Introduction: Hepatitis C virus (HCV) genotyping is very important for the clinical management of HCVinfected patients. The aim of this study was to determine the genotypes of HCV-infected patients and to identify their risk factors and comorbidities. Materials and Methods: This was an observational, cross sectional study in which forty (40) HCV-infected patients attending Gastroenterology Clinic, Hospital Tengku Ampuan Afzan (HTAA) Kuantan Pahang were recruited for the study, from January to July 2014. Nucleotide sequence analysis of the 5’UTR and NS5B region were performed to identify the viral genotypes. Results: Of the 40 samples, 31 (77.5%) isolates were successfully classified into their genotypes and subtypes; 3a (57.5%), 1a (12.5%), 3b (2.5%) and 1b (2.5%). No genotype 2, 4, 5 and 6 were found in this study. However, there was one mixed-genotype (3a/1a) HCV infection. Risk factors and co-morbidities found in this study include IVDUs, haemodialysis, blood transfusion, surgery and co-infection with HIV. Conclusion: Genotype 3 followed by genotype 1 were the common HCV genotypes found in this study population. Furthermore, the highest risk factors and co-morbidities were IVDUs and co-infection with HIV.

Introduction: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population. Methods: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria. Results: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant. Conclusion: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.
Colistin ; Intensive Care Units

The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.
Axillary Artery ; innervation ; Brachial Plexus ; abnormalities ; anatomy & histology ; Cadaver ; Female ; Human Body ; Humans ; Median Nerve ; abnormalities ; anatomy & histology ; Middle Aged

INTRODUCTIONMultiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis.

METHODSRoutine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist.

RESULTSIn all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3-14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon.

CONCLUSIONMultiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery.

Cadaver ; Humans ; Malaysia ; Orthopedics ; Tendons ; anatomy & histology ; Tenosynovitis ; diagnosis ; Upper Extremity ; anatomy & histology ; Wrist ; anatomy & histology

Plant-derived triterpenoids commonly possesses biological properties such as anti-inflammatory, anti-microbial, anti-viral and anti-cancer. Luvunga scandens is one of the plant that produced triterpenoids. The aims of the study was to analyze cell cycle profile and to determine the expression of p53 unregulated modulator of apoptosis (PUMA), caspase-8 and caspase-9 genes at mRNA level in MCF-7 cell line treated with two triterpenoids, flindissol (1) and 3-oxotirucalla-7,24-dien-21-oic-acid (2) isolated from L. scandens. The compounds were tested for cell cycle analysis using flow cytometer and mRNA expression level using quantitative RT-PCR. The number of MCF-7 cells population which distributed in Sub G1 phase after treated with compound 1 and 2 were 7.7 and 9.3% respectively. The evaluation of the expression of genes showed that both compounds exhibited high level of expression of PUMA, caspase-8 and caspase-9 as normalized to β-actin via activation of those genes. In summary, the isolated compounds of L. scandens plant showed promising anticancer properties in MCF-7 cell lines.
Apoptosis ; Caspase 8 ; Caspase 9 ; Cell Cycle Checkpoints* ; Cell Cycle* ; Flow Cytometry ; G1 Phase ; Gene Expression* ; MCF-7 Cells* ; Plants ; Puma ; RNA, Messenger

An antimicrobial compound has been isolated from the leaves of Glochidion superbum. The compound was determined as methyl 3, 4, 5-trihydroxybenzoate (methyl gallate), based on ultraviolet (UV), infrared (IR), nuclear magnetic resonance (NMR) and mass spectroscopy (MS) analysis. The isolated compound exhibited potent antimicrobial activity against three clinical isolates of methicillin resistant Staphylococcus aureus (MRSA) by qualitative agar disc diffusion method and quantitative broth dilution method. Agar disc diffusion was done in a dose-dependent manner for each bacterial isolate at disc potencies of 25, 50, 100, and 150 µg/disc. The zones of inhibition were on average equal to 12.27, 14.20, 15.43, and 24.17 mm respectively. The inhibition zones were compared with that of vancomycin disc at 30 µg as a reference standard. The MIC and MBC values were 50 µg/mL and 100 µg/mL respectively. The results of anti MRSA activity were analyzed using one-way ANOVA with Turkey's HSD and Duncan test. In conclusion, methyl gallate which was isolated from G. superbum showed the inhibition activity against methicillin resistant S. aureus.
Agar ; Diffusion ; Magnetic Resonance Spectroscopy ; Mass Spectrometry ; Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Methods ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin

Callophylum symingtonianum (Guttiferae), an evergreen broad-leaved tree that usually grows in hill forests, can be found distributed in the Malay Peninsula. The barks, leaves, flowers and seeds is often used medicinally to treat diarrhea and rheumatism. In the present study, we isolated two inophyllum type coumarins, 12-O-ethylinophyllum D (1) and iso-soulattrolide (2) from the stembarks of C. symingtonianum together with their antibacterial activity. The compounds were isolated by chromatographic methods on a silica gel. The structures were established by spectroscopic methods including UV, IR, (1D and 2D) NMR and mass spectrometry as well as by comparison with several literature sources. The antibacterial activity of those compounds was tested using a disc-diffusion assay against Staphylococcus aureus, Bacillus cereus, Escherichia coli and Pseudomonas aeruginosa. Both compound exhibited mild inhibition against P. aeruginosa with both 111 µg/ml MIC value. Compound 2 also inhibits S. aureus with 25 µg/ml MIC value.
Bacillus cereus ; Calophyllum ; Coumarins ; Diarrhea ; Escherichia coli ; Flowers ; Forests ; Malaysia ; Mass Spectrometry ; Pseudomonas aeruginosa ; Rheumatic Diseases ; Silica Gel ; Staphylococcus aureus ; Trees

INTRODUCTIONAssisted reproductive techniques (ARTs) result in a deficient luteal phase, requiring the administration of intramuscular, intravaginal or oral exogenous progesterone. Dydrogesterone, an oral retroprogesterone with good bioavailability, has been used in assisted reproductive cycles with outcomes that are comparable to those of vaginal or intramuscular progesterone. However, there are limited reviews on its use for luteal phase support in ARTs, in terms of pregnancy outcomes and associated fetal anomalies. This study aimed to review the live birth rates and associated fetal anomalies of women who were given dydrogesterone for luteal phase support in assisted reproductive cycles at a tertiary hospital in Singapore.

METHODSThis retrospective descriptive study included 1,050 women who underwent in vitro fertilisation/intracytoplasmic sperm injection at the Centre for Assisted Reproduction of Singapore General Hospital between 2000 and 2011. The women were given dydrogesterone for luteal phase support. The main outcome measures were rates of pregnancy, live birth, miscarriage and fetal anomalies.

RESULTSThe pregnancy and live birth rates were 34.7% and 27.7%, respectively. Among those who achieved pregnancy, 17.0% miscarried, 0.8% had ectopic pregnancies and 0.3% had molar pregnancies. Fetal anomalies were detected in 1.9% of pregnancies, all of which were terminated by choice.

CONCLUSIONSince the outcomes of dydrogesterone are comparable to those of intramuscular and vaginal progesterone, it is a reasonable option to provide luteal phase support for women who are uncomfortable with injections or vaginal insertions. Randomised controlled studies are needed to determine the optimal dosage of dydrogesterone for luteal phase support in ARTs.

Introduction: Cytomegalovirus (CMV) infection in pregnancy is the commonest cause of congenital infection worldwide. Primary CMV infection in pregnancy carries a higher risk of fetal transmission compared to non-primary infection. This study aims to determine the cytokines expression in pregnant women with primary and non-primary CMV infections in both types of infection. Methods: This prospective cohort study was conducted at Microbiology Laboratory, Universiti Sains Malaysia (USM) from January 2019 until June 2020. Seventy-four pregnant women with abnormal pregnancy outcomes with positive CMV IgG with or without IgM by electrochemiluminescence assay (ECLIA) were subjected to IgG avidity assay by ECLIA method to discriminate primary and non-primary CMV infection. Later, the sera were subjected to magnetic Luminex multiplex enzyme-linked immunosorbent assay for cytokine analysis to determine their concentrations in both primary and non-primary CMV infection. Cytokines and chemokines tested were IL-12, IL-2, IFN- γ, TNF-α, IL-1β, IL-6, IL-10, IFN- γ, TNF-α, MCP-1 (CCL-2), and IP-10 (CXCL-10). Results: Concentrations of IL-1β, IL-6, and MCP-1 (CCL-2) were significantly elevated in pregnant women with primary CMV infection with the p-values of (0.001, 0.035, and 0.002) respectively. The intensity of IFN-γ, IL-12, and IL-2 were higher in primary CMV infection with the p-values of (0.018, 0.004, and 0.007). Conclusion: The pro-inflammatory cytokines were expressed significantly in pregnant women with primary CMV infection together with MCP-1 (CCL2), showing predominant Th1 response. The low level of cytokines in non-primary CMV infection might be due to the latent state of CMV in a host.

Candida species are the most common cause of fungal infections that range from non-life-threatening mucocutaneous illness to life-threatening invasive processes that may involve virtually any organ. Such a broad range of infections requires an equally broad range of therapeutic approach. Persian shallot (Allium stipitatum Regel.) is a medicinal plant that has been widely used in tradition Persian medicine for various ailments. Allium stipitatum is also used in modern medicine and has been reported to have a range of health benefits including antibiotic (antifungal) properties. The present study assessed the in vitro anticandidal and antibiofilm potential of hexane (ASHE) and dichloromethane (ASDE) extracts of Allium stipitatum (Persian shallot) against planktonic and biofilm forms of 5 medically important Candida spp. Antifungal activity was assessed by disk diffusion, minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC) and time-kill assay. The antibiofilm activity of ASHE and ASDE against reference strain C. albicans ATCC 14053 was determined by XTT [2,3-bis(2-methoxy-4-nitro-5-sulfo-phenyl)-2H-tetrazolium-5-carboxanilide] reduction assay. The zone of inhibition ranged from 22 to 40 mm, while the MICs ranged from 8 to 32 μg mL-1. The MFCs of ASHE and ASDE were in the range of 16 to 32 μg mL-1 each respectively. Time-kill kinetics showed that both extracts were strongly fungicidal against planktonic cultures of C. albicans with ~ 1.45 log reduction in CFU at 4 h post-treatment (hpt). In addition, both ASHE and ASDE were shown to inhibit preformed C. albicans biofilms in a concentration-dependent manner. The results demonstrated that ASHE and ASDE were broad-spectrum in action, and could be developed as a promising alternative to synthetic antifungals in controlling infections due to Candida spp. of clinical significance.