Immunology has now developed into an independent discipline in medicine which covers not only germ infection which is related to immunity solely but also covers a lot of non-infectious diseases such as autoimmune disease, allergies, and others. Therefore, “The Immune Mechanism: “a double-edged sword” means that the immune mechanism (consisted of antibody mediated mechanism and T cell mediated mechanism), just like one edge playing the role of giving benefit (immunity) as it destroys the agent of infection, and another one can be detrimental as it will cause tissue/cell damages and then give rise to immune diseases (immunopathology). Now, the prevalence of these immune diseases is on the rise and has become a new challenge to our country towards developed country in 2020. Therefore, we have to make ample preparation (laboratory facilities/services, main power, and research) from now on in order to face the problems and challenges.

Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.

Background: Up to date, there are handful questionnaires that have been validated in Bahasa Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item (DASS-21) and measure its psychometric properties. Objectives: To determine the construct validity and acceptability of the DASS, BM. Methods: Two forward and backward translations were done in BM in accordance to guideline, and its validation was determined by using confirmatory factor analysis. A total of 263 subjects were selected by systematic random sampling to represent Malaysian population for reliability and validity purposes. Results: The BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for depression, anxiety and stress. In addition, it had good factor loading values for most items (.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21 is correctly and adequately translated to Bahasa Malaysia with high psychometric properties. Further studies are required to support these findings.

To investigate the toxic implications of ethanolic stem bark extract of Azadirachtaindica (A. indica) at 50, 100, 200 and 300 mg/kg body weight in Wistar rats. Methods: Fifty male rats of Wistar strains were randomly grouped into five (A-E) of ten animals each. Animals in Group A (control) were orally administered 1 mL of distilled water on daily basis for 21 days while those in Groups B-E received same volume of the extract corresponding to 50, 100, 200 and 300 mg/kg body weight. Results: The extract did not significantly (P>0.05) alter the levels of albumin, total protein, red blood cells and factors relating to it whereas the white blood cell, platelets, serum triacylglycerol and high-density lipoprotein cholesterol decreased significantly (P<0.05). In contrast, the final body weights, absolute weights of the liver, kidney, lungs and heart as well as their organ-body weight ratios, serum globulins, total and conjugated bilirubin, serum cholesterol, low-density lipoprotein cholesterol and computed atherogenic index increased significantly. The spleen-body weight ratio, alkaline phosphatase, alanine and aspartate transaminases, sodium, potassium, calcium, feed and water intake were altered at specific doses. Conclusions: Overall, the alterations in the biochemical parameters of toxicity have consequential effects on the normal functioning of the organs of the animals. Therefore, the ethanolic extract of A. indica stem bark at the doses of 50, 100, 200 and 300 mg/kg body weight may not be completely safe as an oral remedy and should be taken with caution if absolutely necessary.

Objective: To investigate the phytochemical properties and the anticonvulsant potential of the ethyl acetate soluble fraction of ethanol leaf extract of Globimetula braunii, a plant used in ethnomedicine for the treatment of epilepsy.
Methods:The phytochemical screening was carried out using standard protocol while the anticonvulsant activity was studied using maximal electroshock test in chicks, pentylenetetrazole and 4-aminopyridine-induced seizures in mice.
Results: The preliminary phytochemical screening carried out on the crude ethanol extract revealed the presence of saponins, carbohydrates, flavonoids, tannins, anthraquinones and steroids. Similarly, tannins, flavonoids and steroids/terpenes were found to be present in the ethyl acetate fraction. In the pharmacological screening, 150 mg/kg of the fraction protected 83.33% of animals against pentylenetetrazole-induced seizure in mice whereas sodium valproate a standard anti-epileptic drug offered 100% protection. In the 4-aminopyridine-induced seizure model, the fraction produced a significant (P<0.05) increase in the mean onset of seizure in unprotected animals. The fraction did not exhibit a significant activity against maximal electroshock convulsion. The median lethal dose of the fraction was found to be 1261.91 mg/kg.
Conclusions:These results suggest that the ethyl acetate fraction of Globimetula braunii leaves extract possesses psychoactive compound that may be useful in the management of petit mal epilepsy and lend credence to the ethnomedical use of the plant in the management of epilepsy.

Adult ; Airway Obstruction ; etiology ; Cervical Vertebrae ; diagnostic imaging ; injuries ; Fatal Outcome ; Humans ; Male ; Tomography, X-Ray Computed ; Tracheostomy ; Wounds, Gunshot ; complications ; diagnostic imaging

Intranasal meningoencephalocoele is a rare clinical entity especially in the adult population. It is usually a congenital anomaly but can occur as a result of traumatic head injury or increased intracranial hypertension. We report the case of 25-year-old Malay man who presented with persistent headache of one-year duration that was associated with bilateral nasal blockage and intermittent right nasal discharge. He was also treated for meningitis and previously had two episodes of closed head injuries. Investigations showed that he had an intranasal transethmoidal meningoenchepalocoele. This was successfully treated with an endoscopic excision and fistula repaired using cartilage graft and tissue glue.
Meningitis ; Fistula ; Cerebrospinal Fluid Leak

Muslim relies on the structure or guideline of shari’ah or the maqasid al-shariah, which consist of five essential values, namely preservation/protection of faith, life, intellect, property, and dignity/lineage – to guide them in discovering guiding principles for new concerns such as posed by neuroscience. Like in the case of brain imaging technology, there is in need for proper explanation within Islamic and among the Muslim scientists/scholars on how Islamic beliefs, values, and practices might cumulatively provide ‘different’ meanings to the practice and application of this technology, or whether it is in line with the shari’ah – in the context of preservation of health and protection of disease. This paper highlights the Islamic mechanism for neuroethics as basis for a holistic ethical framework of neuroscience to cope with its new, modern, and emerging technologies in the globalised world, and how Muslim should response to such changes.
Religion and Medicine ; Neuroscience

Renal replacement therapy in Malaysia has changed dramatically. In 1980 there were only 59 patients on dialysis. Since then the number of patients has increased exponentially from 4,540 in 1998 to almost 15,000 in 20061. Autogenous Arteriovenous Fistula (AVF) provides an excellent long term hemodialysis access with low rates of infection, thrombosis and is cost effective. Hospital Sultanah Bahiyah is a tertiary hospital situated in the northern region of Peninsular Malaysia. Vascular Access creation is one of the main services provided by our surgical unit; with an average of 100 patients seen in the vascular access clinic per month. The number of AVF operations has increased from 30 cases in 2001 to 328 in 2007. The reported rates of Primary Fistula Failure (fistula fail to mature) varies from 8% to 53%2,4. Immature fistulae will lead to prolonged dependence on dialysis catheters. This phenomenon is well known to be associated with the risk of infective complications, central venous thrombosis or stenosis and patients’ inconvenience. Numerous studies have reported the predictors of successful fistulae, but are varied in their design, definitions, end points and clinical factors considered 2,3 Preoperative imaging also has been proposed, but their widespread use is generally limited in most of the centres4. Knowing the risk factors for failure will help the surgeon to take the necessary precautions and preventive measures more effectively. The information may help to stratify the patients into various risk groups based on their likelihood to develop fistula failure. Thus, the main objective of this study was to identify clinical risk factors that are related to Failure to Mature (FTM) of autogenous AVF.

Scales 21-item (DASS-21) has been widely used ever since the establishment of its validity. To consolidate the evidence of the BM DASS-21 validity by examining its concurrent validity. Methods: The BM DASS was administered together with the Hospital Anxiety and Depressive Scale (HADS) to a total of 246 patients at International Islamic University Malaysia (IIUM) Infertility Centre. Results: The anxiety domain of BM DASS-21 had good correlation with anxiety domain in HADS (0.61) but for DASS depressive domain, it had modest correlation with its respective domain in HADS (0.49). Conclusions: The results of this study further ensconced the evidence that the BM DASS-21 had relatively satisfactory psychometric properties for clinical subjects in Malaysia.