The pandemic of obesity is of great concern as its associated co-morbidities are devastating; causing lifelong burden to individual’s health and is economically costly to a country. Factors that lead to obesity are a combination of environmental and genetic factors. The Pro-opiomelanocortin (POMC) gene resides in chromosome 2p23.3, and its protein is composed of 241 amino acids which is responsible for the production of polyhormones that regulate appetite and food intake. The study aimed to investigate the prevalence of the RsaI single nucleotide polymorphism (SNP) site in the 5’-untranslated region (UTR) of POMC and its possible association with obesity among 302 multi-ethnic Malaysian subjects (142 obese, 160 non-obese; 120 males, 182 females) from the Kampar Health Clinic. Subjects were recruited by convenience sampling with informed consent and socio-demographic data as well as anthropometric measurements were taken. Subjects were genotyped by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) analysis using DNA extracted from blood. The distribution of the RsaI genotypes was significantly different among the different ethnicities, but the mutated RsaI (- / -) genotype was rare as it only occurred in 8.9% of the subjects. With the frequency of the RsaI (-) allele of 0.31, it was associated with the percentage of skeletal muscles (p<0.05), but not with obesity, gender, ethnicity and related anthropometric measurements. In conclusion, the 5’-UTR RsaI SNP in POMC may not be associated with obesity in the Kampar Health Clinic cohort; however, it could lead to the down-regulation of skeletal muscle build-up of up to 0.71%.

The plants of the genus Phyllanthus (Euphorbiaceae) are distributed in most tropical and subtropical regions of world. This plant has been long used as a traditional medicine to treat problems such as stomach, intestinal infections, kidney and urinary bladder disturbances, diabetes, and hepatitis B. There has been considerable interest in these plants in recent years. This review discusses the antiviral and anticancer aspects of Phyllanthus species. Scientific studies have demonstrated that extracts and purified isolated compounds (flavonoids, lignans, phenols, and terpenes) obtained from these plants possess antiviral effects against herpes simplex (HSV) and dengue virus infections (DENV). These observations are associated with the disruption of essential proteins needed during viral cycle, thus halting the viral replication. In addition, the Phyllanthus species have also been shown to exert inhibitory effects against selected cancers types. In these studies anti-proliferative, anti-metastatic, anti-angiogenic effects and induced apoptosis of human cancers cell lines were observed. These may be explained by the disruption of multiple survival pathways and differential protein expression. CONLCUSION:As a conclusion, tThe Phyllanthus plant possesses multiple medicinal properties, including antiviral and anticancer activities which may potentially be used as a medicinal source for many disease locally.
Antineoplastic Agents ; Dengue

Background Hori’s naevus is an acquired bilateral naevus of Ota-like macules (ABNOM). It was first reported by Hori et al in 1984. It is common among Asians and has a female preponderance. Hori’s naevus is characterised by blue-brown macules typically on the malar region of the face. Objectives To evaluate the clinical characteristics of patients with Hori’s naevus seen at Hospital Kuala Lumpur and the efficacy of Qswitched neodynium-yttrium-aluminium-garnet (Nd:YAG) laser in the treatment of this condition. Method A retrospective analysis of 16 patients diagnosed clinically with Hori’s naevus and treated with Q-switched Nd:YAG laser was carried out. Patient’s demographic data and clinical characteristics, response to Q-switched Nd:YAG laser, complications and recurrence were reviewed. Results A total of 16 patients diagnosed clinically with Hori’s naevus and treated with Q-switched Nd:YAG laser were reviewed. Fifteen of the patients were female with one male. Their ages ranged from 33-61 years old (mean age = 47). Nine of these patients were Chinese with seven Malays. All had Fitzpatrick skin phototype IV. The age of onset ranged from 15-45 years old. The most common clinical presentation was bilateral brown macules on the malar region of the face. Eleven patients received treatment with Q-switched 1064nm Nd:YAG and five combination treatment with Q-switched 532nm Nd:YAG followed by 1064nm laser. Two patients were lost to follow up after a single treatment. After a single treatment, 13 patients graded their clinical response as ‘poor’ (0-25% improvement) and 1 as ‘fair’ (26-50% improvement). Six patients received a total of two treatments of whom 4 graded their response as ‘fair’ (26-50% improvement) and 2 as ‘good’ (51-75% improvement). Two patients who received a total of four treatments graded their responses as ‘good’ and ‘excellent’ (76-100% improvement) respectively. 10 patients had significant hyperpigmentation post laser treatment. However, none reported any recurrences. Conclusion There is no difference in pigment clearance between concurrent use of Q-switched 532nm Nd:YAG laser followed by 1064nm laser and Q-switched 1064nm Nd:YAG laser for Hori’s naevus. However, there is only minimal improvement after a single treatment, and multiple sessions are required to achieve satisfactory improvement. Post inflammatory hyperpigmentation was the main complication seen.

Authors reviewed clinical results of idiopathic club foot, of 52 patients have been treated by surgery and followed up more than 2 years at the Department of Orthopaedic Surgery, Korea University, Guro Hospital in order to evaluate the results after surgery for idiopathic club foot and the best time for surgical management. Materials consist of 3 groups regarding the surgical regimen:Group I was of one-stage postermedial release(58 feet/36 patients), Group II of posterolateral release(11 feet/7 patients)and Group III of Lichtblau osteotomy(10 feet/9 patients). Assessment was made by the radiologic(Beatson and Ponsenti's)and clinical(Preson and Fell's)criterias. From the review the following observations were obtained: 1. Percentage of the surgically treated feet was 30% in author's series(97 feet/327 feet). 2. The mean age at the operation was 1 year 11 months in group I, 1 year 11 months in group II, 6 years 2 months in group III and 3 years 4 months(2 months – 12 years) in all groups. 3. The clinical results evaluated by Preston's method were good in 32 feet(55%), fair in 16 feet(28%), poor in 10 feet(17%) for the group I, 58 feet and good in 4 feet(36%), fair in 4 feet(36%), poor in 3 feet(28%) for the group II, 11 feet and good in 6 feet(60%), fair in 2 feet(20%), poor in 2 feet(20%) for the group OOO, 10 feet. 4. The radiologic results evaluated by Beatson and Posenti's criteriae were good in 44 feet(55%), fair in 18 feet(23%), poor in 17 feet(22%) in all groups. 5. The success rate of primary surgical treatment for idiopathic club foot was 81% in all groups and 83% in PMR group. 6. Regarding age at operation, the best result was showed between 1 and 2 years old in PMR group. In conclusion, the surgery was the satisfactory method for the treatment of idiopathic club foot and the posteromedial release was showed better results than the posterolateral release group. Results according to age at operation in PMR group, the best results obtained between 1 year and 2 years old. The results in posterolateral release group was poor because the forefoot adduction deformity was persistant.
Congenital Abnormalities ; Foot ; Humans ; Korea ; Methods

Tatrate resistant acid phosphatase (TRAP) has been widely used as histochemical marker to identify osteoclast in studies of bone metabolism. However, the value of TRAP as an osteoclast marker is still in discussion. Authors isolated and characterized the cells from synovium of 6 patients of sero-positive rheumatoid arthritis and 4 patients of osteoarthritis, and observed the activity of acid phosphatase (AP) and TRAP. The activity of TRAP was negative in cell cultures in early phase, but the activity of TRAP was increased with time, and at one week the activity of TRAP was as strong as that of AP. If the cultured tissue contained bone, there were observed TRAP positive mononuclear cells and giant cells even in early phase of cultures (1 day, 3 day), and the phenotype of these cells were same as that of osteoclasts and osteoclast precursors by immunocytochemistry. In conclusion, the activity of TRAP was positive in cultured macrophage. TRAP is not a specific marker for osteoclast, and its use for the identification of osteoclast seems meaningful only in the early stage of cell culture.
Acid Phosphatase ; Arthritis, Rheumatoid ; Cell Culture Techniques ; Giant Cells ; Humans ; Immunohistochemistry ; Macrophages ; Metabolism ; Osteoarthritis ; Osteoclasts ; Phenotype ; Synovial Membrane

A small number of viable tuberculosis bacilli can reside in an individual with latent tuberculosis infection (LTBI) without obvious clinical symptoms or abnormal chest radiographs. Diagnosis and treatment of LTBI are important for tuberculosis (TB) control in public and private healthcare facilities, particularly in high-risk populations. The updated 2017 Korean guidelines for TB recommend that tuberculin skin tests, interferon-gamma release assays, or a combination of them can be used for the diagnosis of LTBI, depending on the age and immune status of the patient as well as their TB contact history. For diagnosis of LTBI, exclusion of active TB is essential, and the possibility of healed TB in those without a history of treatment for TB but at risk of its development must be considered. The treatment options for LTBI include isoniazid, rifampicin, isoniazid/rifampicin, and isoniazid/rifapentine. The benefits and risks of these agents based on the age of the patient and their hepatotoxicity must be considered when selecting the appropriate drug. Standardized diagnosis and treatment of LTBI based on the updated 2017 guidelines will contribute to the control of TB in Korea as well as to further revisions of the guidelines.
Delivery of Health Care ; Diagnosis* ; Humans ; Interferon-gamma Release Tests ; Isoniazid ; Korea ; Latent Tuberculosis* ; Radiography, Thoracic ; Rifampin ; Risk Assessment ; Skin Tests ; Tuberculin ; Tuberculosis

Basilic vein transposition is a feasible and a good method to make AVF with autogenous vein. Small incision can be applied to basilic vein transposition, which can be less painful and more comfortable to the patients.

Spirituality and mental adjustment have been widely adopted as coping strategies among women with breast cancer. Little information was available locally on the use of spirituality and mental adjustment as coping mechanisms to fight breast cancer. A cross-sectional study was conducted to assess spirituality and mental adjustment as coping strategies and its association with socio demographic data on 216 women with breast cancer. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and Mental Adjustment to Cancer (MAC) Scales were used to assess spirituality and mental adjustment. Negative correlation between spiritual well-being and helplessness/hopelessness (r=-0.690; p=0.000), anxious preoccupation (r=-0.277; p=0.000) and avoidance (r=-0.235; p=0.000) and positive correlation between spiritual well-being and fighting spirit (r=0.668; p=0.000) were identified. Socio-demographic factors such as race (p=0.000), religion (p=0.000), academic qualification (p=0.004) and type of surgery (p=0.016) revealed significant relationship with spiritual well-being. Fighting spirit, hopelessness/helplessness and anxious preoccupation also yielded significant relationship with race (p<0.0001), religion (p=0.001) and academic qualification (p=0.024). Helplessness/hopelessness had a significant relationship with stage of disease (p=0.017) and type of surgery (p=0.011). Meanwhile, fatalistic and avoidance showed a strong relationship with age (p=0.014, r=0.167), occupation (p=0.001) and income (p=0.006), race (p=0.007) and academic qualification (p=0.005). It is thus, concluded that spirituality and mental adjustment are two coping strategies widely adopted by Malaysian women after a breast cancer diagnosis and throughout their breast cancer journey. Women with breast cancer, therefore, should be treated holistically rather than just the disease itself.
Breast Neoplasms ; Spirituality ; Adaptation, Psychological

A cross-sectional study was conducted on patients attending a primary care facility to determine the prevalence of self reported hearing loss using a single question, “Do you have hearing loss?” Pure tone audiometry was performed to compare the accuracy of the self report. A total of 111 patients were recruited. The prevalence of self reported hearing loss using a single question and pure tone audiometry was 24.3% and 36.9% respectively. By using pure tone audiometry at a cut-offlevel of 25 dBHL (decibels Hearing level), the single question yielded a sensitivity of 41.4% and specificity of 85.0%.The single question performed better at 40 dBHL pure tone audiometry with sensitivity of 55.0% and specificity of 82.0%. In conclusion, the prevalence of hearing loss in elderly was high and the single question self reported hearing loss performed satisfactorily with moderate hearing loss.

Introduction: Lichen planus pemphigoides (LPP) is a rare acquired autoimmune disease characterised by the evolution of subepidermal blisters on normal and lichen planus affected skin. Case summary: We describe a case of lichen planus pemphigoides in a 54-year-old Chinese woman. The patient presented initially with scaly psoriasiform plaques and was diagnosed to have guttate psoriasis. She was treated with narrowband ultraviolet (NBUVB) therapy twice weekly. Within a month of starting phototherapy, she experienced a flare up of her skin lesions with a generalised eruption of violaceous papules, tense bullae over the lower limbs as well as Wickham’s striae over the buccal mucosa. Histology of the violaceous papule over abdomen revealed interface dermatitis, while the specimen from a blister showed subepidermal bulla with linear deposition of IgG and C3 along the basement membrane zone. A diagnosis of LPP was made on clinicopathological grounds. The patient subsequently responded well to oral prednisolone at a dose of 0.5 mg/kg/day. Conclusion: This is the first case report of NBUVB alone unmasking LPP. In the presentation, we will describe the pathological mechanism of NBUVB in the development of LPP and the key features distinguishing LPP from bullous lichen planus (BLP), psoriasis and bullous pemphigoid (BP).