In this paper, we report three cases of orbital rhabdomyosarcoma in different age groups with different histopathologic types. Case 1 is a 10-year old Malay boy who presented with painless proptosis of the left eye. Magnetic resonance imaging (MRI) showed soft tissue mass arising from the lateral rectus muscle. Tissue biopsy revealed rhabdomyosarcoma of embryonal type. Case 2 is a 32-year old Malay man who presented with a progressive left eye proptosis associated with pain and redness. Computed Tomography (CT) scan showed a retrobulbar mass extending medially in the left orbit. Meanwhile, biopsy showed rhabdomyosarcoma of pleomorphic type. Case 3 is a 67-year old Malay woman who presented with proptosis and fungating growth of left orbital region, epistaxis and nasal blockage. CT scan revealed an ill-defi ned mass fi lling up the left orbital cavity. Biopsy showed rhabdomyosarcoma of alveolar type. Rhabdomyosarcoma is the most common in childhood but it should be considered as a differential diagnosis of orbital tumours irrespective of age.

Pericardial cysts occur rarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cyst requires surgical removal. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.

Pericardial cysts occur rarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cyst requires surgical removal. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.

Chlorella vulgaris, a unicellular microalgae, produces many intracellular phytochemicals namely carotenoids, tocopherols, ubiquinone and protein. Skin ageing which is induced by oxidative stress involves decreased extracellular matrix synthesis and increased expression of enzymes that degrade the collagenous matrix. The objective of this study was to determine the effect of C. vulgaris on the expression of genes encoded for collagen (COL) and matrix metalloproteinases (MMPs) which are involved in skin ageing. Human diploid fibroblasts (HDFs) were obtained from circumcision foreskin of 8-12 year-old boys. HDFs were cultured into 3 groups: untreated control cells, cells with stress-induced premature senescence (SIPS; cells were induced with H2O2 at passage 6 for 2 weeks) and SIPS treated with C. vulgaris (prolonged C. vulgaris treatment started at passage 4 and combined treatment with H2O2 at passage 6 for 2 weeks). Senescence-associated ß-galactosidase (SA ß-gal) was determined using senescent cells histochemical staining kit (Sigma, USA). Expression of COLI, COLIII, COLIV, MMPI, MMPII and MMPIII genes was quantitatively analysed with real-time RT-PCR method (iScript™ One Step real-time PCR with SYBR® Green; Biorad). HDFs treated with H2O2 (SIPS) exhibited senescent morphological features of flattening and enlarged with increased expression of SA ß-gal (p<0.05). Gene expression analysis showed COLI was downregulated in SIPS and SIPS treated with C. vulgaris (p<0.05) while COLIII decreased in SIPS and increased in SIPS treated with C. vulgaris (p<0.05). Expression of MMPI was increased in SIPS and SIPS treated with C. vulgaris (p<0.05) indicating its synergistic effect with H2O2 treatment. In conclusion, in skin ageing, COLI and COLIII genes were downregulated while MMPI was upregulated. C. vulgaris modulated the expression of COL and MMP genes by downregulating COLI and upregulating COLIII and MMPI but it did not exert anti-ageing effect.

Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.

Brain tumour occurrence in Malaysia demonstrates an increasing trend from year to year among adults and the second most common cancer among children. Thus, the expansion of numerous research for novel therapy and treatment are necessary. The distribution of brain tumour in a specific population is important to provide substantial information about the current trends for developing new diagnostic technique and research. Consequently, this study is opted to provide descriptive data of brain tumour in Hospital Universiti Sains Malaysia (USM). 217 brain tumour cases were collected from the hospital record between 2011 and 2014. The brain tumour cases were confirmed by pathologists according to WHO classification and grading. Descriptive analysis was evaluated by using Microsoft Excel and IBM SPSS version 22. Gender preponderance in this study shows very little difference. The most common adult primary brain tumour in this study was meningioma (32.7%) followed by glioblastoma (7.8%), a type of diffuse astrocytic tumour. According to age factor, brain tumour distribution pattern shows an increasing trend as the age increases and meningioma is the most common among the elder patients. Secondary tumour takes more than 10% from overall percentage of brain tumour cases. In conclusion, the descriptive data presentation in this study is very helpful to provide baseline information on the current brain tumour occurrence in this region.

Brain tumour occurrence in Malaysia demonstrates an increasing trend from year to year among adults and the second most common cancer among children. Thus, the expansion of numerous research for novel therapy and treatment are necessary. The distribution of brain tumour in a specific population is important to provide substantial information about the current trends for developing new diagnostic technique and research. Consequently, this study is opted to provide descriptive data of brain tumour in Hospital Universiti Sains Malaysia (USM). 217 brain tumour cases were collected from the hospital record between 2011 and 2014. The brain tumour cases were confirmed by pathologists according to WHO classification and grading. Descriptive analysis was evaluated by using Microsoft Excel and IBM SPSS version 22. Gender preponderance in this study shows very little difference. The most common adult primary brain tumour in this study was meningioma (32.7%) followed by glioblastoma (7.8%), a type of diffuse astrocytic tumour. According to age factor, brain tumour distribution pattern shows an increasing trend as the age increases and meningioma is the most common among the elder patients. Secondary tumour takes more than 10% from overall percentage of brain tumour cases. In conclusion, the descriptive data presentation in this study is very helpful to provide baseline information on the current brain tumour occurrence in this region.
Brain tumor ; descriptive epidemiology ; WHO classification ; Hospital USM

Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31st 2004 until January 8th 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.
Disasters ; legal surveillance ; Sri Lanka ; Malaysia ; After values

Artocarpus heterophyllus has been used as traditional medicine. This plant is one of the sources of flavonoid. Flavonoid compounds possessed a wide range of biological properties including anticancer. This study was performed to investigate the cytotoxic effect of flavonoids from A. heterophyllus on H460 and MCF-7 cell lines. The interaction of flavonoids and cisplatin against tested cancer cells was also evaluated. MTT assay was used to determine the cytotoxic effect of flavonoid. Isobologram analysis was selected to evaluate the synergistic effect between flavonoid and cisplatin, their interaction was then confirmed using AO/PI staining method. Amongst of flavonoid compounds, artocarpin exhibited strong cytotoxic effect on both MCF-7 and H460 cell lines with IC₅₀ values of 12.53 µg/mL (28.73 µM) and 9.77 µg/mL (22.40 µM), respectively. This compound enhanced anticancer activity of cisplatin against H460 and MCF-7. The combination produced a synergistic effect on H460 and MCF-7 cell lines with a combination index (CI) values of 0.2 and 0.18, respectively. The AO/PI stained demonstrated that the combination of artocarpin and cisplatin caused morphological changes that indicated apoptosis. Moreover, artocarpanone also significantly increased cytotoxic effect of cisplatin compared to its single concentration with CI below than 1. This result suggested the potency of flavonoid named artocarpin to enhance the anticancer activity of cisplatin on H460 and MCF-7 cell lines.
Apoptosis ; Artocarpus ; Cell Line ; Cisplatin ; Flavonoids ; MCF-7 Cells ; Medicine, Traditional ; Methods ; Plants