We report a case of a 21 year old girl who presented with sudden onset of abdominal, back and bilateral leg pain, paralysis with unexpected collapse at home. Physical examination was suggestive of acute aortic occlusion. CTangiogram revealed multi-system thrombo-embolic shower. She proceeded to urgent aortic thrombectomy and fasciotomy of the bilateral lower limb. Further investigation revealed atrial myxoma and we report the patient's postoperative progress and eventual transfer to rehabilitation facility.

Aims: To evaluate the possible in vitro interaction between methanolic extract of root of Adiantumcapillus-veneris and certain known antimicrobial drugs i.e. Oxacillin, Ceftazimide, Cefriaxone, Ofloxacin, Meropenem, Erythromycin, Cefuroxime, Cefoxitin, Cefotaxime and Ampicillin. Methodology and results: The study was carried out against ten bacterial strains (Staphylococcus aureus, S. epidermidis, Salmonella typhi, Klebsiella pneumoniea, Shigella dysentriea, Proteus vulgaris, Pseudomonas aeruginosa, Providencia species, Citrobacter freundii and Escherichia coli isolated from urine, pus and blood samples. Both disc diffusion and well diffusion methods were used to determine antimicrobial activity of plant extract in combination with antibiotics. Antimicrobial sensitivity showed that Meropenem was the most effective antibiotic with zone of inhibition (ZI) of 25-33 mm among all tested antibiotics followed by Ofloxacin (10-26.5 mm), Ceftriaxone (8-20 mm), while Oxacillin showed no activity against almost all bacterial strains. The study showed that most bacterial strains were resistant to most of the antibiotics used, ranging from 20-60%. The methanolic extract (mEXT) of A. capillus-veneris used alone was active against most of the bacterial isolates with maximum activity against E. coli with 16 mm ZI. The study also indicated that there was an increased activity in case of combination of mEXT with antibiotics. The combined effects of plant extract with antibiotics were synergistic against most of the bacterial strains. The mEXT showed maximum synergistic effect with Ceftazimide with ZI of 42 mm followed by Meropenem (40 mm) and Ceftriaxone (28 mm) against multidrug-resistant (MDR) bacterial strains. Conclusion, significance and impact of study: The data suggests that plant extract could be used as alternative to antibiotics. These results give scientific backing that combination between plant extract and antibiotics would be useful in fighting the emerging drug-resistant bacterial pathogens.
Anti-Infective Agents ; Plants, Medicinal

Acquired subglottic cyst in infancy is almost always associated with episodes of early life intubation. Most cases typically presented late, usually days to months after extubation. We report a case of a subglottic cyst with different presentation than the norm. This case highlights that subglottic cyst can present acutely, and rapidly enlarging soon after the airway extubation. As the management of a large subglottic cyst can be challenging, a close observation for early diagnosis and intervention are recommended post extubation in the high-risk cases, such as in the premature infant.

Background: Parenting behaviour is culturally sensitive. The aims of this study were (1) to translate the Parental Bonding Instrument into Malay (PBI-M) and (2) to determine its factorial structure and validity among the Malaysian population. Methods: The PBI-M was generated from a standard translation process and comprehension testing. The validation study of the PBI-M was administered to 248 college students aged 18 to 22 years. Results: Participants in the comprehension testing had difficulty understanding negative items. Five translated double negative items were replaced with five positive items with similar meanings. Exploratory factor analysis showed a three-factor model for the PBI-M with acceptable reliability. Four negative items (items 3, 4, 8, and 16) and item 19 were omitted from the final PBI-M list because of incorrect placement or low factor loading (< 0.32). Out of the final 20 items of the PBI-M, there were 10 items for the care factor, five items for the autonomy factor and five items for the overprotection factor. All the items loaded positively on their respective factors. Conclusion: The Malaysian population favoured positive items in answering questions. The PBI-M confirmed the three-factor model that consisted of care, autonomy and overprotection. The PBI-M is a valid and reliable instrument to assess the Malaysian parenting style. Confirmatory factor analysis may further support this finding.

Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution of the retinal detachment such as in this particular case suggested possibility of early treatment failure.
Vitrectomy

The present study was carried out to determine the concentrations of selected metal elements (lead, copper, manganese, zinc and iron) in 51 samples of commercial drinking water and tap water available in Malaysia. The results indicated that low metal elements were found in the studied water samples. Lead, manganese, zinc and iron were not detected in some of the studied samples, except copper. The concentrations of the metal elements in the studied samples were well below the maximum permitted concentrations as recommended. Therefore these drinking water are safe for consumption and do not pose adverse effect to the health of consumers due to metal toxicity.

OBJECTIVE: We investigated the effects of antipsychotics on immune-challenged peripheral blood mononuclear cell (PBMC) cultures. METHODS: Blood samples were collected from twelve patients with first-episode schizophrenia. The PBMCs were separated and cultures were prepared and stimulated with lipopolysaccharide (LPS) or polyinosinic:polycytidylic acid (poly[I:C]), and then separately treated with a typical antipsychotic (haloperidol) or atypical antipsychotic (clozapine, quetiapine, or risperidone). Pro-inflammatory (interferon gamma [IFN-gamma]) and anti-inflammatory (interleukin [IL]-4 and IL-10) cytokine levels were measured in the LPS- or poly(I:C)-stimulated PBMC cultures treated with antipsychotics. RESULTS: Haloperidol and quetiapine significantly increased the IL-4 levels (p<0.05) in LPS-stimulated PBMC cultures, while clozapine and quetiapine significantly enhanced the IL-4 levels (p<0.05) in poly(I:C)-stimulated PBMC cultures. Only treatment with haloperidol resulted in a significant increase in IL-10 production (p<0.05) in LPS-stimulated PBMC cultures, whereas clozapine, quetiapine, and risperidone treatment significantly increased IL-10 production (p<0.05) in poly(I:C)-stimulated PBMC cultures. All of the antipsychotics reduced the IFN-gamma level significantly (p<0.05) in LPS- and poly(I:C)-stimulated PBMC cultures. CONCLUSION: Antipsychotic treatment altered immune function by raising the levels of anti-inflammatory cytokines (IL-4 and IL-10) and suppressing the levels of pro-inflammatory cytokines (IFN-gamma).
Antipsychotic Agents* ; Cell Culture Techniques* ; Clozapine ; Cytokines ; Haloperidol ; Humans ; Interleukin-10 ; Interleukin-4 ; Lipopolysaccharides ; Risperidone ; Schizophrenia* ; Quetiapine Fumarate

Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzyme-linked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.

Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzymelinked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.
IL-31 ; serum levels ; predisposing factors ; allergic diseases ; Kelantan

The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNA-based vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.