Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.

Objective: This case report aims to highlight the importance of parental contribution to the school refusal problem. Methods: We report a case of a 9-year old boy who presented with school refusal behaviour. Results: There was no psychiatry diagnosis made in this patient. Parental issues such as ineffective and inconsistent parenting, and parental marital disharmony contribute significantly to the school refusal behaviour. Conclusion: Parents in particular are important team players in the management of school refusal. Parental issues need to be explored and managed accordingly to ensure good outcome.
Parents ; Schools ; Child ; Behavior

Background: Bamboo shoot has been used as a treatment for epilepsy in traditional Chinese medicine for generations to treat neuronal disorders such as convulsive, dizziness and headaches. 4-hydroxybenzoic acid (4-hba) is a non-flavonoid phenol found abundantly in Dendrocalamus asper shoots (bamboo), fruits (strawberries and apples) and flowers. Kv1.4 is a rapidly inactivating Shaker-related member of the voltage-gated potassium channels with two inactivation mechanisms; the fast N-type and slow C-type. It plays vital roles in repolarisation, hyperpolarisation and signaling the restoration of resting membrane potential through the regulation of the movement of K+ across the cellular membrane. Methods: Chemical compounds from Dendrocalamus asper bamboo shoots were purified and identified as major palmitic acids mixed with other minor fatty acids, palmitic acid, 4-hydroxybenzaldehyde, lauric acid, 4-hydroxybenzoic acid and cholest-4-ene-3-one. The response of synthetic 4-hydroxybenzoic acid was tested on Kv1.4 potassium channel which was injected into viable oocytes that was extracted from Xenopus laevis. The current were detected by the two-microelectrode voltage clamp, holding potential starting from −80 mV with 20 mV stepup until +80 mV. Readings of treatments with 0.1% DMSO, 4-hba concentrations and K channel blockers were taken at +60 mV. The ratio of tail/peak amplitude is the index of the activity of the Kv1.4 channels with n ≥ 6 (number of oocytes tested). The decreases of the ratios of five different concentrations (1 μM, 10 μM, 100 μM, 1 mM and 2.5 mM) were compared with 0.1% DMSO as the control. Results: All concentration showed statistically significant results with P < 0.05 except for 100 μM. The normalised current of the 4-hba concentrations were compared with potassium channel blockers (TEA and 4-AP) and all groups showed statistically significant results. This study also showed that time taken for each concentration to affect Kv1.4 does not play any significant roles. Conclusion: 4-hydroxybenzoic acid was found to be able to enhance the inactivation of Kv1.4 by lowering the membrane potential so that the abnormal neuronal firing can be inhibited. With IC50 slightly higher than 10 μM, increasing concentrations (100 μM, 1 mM and 2.5 mM) had shown to exhibit toxicity effects. The best concentration from this study is 10 μM with Hill slope of 0.1799.

Initial clinical presentation of Systemic Lupus Erythematosus (SLE) is varied as it affects various organs in the body. While the typical presentation of SLE is mucocutaneous, musculoskeletal and haematological manifestation, gastrointestinal (GI) manifestation is a rare initial presentation of SLE. We discuss the case of a 13-year-old girl who was diagnosed with SLE after she presented with isolated gastrointestinal symptoms. She presented with vomiting, diarrhoea, mild colicky abdominal pain and bilateral ankle oedema; and was treated as acute gastroenteritis. She returned after one week with worsening symptoms. Her full blood count showed bicytopenia; urinalysis had proteinuria and haematuria, and renal profile revealed acute on chronic kidney injury which triggered suspicions of a more serious disease rather than simple viral gastroenteritis. Further investigations of positive anti-nuclear antibody, low complements and positive Coombs’s test supported the diagnosis of SLE. The diagnosis of SLE was confirmed when her renal biopsy reported crescentic lupus nephritis ISN/RPS Class IV. Additional investigation to investigate the cause of her gastrointestinal symptoms included an ultrasound abdomen which showed minimal ascites and bilateral renal parenchymal disease. She was planned for colonoscopy but due to the unavailability of paediatric endoscopy, colonoscopy was postponed. However, her symptoms markedly improved with intravenous Cyclophosphamide which supported the diagnosis of GI SLE. This case report is to highlight that a patient with symptoms of simple viral gastroenteritis might have a more serious underlying disease. Even though rare, SLE can present with gastroenteritis symptoms and is one of the differential diagnoses that should be considered.

Background: Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a procedure of choice for the treatment of severe mitral stenosis. We aimed to describe our experiences on management of rheumatic heart disease with PTMC in Malaysia. Methods: Patients who underwent PTMC were traced through the electronic medical record of University Malaya Medical Centre. The patients detailed echocardiogram parameter pre-procedure, post-procedure and outcome were documented. Statistical analysis was performed using SPSS version on 18 for windows. Results: 11 patients were treated with PTMC in our centre with 90.9% (n=10) success rate. Subjects underwent PTMC were statistically significant associated with improved echocardiogram parameters as following: increase in mitral valve size (p=0.0058) from 0.89 ± 0.2 cm2 (pre) to 1.4 ± 0.4 cm2 (post); reduction in mean pressure gradient across mitral valve (p=0.0283) from 11.5 ± 4.9 mmHg (pre) to 6.9 ± 3.5 mmHg (post); and reduction (p=0.0019) in elevated pulmonary artery systolic pressure from 65.7 ± 21.4 mmHg (pre) to 45.6 ± 10.0 mmHg (post). More than half (62.5%, n=5) of the subjects with favourable Wilkin score 8 or less achieved good outcome defined as post-PTMC mitral valve size ≥ 1.5 cm2 . All subjects with unfavourable Wilkin score of more than 8 only achieved sub-optimal post-PTMC mitral valve size ≤ 1.5 cm2 . Conclusion Given the minimally invasive nature of PTMC with comparable excellent haemodynamic outcome to invasive vascular repair, PTMC should be the recommended first line therapy in mitral valve stenosis.
Mitral Valve Stenosis