Introduction: Neurodegeneration resulting from pathogen invasion or tissue damage has been associated with activation of microglia, and exacerbated by the release of neurotoxic mediators such as pro-inflammatory cytokines, chemokines and reactive oxygen species. Activation of microglia stimulated by lipopolysaccharide is mediated in part by GSK-3 signaling molecule. Induced IL-10 expression via GSK-3 inhibition is noteworthy since IL-10 has been remarkably shown to suppress inflammation. Objectives: We aimed to inactivate microglia through inhibition of GSK-3 signaling and to determine its effects on the production of pro- and anti-inflammatory mediators. Methods: LPS-stimulated BV-2 cells were treated with a GSK-3 inhibitor (LiCl, NP12, SB216763 or CHIR99021). Inhibition of GSK-3 was determined by the phosphorylation status of GSK-3β. The effects of GSK-3 inhibition on microglial inflammatory response were investigated by examining various mediators and CD200R marker. Production of nitric oxide (NO), glutamate and pro- and anti-inflammatory cytokines were measured using flow cytometry, Griess assay, glutamate assay and Cytometric Bead Array (CBA) respectively. Results: GSK-3β signaling in LPS-stimulated microglia was blocked by GSK-3 inhibitor through increased phosphorylation at Serine 9 residue. GSK-3 inhibitors had also led to reducing in microglia activity via increased expression of CD200R. Inhibition of GSK-3 also diminished inflammatory mediators such as nitric oxide (NO), glutamate, pro-inflammatory cytokines (TNF-α and IL-6) and chemokine, MCP-1. Reduction of pro-inflammatory mediators by GSK-3 inhibitor was coincided with increased IL-10 production. Conclusions: Suppression of microglia-mediated inflammatory response was facilitated by GSK-3 inhibition with associated increased in IL-10 production.
Microglia

Objectives: Drug addiction poses a significant threat to the health, social and economic fabric of families, communities and nations. The aim of this study was to determine factors associated with drug addiction amongst Malaysian males. Methods: A population-based case control study was carried out in Johor state. Cases were defined as confirmed male drug dependents aged 15 and above. Controls were defined as those aged 15 and above who had never used illegal drugs in their lifetime. A total of 1016 cases were selected at random from a list obtained from the state anti-drug agency and 1106 controls were sampled from a population-based sampling frame. After obtaining verbal consent, they were interviewed by trained graduates. Multiple logistic regression analysis was performed using StataV8.2. The final model was adjusted for smoking, age, alcohol consumption, importance of religion, ethnicity, education level and self-esteem. Results: The final model had good fit (p>0.05) and good discrimination (AUC=0.94). Compared with those aged 15-19 years, the highest risk was amongst the 20-29 years age group (adjusted OR(aOR) 7.2; 95%CI=3.8,13.7) followed by the 30-39 year age group (aOR 5.4; 95%CI=2.9, 10.2) and 40-49 year age groups (aOR 5.0;95%CI=2.6,9.8). Being an ever-smoker was highly associated with drug addiction (aOR 98.7; 95%CI=28.7, 339.5). Compared with the Chinese, Malays (aOR 7.4;95%CI=4.9,11.2) and Indians (aOR 3.8;95%CI=2.1,7.0) had a higher risk of drug addiction. Drug addiction was associated with disagreeing "that religion is important as guidance in their life" (aOR 16.2;95%CI=8.3,31.9), and a histor of alcohol consumption (aOR 7.6; 95%CI=5.6,10.4). Conclusion: In conclusion the important risk factors associated with drug addiction is smoking, ethnicity, age, education level, alcohol consumption and not giving importance to religion as guidance in their life.However an increased self-esteem (aOR 0.6;95%CI=0.4,0.5) is protective against drug addiction.

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was given over six months. Visual function improved gradually and was maintained at one year follow-up. This case highlights the importance of differentiation between optic neuritis and optic perineuritis as visual recovery depends on prolonged management with corticosteroid in optic perineuritis.

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was given over six months. Visual function improved gradually and was maintained at one year follow-up. This case highlights the importance of differentiation between optic neuritis and optic perineuritis as visual recovery depends on prolonged management with corticosteroid in optic perineuritis.
Optic Neuritis

Background: The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses. Methods: This cross-sectional study was conducted at the tertiary referral centre of Ampang Hospital, Kuala Lumpur, involving 105 patients. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) questionnaire was used to measure their quality of life. Results: The study involved patients diagnosed with all types of haematological cancer, including non-Hodgkin lymphoma (NHL), acute myelogenous leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL), and multiple myeloma (MM), with a response rate of 83.3%. The patients with ALL, HL, without NHL, and without MM were younger than other patients. There were significant differences in quality of life scores in different socio-demographic groups and types of cancer diagnosis. The global quality of life of the female patients was much better than that of the male patients. Patients who were 40 years old or younger had a better global quality of life and physical functioning, as well as fewer symptoms of constipation, nausea, and vomiting. Employed patients were in less pain but showed greater impairments of cognitive function than did unemployed patients. Patients who earned a monthly wage of RM1000 or less had reduced physical function, more symptoms of pain, and more financial difficulties compared with patients who earned more. Patients with AML tended to have better physical functioning than did patients with MM, whose physical functioning was impaired. Comparatively, more symptoms of dyspnoea were found in ALL and HL patients than in other types of lymphoma. Compared with other patients, those with ALL had a greater loss of appetite, and other lymphoma patients had fewer symptoms of pain. Patients with NHL had impaired role functioning and more constipation compared with other patients. The results were all statistically significant (P < 0.05). Conclusion: The quality of life of haematological cancer patients is affected by sociodemographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.

A clinical descriptive study was done to determine the sociodemographic, laboratory and clinical characteristics of patients with congenital adrenal hyperplasia (CAH) referred to Hospital Putrajaya, a tertiary endocrine centre in Malaysia. Electronic laboratory data of 51 CAH patients were obtained. The demographics and clinical details of the study population were acquired from a questionnaire completed by parents of participants. There were 25 males (49%) and 26 females (51%), of which, 58.8% were Malays. Median age of participants was 4 years whilst median age at diagnosis of CAH was two years. Parental consanguinity was documented in three patients (5.9%). Patients originated from Johor (19.6%), Selangor (19.6%), Negeri Sembilan (17.6%) and Kedah (13.7%). Majority of patients were diagnosed after one week of life (80.4%) although more females were diagnosed under the age of one week compared to males (p=0.041). Most females presented with ambiguous genitalia (42.3%) [p=0.001] whereas 72% of males presented with salt wasting (p=0.003). No significant associations between race and all other variables, though interestingly three Malay patients presented with ambiguous genitalia and hypertension. Equal gender distribution noted as expected in an autosomal recessive condition, although not in keeping with other Asian countries. Early diagnosis in females attributed to obvious genital ambiguity at birth. Varied clinical presentation, although in minority, necessitates genetic studies for prompt diagnosis and treatment. Considering that majority of patients presented with salt wasting and the age at diagnosis was delayed, the introduction of a neonatal screening programme is essential in Malaysia.
Adrenal Hyperplasia, Congenital

Background: Pruritus is a common complication of intrathecal opioids and numerous medications have been used to prevent or treat this complication. However, the efficacy of these medications vary. The choice of medications also depends on the availability and the cost. We performed a randomised double-blind study to evaluate whether nalbuphine is as effective as chlorpheniramine, a medication that is commonly used for treating pruritus for the treatment of intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section. Materials and Methods: Two hundred and thirty four parturients with American Society of Anaesthesiologists (ASA) physical status I or II who had intrathecal opioid-induced pruritus were assigned to receive either intravenous nalbuphine (4 mg eight-hourly) or intravenous chlorpheniramine (5 mg eight-hourly) for a period of 24 hours. Pruritus was assessed using a qualitative scale at pre-treatment, six, nine, 12 and 24 hours post-treatment. Results: The occurrence of intrathecal opioid-induced pruritus was significantly reduced in parturients treated with intravenous nalbuphine as compared to intravenous chlorpheniramine at all intervals studied. Conclusion: In conclusion, nalbuphine is more effective than chlorpheniramine in reducing intrathecal opioid-induced pruritus for parturients undergoing lower-segment caesarean section.
Anesthesia ; Histamine H1 Antagonists ; Injections, Spinal ; Analgesics, Opioid ; Pregnancy

Introduction: Continuous professional development (CPD) is an important aspect of a medical practitioner’s career. Aiming to be at par with other developed countries for high quality of professional practice, Malaysia is planning to implement compulsory CPD for the doctors. Aim: The aim of the study was to explore the private general practitioners’ (GPs) views, experiences and needs regarding CPD programme in the primary care service. Methods: This study used a qualitative methodology. Seven semi-structured interviews and three focus group discussions were conducted with private general practitioners from an urban area of Malaysia between January and December 2012. An interview topic guide was developed based on literature review and researchers’ discussions and it was used to guide the interviews. All the interviews were audio-recorded, transcribed verbatim and the transcripts formed the data for analysis using the thematic approach. Results: GPs undertook a wide range of CPD programmes to keep up with medical advances, meet patients’ expectations and improve financial rewards. Conferences, lectures and online recourses were the most mentioned methods of keeping updated. Some of the GPs felt that peer motivation and networking seem to motivate and facilitate participation in CPD programmes. However, they were wary of the validity and relevance of some CPD programmes, particularly those related to pharmaceutical industry. Although the participants agreed to the new mandatory CPD regulation, they voiced concerns on how it would be implemented and wished for a more effective method of monitoring. Conclusions: Organised peer support and relevant CPD content may improve GP participation in CPD but adequate regulatory measure should be in place to monitor the CPD activities.
Education, Medical ; Primary Health Care ; Education, Professional

Abstract This study was conducted with the aim of isolating and identifying pathogenic bacterial communities from actively shedding anatomical sites of Macaca fascicularis and M. namestrina in Jambu Rias (JR) and Chemomoi (CM) in Kemasul Forest Reserve, Pahang and to determine the antibiotic susceptibility of these isolates. The findings show that M. fascicularis had higher bacterial density and ten different isolates were identified from these samples. The antibiotic susceptibility tests determined that ciproflaxin and vancomycin as most effective antibiotic towards these isolates.

Purpose: Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS. Methods: This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery. Results: Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13). Conclusion Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.