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.

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

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

The worldwide upsurge of Type 2 Diabetes Mellitus (T2DM) warrants the attention of public health, especially in complications. Diabetic Retinopathy (DR), the commonest ocular complication, contributes to the growing incidence of blindness. Recommendations that the visual acuity (VA) assessment guidelines should be used in DR screening was not routinely practiced. This study aims to model the predictive effect of VA - a simple economic clinical assessment - upon DR in patients with T2DM. A case-control study was conducted in Hospital Universiti Sains Malaysia with subjects recruited from the ophthalmology clinic. The primary variable during analysis was VA, and the outcome variable was DR. Models with eight control variables which included age, gender, and duration of DM were developed. The predictive effect measured by logistic regression showed that when unadjusted; four variables had a significant association with DR, at p-value<0.25; they were the duration of DM, systolic blood pressure, glycosylated haemoglobin and VA. From the eight different predictive models, the estimated adjusted odds ratio produced ranges from 6.09 to 11.64. Our study shows that VA has a predictive effect upon DR in T2DM patients. We suggest VA assessment, to be on par with the monitoring of blood pressure and blood glucose.
Predictive ; Visual acuity ; Diabetic Retinopathy ; Type 2 Diabetes Mellitus

Objective: To investigate the level of heavy metals (Cu, Zn, Fe Mn Ni, Pb and Cd) in muscles, gills and liver tissue of Croaker fish from oil spilled rivers of Bonny and Finima, Niger Delta region, Nigeria. Methods: Twenty four Croacker fishes (Genyonemus lineatus) weighing between 250 and 260 g and 24–26 cm length were collected from each sampling sites (Bonny and finima rivers). The frozen fishes were thawed and dried at 105 ℃ until they reach a constant weight. The dried samples were homogenized and digested with 10 ml tri-acid mixture (HNO3: HClO4:H2SO4), and then the digested samples were diluted to 100 ml with deionized water. Heavy metals (Cu, Ni, Zn, Pb, Mn, Iron Fe, and Cd) concentrations were determined by atomic absorption spectrophotometer. Results: Our results revealed that concentrations and distribution patterns of all heavy metals studied varied significantly (P < 0.05) amongst the fish tissues analyzed and sampling sites. Moreover, liver tissue of fish caught from Finima creek accumulated the highest concentrations of Cu (52.64 ± 3.01μg/g dry wt), Zn (166.50 ± 6.45μg/g dry wt) and Fe (801.50 ± 14.15μg/g dry wt) in comparison to the liver of fish caught from Bonny river in which the levels of Cu, Zn and Fe were (45.00 ± 2.79), (49.90 ± 2.91) and (216 ± 6.11μg/g dry wt), respectively. In addition, Mn, Ni, Pb and Cd exhibited their highest concentrations in gills from both locations. As expected, muscle tissue contained the least concentrations of all metals investigated from both sampling sites. Furthermore, all the metals investigated exhibited highest concentration in fish collected from Finima creek. These abnormal high level heavy metals accumulation observed in this location could be linked to the frequent crude oil spills as well as industrial activity around the area which might get discharged into Finima creek. In general, the mean concentrations of some toxic heavy metals investigated exceed the recommended maximum permissible limits set by the Joint FAO/WHO committee. However, some metals are within the acceptable limits. Conclusions: In conclusion, our data showed the abnormal higher concentration of these metals and this might be toxic to the fish and other aquatic organisms directly or by extension to humans that frequently consumed such contaminated fishes.

Objective To retrospective analyze the drug characteristic and clinical effect of Uygur medicine for treating insomnia. Methods Totally 234 cases of insomnia in hospitalized records were selected by record statistical system of HIS. Patients’ general conditions, Uygur medicine utilization rate, combination medication, pathogenic humoral, treatment course and therapeutic effect were retrospectively analyzed. Results Insomnia patients were mainly 30-60 years old (81.82%). Abnormal Sawda and Balgam were the main pathogenic humoral, accounted for 54.27% and 28.63% respectively. And 85 kinds of preparation were involved, including Yinao Wusiti Kudousi syrup and Muniziqii Sawda mixture, 213 and 163 times of frequency (91.03% and 69.66%) respectively. Most of patients used 5-12 kinds of preparation, accounted for 89.13%, and treated for one week to one month, accounted for 73.16%. Conclusion The Uygur medicine for insomnia is unique, and has good clinical efficacy and safety.