Haemoglobin Constant Spring (Hb CS) mutation and single gene deletions are common underlying genetic abnormalities for alpha thalassaemias. Co-inheritance of deletional and non-deletional alpha (α) thalassaemias may result in various thalassaemia syndromes. Concomitant co-inheritance with beta (β) and delta (δ) gene abnormalities would result in improved clinical phenotype. We report here a 33-year-old male patient who was admitted with dengue haemorrhagic fever, with a background history of Grave’s disease, incidentally noted to have mild hypochromic microcytic red cell indices. Physical examination revealed no thalassaemic features or hepatosplenomegaly. His full blood picture showed hypochromic microcytic red cells with normal haemoglobin (Hb) level. Quantitation of Hb using high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) revealed raised Hb F, normal Hb A2 and Hb A levels. There was also small peak of Hb CS noted in CE. H inclusions was negative. Kleihauer test was positive with heterocellular distribution of Hb F among the red cells. DNA analysis for α globin gene mutations showed a single -α-3.7 deletion and Hb CS mutation. These fi ndings were suggestive of compound heterozygosity of Hb CS and a single -α-3.7 deletion with a concomitant heterozygous δβ thalassaemia. Co-inheritance of Hb CS and a single -α-3.7 deletion is expected to result at the very least in a clinical phenotype similar to that of two alpha genes deletion. However we demonstrate here a phenotypic modifi cation of α thalassemia presumptively as a result of co-inheritance with δβ chain abnormality as suggested by the high Hb F level.

Malaysia is one of the countries that have signed the WHO Framework Convention on Tobacco Control (FCTC). The WHO FCTC is a form of evidence-based agreement that recognises the right of all people to attain the highest standard of health. Policies established by the government were in line with the WHO requirements to gazette the nationwide smoking ban so that enforcement measures can be taken to control smoking activities in public places. The purpose of this scoping review is to give an overview of the extent of knowledge, attitude, and the perception of the public on smoking ban policies implemented in Malaysia. The keyword search strategy was as follows: smoking AND policy AND Malaysia AND (knowledge OR attitude OR perception) for publications between the year 2015-2021, conducted through several databases including Medline (search results of 5 publications), Web of Science (search results of 9 publications) and Scopus (search results of 19 publications). A total of 12 articles were considered relevant to answer the research objectives. We found that the level of knowledge, attitude, and perception of the public towards the smoking ban policy in Malaysia was still defective and inadequate. Therefore, it is hoped that the results of this multifactorial relationship study could cultivate governance in administration and governmental policies to imbue competency and efficiency.