissue defects with living cells, or cell based therapy. Advances in tissue engineering techniques would potentially yield to a cell-based product that could regenerate functional tendon tissue.
Tissue Engineering