Stress modulates pain perception, resulting in either stress-induced analgesia or stress-induced hyperalgesia, as reported in both animal and human studies. The responses to stress include neural, endocrine, and behavioural changes, and built-in coping strategies are in place to address stressors. Peculiar to humans are additional factors that modulate pain that are experienced in times of stress, notably psychological factors that potentially influence the directionality of pain perception.

Objectives: Alpha thalassaemia is wide spread in Malaysia and is a public health problem. This study aimed to describe the carrier frequencies of α‒thalassaemia and its distribution among major ethnic groups in three states of Malaysia. Methods: Educational forums were organised and study was explained to students from three schools. Students were invited to take part in the screening with parent consent. A total of 8420 adolescent students aged 16 years volunteered to participate in the study. Peripheral blood samples were analysed for complete blood counts, haemoglobin quantification and typing, and serum ferritin levels. Genomic DNA was used for screening alpha thalassaemia alleles by PCR based molecular methods. Results: We identified seven α‒globin gene defects in 341 (4.08%) students: amongst them α+‒ and α0‒thalassaemias were detected in 232 (2.77%) and 107 (1.28%) students respectively. Genotype ‒α3.7/αα was the most prevalent among sub-populations of Malay, indigenous communities of Sahab and Indian, while ‒‒SEA/αα deletion is more prevalent in Malaysian Chinese. It is estimated that 63 pregnancies annually are at risk of Hb Bart’s hydrops fetalis. Conclusions: We have demonstrated the prevalence and mutation patterns of α‒thalassaemia in the 16 year olds in three states of Malaysia. High α0‒thalassaemia deletions amongst the study subjects place these carriers at an increased risk of conceiving fetuses with HbH disease and Hb Bart’s hydrops fetalis should they choose another heterozygous partner. It is therefore highly recommended to institute community screening programmes and provide prospective carriers with genetic counselling to help them make informed choices.

Background: β-thalassaemia is one of the most common single-gene disorders worldwide. Each ethnic population has its own common mutations, accounting for the majority of cases, with a small number of mutations for the rarer alleles. Due to the heterogeneity of β-thalassaemia and the multi-ethnicity of Malaysians, molecular diagnostics may be expensive and time consuming. Methods: A simple polymerase chain reaction (PCR) approach involving a multiplex amplification refractory mutation system (MARMS) and one amplification refractory mutation system (ARMS), consisting of 20 β-globin gene mutations, were designed and employed to investigate β-thalassaemia patients and carriers. Results: Out of 169 carriers tested with the MARMS, Cd 41/42 (–TTCT), Cd 26 (A–G) HbE, IVS 1–1 (G–T), and IVS 1–5 (G–C) were the most common mutations, accounting for 78.1%. Among the Malays, Cd 26 (A–G) HbE, Cd 41/42 (–TTCT), IVS 1–1 (G–T), and IVS 1–5 (G–C) were the most common mutations, accounting for 81.4%, whereas Cd 41/42 (–TTCT) and IVS 2–654 (C–T) were most common among the Chinese (79.1%). Conclusion: We propose the use of this cheap, easy to interpret, and simple system for the molecular diagnostics of β-thalassaemia among Malaysians at the Institute for Medical Research (IMR)

Haemoglobin S D-Punjab is a rare compound heterozygous haemoglobinopathy characterised by the presence of two β globin gene variants: β6(GAG→GTG) and β121(GAA→CAA). These patients’ clinical and haematological features mimic haemoglobin S disease. We describe the first case of doubly heterozygous HbSD-Punjab from Malaysia managed with regular blood transfusion at the age of one. This case highlights the propensity for occurrence of rare phenotypes within our multi-ethnic population and emphasises the importance of accurate genotyping to avoid erroneous counselling, and to plan an effective patient management strategy before complication evolves.

Introduction:Patch test is the gold standard diagnostic test for contact allergy. Periodic analysis of the trend ofcontact allergy provides a valuable guide to clinicians. We aim to study the pattern of contact allergyin adults at Hospital Selayang.Methods:This is a retrospective review of patch test data in adults suspected with allergic contact dermatitisbetween January 2011 and December 2013 at Hospital Selayang.Results:There were 705 subjects with 247 males (35%) and 458 females (65%). At least 1 positive reactionwas detected in 546 (77.4%) subjects patch tested with European Baseline Series (EBS) and additionalseries. The top 5 common allergens in the EBS were nickel sulfate (28.7%), cobalt chloride (13.6%),paraben mix (11.6%), balsam of peru (10.6%), and potassium dichromate (10.5%). Among thosepatch tested with rubber additives series, the top 3 allergens were N,N-Diphenylguanidine (DPG),N-Cyclohexyl-N-phenyl-4-phenylenediamine (CPPD), and N-Cyclohexylthiophthalimide. Of thetop 5 common allergens in the group tested with fragrance series, all except Ylang ylang oil werecomponents of fragrance mix I. Among the subjects tested with fragrance series, the top 5 commonallergens were individual components of fragrance mix I and Ylang ylang oil.Conclusion:A multicentre study would reflect better the pattern of allergen exposure of the nation. Furtherevaluation of the prevalence of contact allergy to DPG, CPPD, N-Cyclohexylthiophthalimide andYlang ylang oil would guide the need to incorporate these allergens in routine testing along with EBS.

The global COVID-19 Pandemic combined with nationwide economic depression and public fear had caused dental clinics in Malaysia to experience a significant reduction in patient visits with a potential impact on the socio-economic and psychological status of Malaysian private dentists. This study assesses the socio-economic and psychological impacts of the COVID-19 pandemic on Malaysian private dentists. A cross-sectional online questionnaire included demographic profile, socioeconomic factors and psychological status was used. Participation was voluntary. Descriptive statistics on the three variables were generated. Pearson Chi-square test was used to check for significant difference (p<0.05). In all, 95 private dentists voluntarily participated. Male and female participants were equally represented, mostly in the 22-25 group (62%). The Job Insecurity Scale measurement showed 58% and 48.5% participants respectively, were socio-economically and psychologically affected. The Financial Threat Scale showed 44.4% of respondents were financially affected, while 51% (measured by the General health questionnaire) displayed affected health. The socio-economicpsychological aspect was found to be statistically significant (p =0.018). Within the limitation of sample size, participating private dentists were found to be socio-economically and psychologically affected by the COVID19 pandemic.