Malaysian Journal of Medical Sciences

Published by Penerbit Universiti Sains Malaysia
Online ISSN: 2180-4303
Absorbed dose to water was measured with ionisation chambers NE 2561 (#267), NE 2581 (#334), NE 2571 (#1028), using the IAEA standard water phantom. The ionisation chamber was inserted in the water phantom at a reference depth dependent on the type of the radiation quality used. Three radiation qualities were used namely 1.25 MeV gamma ray, 6 MV x-rays and 10 MV x-rays. The values of the absorbed dose to water were determined by the N(K)- and N(X)- based methods, i.e with the use of IAEA, HPA, NACP, AAPM, NCRP and ICRU protocols. The aim of this study was to make an intercomparison of the results, by taking the IAEA protocol as a standard. The largest deviation contributed by any of these protocols was recorded for each quality. It was found that AAPM, NCRP and ICRU protocols contributed 0.94% for 1.25 MeV gamma ray, NACP contributed 2.12% for the 6 MV x-rays, and NACP contributed 2.35% for 10 MV x-rays. Since the acceptable limit of deviation set by the IAEA for this absorbed dose work is ± 3%, it is clear that the overall deviations obtained were all satisfactory.
Immunohistochemistry staining of the Bax protein in breast cancer tissue. A: The protein expression levels (stained brown) were assessed in both tumour cells (T) and normal cells (N) (40× magnification). B: Immunopositive and immunonegative cells within the tumour sections (100× magnification). C: Immunopositive and immunonegative cells within the tumour sections (400× magnification). 
Frequencies of the mtDNA 10398 variant in the Malay population.
The expression of Bax and Bcl-2 (immunopositive score) in breast cancer cells in relation to the 10398 variant. 
The mitochondrial DNA (mtDNA) 10398 polymorphism is hypothesised to alter a mitochondrial subunit of the electron transfer chain and is associated with several neurodegenerative disorders and cancers. In this study, an mtDNA polymorphism at nucleotide position 10398 was screened in 101 Malay female patients with invasive breast cancer and 90 age-matched healthy female controls using minisequencing analysis. The Malay women with the 10398G variant showed a significantly increased risk of invasive breast cancer (OR = 2.29, 95% CI 1.25-4.20, P = 0.007). Immunohistochemistry analysis was conducted to investigate the effect of this polymorphism on the levels of apoptosis in breast cancer cells. The level of Bax (a pro-apoptotic protein) expression was significantly higher than that of Bcl-2 (an anti-apoptotic protein) in patients carrying the G allele (P = 0.016) but not in those carrying the A allele (P = 0.48). Based on these findings, we propose that the mtDNA 10398 polymorphism may be a potential risk marker for breast cancer susceptibility in the Malay population.
(a) Hyperdense image exceeding the heart contours in mediastinum and right shift of mediastinal structures in chest radiography. (b) Image of compression over the right atrium and SVC (red arrow) due to an external mass on transthoracic color Doppler echocardiographic imaging (RA: right atrium, LA: left atrium, SVC: superior vena cava).  
(a) Dense hypermetabolic conglomerated lymphadenomegaly consistent with lymphoproliferative malignant pathology was found in supradiaphragmatic and infradiaphragmatic localizations (arrows) in fluorine-18-fluorodeoxyglucose positron emission tomography. (b) Microscopic picture of the lymph node biopsy. CD3 immunohistochemistry staining on the blastic cells (arrows) 40× magnification.  
Superior vena cava syndrome (SVCS) is rare in infants. Non-Hodgkin lymphoma is the most common cause of SVCS in children. Swelling in the face and neck are the most common clinical symptoms associated with this syndrome. However, these clinical findings are also observed in allergic diseases, which therefore often leads to misdiagnosis. Here, we reported the importance of echocardiography in diagnosing SVCS in an infant with advanced stage non-Hodgkin lymphoma.
Important practical issues prior to administration of RAI Adapted from The Society of Nuclear Medicine Guidelines (18) Informed consent must be obtained after adequate discussion of the issues outlined below 
Graves' disease is a common cause of hyperthyroidism. Treatment options for Graves' disease include antithyroid medication, surgery or radioactive iodine (I-31) or RAI. This review will focus on the approach to RAI therapy; discussing dose selection, patient preparation, and consideration before and after administering RAI, examining aspects of pre-treatment with antithyroid medication as well as discussing possible adverse events including hypothyroidism and possible worsening of thyroid-associated opthalmopathy. Follow-up is lifelong with the aim of ensuring the patient remains euthyroid or on replacement therapy if there is evidence of hypothyroidism. While there are controversies in treatment of thyrotoxicosis with RAI, with appropriate patient selection and regular follow-up, radioiodine is a safe and effective modality in achieving high cure rates.
Traumatic Brain Injury (TBI) in children has been poorly studied, and the literature is limited. We evaluated 146 children with severe TBI (coma score less than 8) in an attempt to establish the prognostic factors of severe TBI in children. The severity of TBI was assessed via modified Glasgow Coma Score for those more than 3 years old and via Children Coma Score for those under 3 years old. Clinical presentations, laboratory parameters and features of Computerised Tomography brain scans were analyzed. Outcomes were assessed at 6 months with the Pediatric Cerebral Performance Categories Scale; the outcomes were categorised as good or poor outcomes. Correlations with outcome were evaluated using univariate and multivariate logistic models. A low coma score upon admission was independently associated with poor outcome. The presence of diabetes insipidus within 3 days post-TBI (OR: 1.9), hyperglycaemia (OR: 1.2), prolonged PT ratio (OR: 2.3) and leukocytosis (OR: 1.1) were associated with poorer outcome. Knowledge of these prognostic factors helps neurosurgeons and neurocritical care specialists to manage and improve outcome in severe TBI in children.
Submission of manuscripts to the Malaysian Journal of Medical Sciences from 1 January to                                31 December 2011, according to month of submission. 
Submission of manuscripts to the Malaysian Journal of Medical Sciences from 1 January to                                                                                    31 December 2011, according to manuscript type. 
Malaysian Journal of Medical Sciences Quick Response Code. 
As a small-although growing-journal based in Malaysia, the Malaysian Journal of Medical Sciences (MJMS) has faced several challenges in the past, such as promoting our journal as well as making sure our article bank does not go empty. However, we strive to improve ourselves by taking all means necessary to increase the quantity and, most importantly, quality of our publications, as well as to increase our journal's visibility and citability. This editorial will focus on MJMS statistics throughout 2011-where MJMS turned 18-as well as future plans for our journal.
This paper investigates the pattern of sexual offence cases attended at the One Stop Crisis Center (OSCC) of the Accident and Emergency Department, Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 439 reported sexual offence cases were examined over a period of 4 years from 2000 to 2003. Sexual offence constituted by male partner or boyfriend in 18.9%, by relatives in 27.3% and by "others" in 53.8% of cases. Only 0.7% of victims did not attempt to lodge a police report. There is a significant relationship between occupation and the risk of experiencing sexual violence. Students were mostly targeted by the perpetrator throughout the study period. Among the offences, rape cases were the highest in number, among those who attended at the OSCC, HUSM with a total of 72.7%; followed by 27.3% of incest; 26.4% of child sexual abuse; 4.8% of sodomy and lastly 1.6% of gerontophilia cases. Only 70% of the specimens obtained from sexual offences victims were sent for laboratory analysis. The result remained negative in 82.4% specimens and thus the laboratory analysis result is merely functioning as a supportive evidence for sexual offence cases attended at OSCC. The studies showed that most of the sexual assault perpetrators were known to the victims. The place of crime was also known to the perpetrators. Health sectors of various levels should be working in conjunction to promote a societal changes to improve more of the women's right and thus to reduce the violence crime.
Our purpose is to report on the epidemiological variables and their association with the results of the exercise tolerance test (ETT) in the series of patients referred for standard diagnostic ETT at Seremban Hospital during the year 2001. ETT is widely performed, but, in Malaysia, an analysis of the associations between the epidemiological data and the results of the ETT has not been presented. All patients referred for ETT at Seremban Hospital who underwent exercise treadmill tests for the year 2001 were taken as the study population. Demographic details and patients with established heart disease (i.e. prior coronary bypass surgery, myocardial infarction, or congestive heart failure) were noted. Clinical and ETT variables were collected retrospectively from the hospital records. Testing and data management were performed in a standardized fashion with a computer-assisted protocol. This study showed that there was no significant predictive epidemiological variable on the results of the ETT. However, it was found that there was statistically significant difference between the peak exercise time of males and females undergoing the ETT.
Analysis of demographic and clinical data according to the severity of traumatic brain injury 
Analysis of the patients' outcomes and blood glucose levels 
Traumatic brain injury (TBI) has been associated with an acute stress response mediated by the sympathoadrenomedullary axis, which can be assessed by measuring blood glucose level. This prospective observational study was conducted for a year in 2007 among 294 patients who had been treated for TBI in Hospital Kuala Lumpur. Patients fulfilling the set criteria were recruited into the study and data, including blood glucose level and Glasgow Outcome Score at 3-month follow-up, were collected. 294 patients were included in the study: 50 females (17.0%) and 244 males (83.0%). The majority of cases were young adult patients (mean age of 34.2 years, SD 13.0). The mean blood glucose level during admission and post-surgery were 6.26 mmol/L (SD 1.30, n = 294) and 6.66 mmol/L (SD 1.44, n = 261), respectively. Specifically, the mean admission glucose level associated with mild TBI was 5.04 mmol/L (SD 0.71); moderate TBI, 5.78 mmol/L (SD 1.02); and severe TBI, 7.04 mmol/L (SD 1.18). The mean admission glucose level associated with a poor outcome in patients with isolated TBI was 6.98 mmol/L (SD 1.21). Patients with admission glucose of 5.56 mmol/L (SD 1.21) were more likely to have a favourable outcome. Mild, moderate, and severe TBI were associated with an increase in blood glucose levels during admission, and the mean increase in glucose levels is based on the severity of the isolated TBI. Surgical intervention did not cause further significant changes in blood glucose levels. Patients with isolated TBI and minimal increases in blood glucose levels were more likely to have a favourable outcome.
Genotyping of CYP2B6 variants by PCR-RFLP analysed with 2% agarose gel electrophoresis: (a) show the fragments after digestion with Hae II of the PCR product for identification of CYP2B68 *2 (c. 64C>T) variant. (b) show the fragments after digestion with Bgl II of the PCR product for identification of CYP2B6*5 (c.1459C>T). (c) show the fragments after digestion with Hae II of the PCR product for identification of CYP2B6*3 (c.777C>A). (d) show the fragments after digestion with Sty I of the PCR product for identification of CYP2B6*4 (c.785A>G) and (e) fragments of the PCR product after digestion with Bsr I for identification of CYP2B6*9 (c.516G>T). *1/*1 - represent a typical profile for subject genotyped as homozygous wild type; *1/*2, *1/*5, *1/*4, *1/*9 - represent a profile for a single subject genotyped as heterozygous; *4/*4, *9/*9 - represent a typical profile for subject genotyped as homozygous mutant. 
Genotyping method for CYP2B6 and CYP2C8 polymorphisms by PCR-RFLP
Allele and genotype frequencies and percentage of SNPs of CYP2B6 and CYP2C8 genes in study population
Abbreviations: bp = base pairs, wt = wild type, mt = variant type.
The cytochrome P450 enzymes (CYP) play an important role in the metabolism of many therapeutic agents. The activities of different enzymes exhibit variability in different populations, which causes variations in drug response or toxicity. The CYP2B6 and CYP2C8 enzymes are encoded by polymorphic genes characterised by different single nucleotide polymorphisms (SNPs). Several of these CYP variants are often associated with slow metabolism phenotypes. This study aimed to analyse the frequencies of allelic variants of CYP2B6 and CYP2C8 in the Mozambican population. Using a polymerase chain reaction and restriction fragment length polymorphism assay (PCR-RFLP), the frequencies of the allelic variants of CYP2B6 (c.64C>T, c.516G>T, c.777C>A, c.785A>G, c.1459C>T) and CYP2C8 (c.805A>T, c.416G>A, c.1196A>G, c.792C>G) were determined in 360 Mozambican blood donors. The frequencies of the allelic variants of the CYP2B6 gene were 0.057, 0.426, 0.0, 0.410, and 0.004. For the CYP2C8 gene, the frequencies of the allelic variants were 0.160, 0.048, 0.0, and 0.005. No significant differences were observed between the gender and geographic distribution of volunteers around the country. The frequencies of the allelic variants of the CYP2B6 and CYP2C8 genes were found to be homogeneously distributed in the Mozambican population and were comparable to other African populations. Further studies are required to explore the impact of these variants on the clinical response (efficacy and toxicity) of drugs, including antimalarials.
Mouse embryonic stem cell differentiation after neural induction at (a) day 0 (mouse embryonic stem cells), (b) day 3 (neural progenitor cells), (c) day 7 (precursor cells), (d) day 11 (immature neural cells), (e) day 17 (immature/differentiating neural cells) and (f) day 22 (differentiating/mature neural cells). The scale bar represents 50 µm for all micrographs except for (c), which represents 100 µm. 
Summary of primers used for RT-PCR analysis 
(a,b) Immunocytochemistry at day 7 after induction by using antibody against Tuj1 the special marker for immature neurones. (c,d) Sox1 expression was detected on cells 7 days after neural induction. 46C transgenic mouse embryonic stem cells bear a knock-in GFP (green fluorescent protein) that fluoresce under UV excitation, which served as a reporter gene that represent the expression of Sox1. PI denotes propidium iodide and the scale bar represents 50 µm for micrographs (a) and (b) whereas represents 100 µm for micrographs (c) and (d). 
Semi quantitative RT-PCR cells on total RNAs purified from mES cells on day 0, 3, 7, 11, 17, and 22 after neural induction for various markers and miR-3099 expression. 
MicroRNAs (miRNAs) have a crucial role in gene expression regulation and protein synthesis, especially in the central nervous system. In developing mouse embryos a novel miRNA, miR-3099, is highly expressed, particularly in the central nervous system. This study aims to determine the expression of miR-3099 during cellular differentiation of 46C mouse embryonic stem cells after neural induction with N2/B27 medium. 46C mouse embryonic stem cells were subjected to neural induction with N2/B27 medium. At 0, 3, 7, 11, 17, and 22 days after neural induction, the cells were screened for various pluripotent, progenitor, and differentiating/differentiated cells markers by immunocytochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR). Stem-loop pulse RT-PCR was performed to determine the expression of miR-3099 at all selected time points after neural induction. Our findings showed that after induction, mouse embryonic stem cells differentiated into heterogeneous pools of cells containing neurons, astrocytes, and oligodendrocytes. Mouse embryonic stem cells and neural progenitor/precursor cells were also present in culture up to day 22 as indicated by RT-PCR analysis. Elucidation of miR-3099 expression during in vitro neural induction revealed that this miRNA was expressed throughout the differentiation process of 46C mouse embryonic stem cells. miR-3099 was expressed at higher levels on day 11, 17, and 22 as compared to day 0, 3 and 7 after neural induction. The level of miR-3099 expression was higher in differentiated mouse embryonic stem cells after neural induction. This finding suggested that miR-3099 might play a role in regulating neural stem cell differentiation. However, further characterisation of miR-3099 in a better characterised or optimised differentiated neural stem cell culture would provide increased understanding of the cellular function and molecular targets of miR-3099, especially in neuron development.
Thyrotoxic Periodic Paralysis (TPP) is a rare and life threatening condition commonly occurring in young Asian males. It is characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Serum potassium levels may be normal in rare cases of TPP. The diagnosis of normokalemic TPP may be overlooked and/or delayed in most cases. Here, we describe a 32-year-old Iranian man with normokalemic TPP misdiagnosed as somatization disorder with the correct diagnosis made one year after the onset of symptoms.
This study was done compare the accuracy of non-contrast enhanced 3D time of flight magnetic resonance angiography (3D TOF MRA) with intraarterial digital subtraction angiography (IADSA) in depicting the arterial segments of the circle of Willis. 398 arterial segments were analysed from 38 patients who underwent both non-contrast enhanced 3D TOF MRA and IADSA examinations in Hospital Universiti Sains Malaysia from November 1998 to December 2000. Two observers performed blinded retrospective analysis of the IADSA images and Maximum Intensity Projection display of the 3D TOF MRA of the circle of Willis on separate sessions. Non-contrast enhanced 3D TOF MRA was sensitive and specific in depicting the A1, A2, M1, P1 and Anterior Communicating segments of the circle of Willis with a sensitivity ranging from 94.5% to 100% and specificity ranging from 90.5% to 100%. However it was poor in depicting the Posterior Communicating segments with a sensitivity of 21.4%. MIP display of the non-contrast enhanced 3D TOF MRA is sensitive in depicting the anatomy of the circle of Willis except for the PCOM segment. It is thus a reliable method for screening of this arterial circle.
A 66-year-old Malay woman, known hypertensive, presented with post menopausal bleeding associated with clot for three months. She was postmenopausal for last ten years. She also complaints of developing a mass in the abdomen which was growing in size also for last three months. Abdominal examination revealed a twenty week size mass, movable from side to side but unable to get below the mass. Vaginal examination revealed a fleshy fungating mass arising from the uterus coming out through the vagina. Cervix could not be visualized properly. Subsequent histopathology of the removed mass was reported as a Malignant Mixed Mullerian Tumour - Heterologous.
Ultrasound image showing the intra abdominal cystic mass. 
Outcome of the babies during delivery and neonatal period
Ultrasound image showing turbulence flow on colour Doppler in the   cystic mass. 
Literature review of umbilical vein varix in multiple pregnancy
A 30-years-old Taiwanese female in her second pregnancy spontaneously conceived a monochorionic twin pregnancy. A routine ultrasound at 27 weeks of gestation revealed a selective intrauterine growth restriction (sIUGR) fetus and an appropriate gestational age (AGA) fetus. The AGA fetus was found to have a fetal intra-abdominal umbilical vein (FIUV) varix. Serial ultrasounds showed no changes in the FIUV varix. 2 weeks later, the pregnancy progressed to twin-twin transfusion syndrome (TTTS). Repeated amnioreductions were required at 29 and 30 weeks gestation. The babies were delivered by caesarean section at 31 weeks due to fetal distress in the sIUGR fetus. Both fetuses survived the neonatal period with problems of prematurity. The FIUV varix disappeared a few days after delivery.
Ventriculoperitoneal shunt tip protruding periorally  
Abdominal X-ray showing ventriculoperitoneal shunt tip perforating the stomach and migrating up the oesophagus (black arrow)  
Chest X-ray showing ventriculoperitoneal shunt tip ascending the oesophagus (black arrow). Right-sided ventriculopleural shunt could be seen (white arrow)  
A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies. The ventriculopleural (VP(L)) shunt inserted for hydrocephalus was complicated by pleural effusion, for which a ventriculoperitoneal (VP) shunt was inserted on the contralateral side. He subsequently presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract. The child also had a history of peritonitis post-exomphalos repair, which may have predisposed him to this relatively uncommon shunt complication. Probable causes and risk factors of the perforation are discussed.
Cyst wall composed of fibrocollagenous tissue (arrow)  
Abdominal cocoon or sclerosing encapsulating peritonitis is a rare condition. A 46 year old Malay woman with adenomyosis and leiomyomata of the uterus and ovarian endometriotic cyst in association with abdominal cocoon is reported.
Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.
Screening of the entire human genome using high-density single nucleotide polymorphism array (SNPA) has become a powerful technique used in cancer genetics and population genetics studies. The GeneChip® Mapping Array, introduced by Affymetrix, is one SNPA platform utilised for genotyping studies. This GeneChip system allows researchers to gain a comprehensive view of cancer biology on a single platform for the quantification of chromosomal amplifications, deletions, and loss of heterozygosity or for allelic imbalance studies. Importantly, this array analysis has the potential to reveal novel genetic findings involved in the multistep development of cancer. Given the importance of genetic factors in leukaemogenesis and the usefulness of screening the whole genome, SNPA analysis has been utilised in many studies to characterise genetic aberrations in childhood acute lymphoblastic leukaemia.
Demographic and laboratory characteristics of controls and hypercholesterolaemic patients Controls n = 20 Hypercholesterolaemic patients n = 17 
Post-occlusive skin reactive hyperaemia (PORH) is a model used to assess microvascular reactivity. This study aims to compare PORH response among pregnant hypercholesterolaemic patients with age and gestational age-matched controls. This cross sectional study involved 17 hypercholesterolaemic, pregnant women and 20 pregnant controls entering their early third trimester. Laser Doppler fluximetry (LDF) was used to measure skin perfusion. The process of PORH was performed by occluding the upper arm with an occlusion cuff at 200 mmHg for 3 minutes. Skin perfusion was recorded before, during, and after occlusion release. Baseline perfusion, time to achieve peak perfusion (Tp), peak perfusion after occlusion release (PORH(peak)), and maximum change in perfusion due to occlusion (PORH(max)) were recorded. Serum total cholesterol (TC) was significantly different (P < 0.001) between the 2 groups: 7.25 (SEM 0.18) mmol/L for hypercholesterolaemic women and 5.54 (SEM 0.15) mmol/L for the control group. There were no significant differences in their baseline, PORH(peak), and PORH(max). However, Tp in the hypercholesterolaemic group was significantly increased (P = 0.024) compared with the controls at 14.9 (SEM 0.6) seconds and 13.1 (SEM 0.5) seconds, respectively. Pregnant hypercholesterolaemic patients showed an abnormal microvascular reactivity response. Tp with ischemia was significantly increased compared with normocholesterolaemic controls.
Association between eLP andfacial profile abnormality (outcome variable) adjustedfor race, gender and age using Multiple Logistic Regressiono ! Variable Adjusted OR (95% CI) LR statistic (df) p-value 
Distribution of skeletal profile in Shrophire children age 11-12 years
This study was done to determine the prevalence of dental anomalies and facial profile abnormality and its association with the non-syndromic cleft lip and palate (CLP) as compared to the non-cleft children. A comparative cross sectional study was conducted where the case group consist of 98 non-syndromic CLP children-unilateral (UCLP) and bilateral (BCLP) who attended the Combined Clinic at Kota Bharu Dental Clinic (KBDC) while the comparison group comprised of 109 non-cleft children who attended the outpatient clinic at KBDC. Their ages were between 3 to 12 years old. Clinical oral and facial profile examinations were carried out to look for dental anomalies (morphology, number and alignment of teeth) and facial profile abnormality. The prevalence of anomalies in morphology of teeth in CLP (24.5%) and non-cleft (10.1%), number of teeth in CLP (44.9%) and non-cleft (7.3%), mal-alignment in CLP (79.6%) and non-cleft (27.5%) and facial profile abnormality in CLP (26.5%) and non-cleft (9.1 %). There was a significant association between CLP and anomalies in morphology, number, mal-alignment and abnormality in facial profile; (p < 0.05). Therefore, there was a high prevalence and risk of dental anomalies and facial profile abnormality in the CLP children compared to the non-cleft children.
Helicobacter pylori infection is a major risk factor for chronic gastritis and gastric cancer. Some findings show increased frequencies of these diseases in individuals with type O blood and in secretors (expressing Le(b) antigen), but other studies have not found any relationship between blood groups and this infection. Given that H. pylori infection and gastric cancer are common in Iran, the assessment of the pathogenesis of this infection in relation to these blood groups could be valuable. In a cross-sectional study, we determined the ABO and Lewis blood groups of participants using the tube method and evaluated the level of anti-H. pylori immunoglobulin G using an enzyme-linked immunosorbent assay. This study included 171 Iranian blood donors from Mashhad, Iran, during 2010. The significance of the differences in the frequencies of the Lewis and ABO phenotypes between individuals infected with and without H. Pylori infection were tested using the Chi-square test. A P-value < 0.05 was considered significant. H. pylori infection was found in 76.6% of the study subjects (n = 131). The most common ABO blood group was O (33.9%), and the most common Lewis blood group was Le(a-b+) (54.7%). The frequencies of the ABO, Lewis, and secretion phenotypes were not significantly different between the infected and uninfected subjects. We did not find any significant relationship between the Lewis, ABO, and secretion phenotypes and H. pylori infection.
Representative images in coronal plane of T1WI (TE = 11 msec, TR = 440 msec) of a 63 years old male subject showing the manual tracing of left hippocampus. (a) No clear boundary identified as alvelus is not visualised, therefore the head is separated from the overlying amygdala by drawing an arbitrary line below the uncal recess; (b) The alveus is included in the mesurement; (c) The first slice of the body is identified when choroidal fissure is visualised; (d) First slice of the tail is identified when the crus of fornix is in profile.
Comparison between right and left hippocampal volumes in all subjects
Comparison of total original total hippocampal volume between genders
Normalised right and left hippocampal volume
Comparisons of our HCV values against published studies
Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. Mean right and left hippocampal volumes (HCVs) were 3.43 cm³ (SD 0.32) and 3.26 cm³ (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm³ (SD 0.31) and 3.26 cm³ (SD 0.32). The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.
CECT of the brain showing a lesion of mixed density in the region of the right Cerebello pontine angle 
Pathological slide of the patient showings areas of necrosis and nuclear pleomorphism. 
Axial T1 weighted MRI shows diffuse expansion of the pons measuring 3.2cm x 2.6 cm x 3.4cm. 
We describe rare case of a 9-year old boy who presented with a two-week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme.
The purpose of the study is to compare the two surgical methods (burr hole and craniotomy) used as treatment for superficial cerebral abscess and its outcome in terms of radiological clearance on brain CT, improvement of neurological status, the need for repeated surgery, and survival and morbidity at three months after surgery. This report is a retrospective case review of the patients who were treated surgically for superficial cerebral abscess in Hospital Kuala Lumpur (HKL) and Hospital Sultanah Aminah (HSA) over a period of four years (2004 to 2007). Fifty-one cases were included in this study: 64.7% of patients were male and 35.5% were female. Most of the patients were Malay (70.6%); 28 patients (54.9%) had undergone craniotomy and excision of abscess, and the rest had undergone burr hole aspiration as their first surgical treatment. This study reveals that patients who had undergone craniotomy and excision of abscess showed a significantly earlier improvement in neurological function, better radiological clearance and lower rate of re-surgery as compared to the burr hole aspiration group (P<0.05). However, with respect to neurological improvement at 3 months, morbidity and mortality, there is no significant difference between the two surgical methods. The significance of these findings can only be confirmed by a prospective randomised series. Further study will be required to assess the cost effectiveness, intensive care needs, and possibility of shorter antibiotic usage as compared to burr hole aspiration.
Amoebic liver abscess (ALA) with jaundice and encephalopathy is a rare occurrence and has been recognised and studied more frequently in recent years. We present a case of massive ALA presenting with jaundice, hepatic encephalopathy, and septicaemia that was treated successfully with percutaneous drainage of the abscess, right-sided chest tube insertion, and anti-amoebic therapy.
Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.
Appearance of the left eye at presentation 
Magnetic resonance imaging showing left superior ophthalmic vein thrombosis
A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.
Age-sex frequency chart of patients with peritonsillar abscess.
Site frequency chart or location of peritonsillar abscess at presentation.
Cross tabulation of age (years) with duration of presentation (days)
The aim of this study was to describe the clinico-epidemiologic profile of peritonsillar abscess (PA) seen in our center in northern Nigeria. This was a to retrospectively review of all patients with PA managed in our hospital over a 7-year period. Case notes were reviewed and information retrieved included biodata and clinical information were entered into an SPSS statistical software version 20.0 and analysed descriptively and result presented in table and figures. A total of 25 patients were seen during the study period age ranged from 2-52 years with a mean age of 25.96 years; 14.1 (SD 2.8). Male to female ratio of ≈ 1.1:1.0. Right side was affected in 60%. The period of presentation of patients with PA varied between 4-12 days with a mean duration of 6.5 days. The presenting complaints in these patients varied from sore throat alone in 4 (16%), fever and sore throat in 17 (68%), others 16%. The duration of hospital stay varied from between 1 to 8 days with mean of 4.2 days; 3.32 days (SD 1.1). All the patients had incision and drainage with no recurrence of symptoms. PA is an Ear, Nose and Throat emergency that is commoner amongst the young adult males and the modality of treatment is still incision and drainage in our setting.
Demographics of patients diagnosed with acute otitis media with mastoid abscess (Group A) 
Mastoid abscess remains a recognised complication of otitis media despite the advent of antibiotics. The objectives of this study were to describe the risk factors in patients with mastoid abscess following acute and chronic otitis media and discuss the management of this infection. A retrospective analysis was done on all patients who underwent mastoidectomy for mastoid abscess from January 2002 to December 2007. Data on the patients' presentation, associated complications, management, and follow-up were analysed. A total of 12 patients were enrolled in this study population. Group A consisted of patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial complications, and 1 patient had intracranial complications. Most patients recovered well after mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia. Mastoid abscess is still a recognised complication of acute otitis media, especially in patients who are immunocompromised. Immunocompetent patients may also develop mastoid abscess following chronic otitis media associated with cholesteatoma. Thus, early treatment of otitis media and close vigilant follow-up are advocated to ensure prompt detection of mastoid abscess complications.
Familial defective apolipoprotein B-100 (FDB) is an autosomal dominant genetic disorder associated with hypercholesterolaemia and premature coronary heart disease. FDB is caused by mutations in and around the codon 3500 of the apolipoprotein B (apo B) gene. Apo B R3500Q mutation is the first apo B mutation known to be associated with FDB and it is the most frequently reported apo B mutation in several different populations. The objective of the present study was to determine the association of apo B R3500Q mutation with elevated plasma cholesterol concentration in Kelantanese population in which both hypercholesterolaemia and coronary heart disease are common. Sixty-two Malay subjects with hyperlipidaemia, attending the lipid clinic at Hospital Universiti Sains Malaysia, Kelantan, were selected for this study. The DNA samples were analysed for the presence of apo B R3500Q mutation by polymerase chain reaction-based restriction fragment analysis method using mutagenic primers. This mutation was not detected in the subjects selected for this study. Apo B R3500Q mutation does not appear to be a common cause of hypercholesterolaemia in Kelantanese Malays.
Genetic Absence Epilepsy Rats from Strasbourg (GAERS) are a prognostic genetic model of absence epilepsy. This model displays the electro-clinical, behavioural, and pharmacological features of absence seizures. Although GAERS share typical characteristics, including spike-and-wave discharges (SWDs) in the electroencephalography (EEG), age-dependent studies with these animals have not yet been reported. The aim of the present study is to perform a systematic comparison contrasting the SWDs of young and older GAERS, in terms of the number, duration, frequency, and waveform morphology of the discharges, as well as the pre-SWD EEG characteristics, using identical measurement and analysis techniques. The number, cumulative total duration and mean duration of SWDs were significantly higher in young GAERS (4 to 6 months) compared to older GAERS (12 to 14 months). Furthermore, the SWD spectra and average SWD waveforms indicated that a single cycle of the SWD contains more energy in faster components, such as increased spikes and higher power, in the SWDs of the young GAERS. Additionally, older GAERS showed weak amplitude spikes in SWDs and higher power pre-SWDs. These clear morphological differences in the EEGs of young and older GAERS rats should be further examined in future studies that explore new dimensions of genetic absence epilepsy.
Neoplastic transformation appears to be a multi-step process in which the normal controls of cell proliferation and cell-cell interaction are lost, thus transforming normal cells into cancer. The tumorigenic process involves the interplay between oncogenes and tumour suppressor genes. In this study, we have selected the ras family, c-myc and epidermal growth factor receptor (EGFR) genes to detect whether their abnormalities are associated with the expression and progression of glioma cases in Malay patients. We have used the polymerase chain reaction-single stranded conformation polymorphism followed by direct sequencing for the study. For the ras gene family, we screened the point mutations in codons 12 and 61 of the H-, K-, and N-ras gene; for EGFR and c-myc, we analyzed only the exon 1 in glioma samples. In mutational screening analyses of the ras family, c-myc and EGFR gene, there was no mobility shift observed in any tumour analyzed. All patterns of single stranded conformation polymorphism (SSCP) band observed in tumour samples were normal compared to those in normal samples. The DNA sequencing results in all high-grade tumours showed that all base sequences were normal. All 48 patients survived after five years of treatment. In simple logistic regression analysis, variables which were found to be significant were hemiplegia (p=0.047) and response radiotherapy (p=0.003). Hemiplegics were 25 times more likely to have high pathological grade compared to those without. Patients with vascular involvement were 5.5 times more likely to have higher pathological grade. However, these findings were not significant in multivariate analysis. Patients who had radiotherapy were nearly 14 times more likely to have higher pathological grade. Multivariate analysis revealed that patients with hemiplegia were more likely to have higher pathological grade (p= 0.008). Those with higher pathological grading were 80 times more likely to have radiotherapy (p=0.004).
Distribution of female drug abusers by age and ethnic group 
The prevalence of sexually transmitted diseases (STD) among female drug abusers was studied by screening 130 new inmates of a rehabilitation centre. Data was collected using a structured questionnaire, physical examination and specimen collection for laboratory investigation at the Community Medicine Clinic of HUSM. The majority (64.6%) were Malays and self-confessed sex workers (77.7%). A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%), trichomoniasis (19.2%) and gonococcal vaginitis (8.5%) was noted. More than half of them harbour 2 or more STDs. Six subjects, of whom 5 were Malays, were HIV positive. The evidence indicates that female drug abusers need a thorough screening for STD followed by an aggressive treatment regimen. Since the majority of them were born Muslims, they should have access to spiritual counselling and rehabilitation, stressing on repentance, and adopting a compassionate and forgiving approach.
The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge. To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre. A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed. The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11-20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%). A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.
If Malaysia is to become a high-income country by 2020, it will have to transform into a knowledge-based, innovation economy. This goal will be achieved by developing an atmosphere conducive to experimentation and entrepreneurship at home; while reaching out to partners across the globe. One of Malaysia's newest partnerships is with the New York Academy of Sciences. The Academy has expertise in innovation and higher education and a long history of promoting science, education, and science-based solutions through a global network of scientists, industry-leaders, and policy-makers. Malaysia's Prime Minister, Dato' Sri Mohd Najib Tun Abdul Razak, leveraged the Academy's network to convene a science, technology, and innovation advisory council. This council would provide practical guidance to establish Malaysia as an innovation-based economy. Three initial focus areas, namely palm-oil biomass utilisation, establishment of smart communities, and capacity building in science and engineering, were established to meet short-term and long-term targets.
Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with a poor prognosis and a high mortality rate. Thus, early diagnosis and prompt surgical intervention has been recommended to improve the outcome of AAC. Herein, I present a case report of AAC complicating laparoscopic appendicectomy. Unlike previous studies that have reported the need for urgent intervention in patients with AAC, in this study, our patient responded to conservative management. Therefore, the management of AAC after laparoscopic appendicectomy should be individualised.
Computed tomography fluoroscopy showing the puncture needle (white arrow) approaching the infrarenal inferior vena cava (white arrowhead). 
Lateral radiograph showing the translumbar chemoport. The tip of the catheter is near the cavaatrial junction (black arrow), and the subcutaneous port is seen anterolaterally (white arrowhead).
Frontal radiograph showing the transhepatic subcutaneous port placement of the patient.
Left upper limb venogram showing central vein stenosis with collateral formation. 
Fluoroscopy image showing the peripherally inserted central catheter, which was treaded across a collateral vein.
Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.
Coronal reformatted contrasted computed tomography of the neck showing an opacified artery (arrowheads) demonstrating a hairpin turn that leads to a focal ovoid region of active contrast extravasation (arrow) within the neck haematoma (its inferolateral margin is marked by dotted lines).  
Digitally subtracted arteriogram of the pre-embolisation, left, external carotid artery. The artery showing contrast extravasation (arrow) is a proximal branch of the left lingual artery (arrowheads). F = left facial artery.  
Post-embolisation, digitally subtracted, selective angiography of the lingual artery shows non-opacification of the embolised artery.  
Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.
Road accident is 'a global tragedy' with ever-rising trend. The goal of this article includes review of the causes and nature of accidents, statistical data regarding road accidents and the economical impact. 1.17 million deaths occur each year worldwide due to road accidents 70 % of which occur in developing countries. 65% of deaths involve pedestrians, 35 % of which are children. Estimates suggest that 23-34 million people are injured worldwide every year in road crashes - a value almost twice that previously estimated. It is estimated that more than 200 U.S. citizens die each year due to road accidents abroad. Every year in Europe, more than 50,000 peoples are killed in road accidents, and more than 150,000 remain disabled. It is a sad fact that the total number of road accidents in Malaysia exceeded 223,000 in 1999. On the average, 16 persons died from these road accidents, every single day in 1999. Lack of attention, reckless driving, lack of proper protection, speeding, bad personal habits, social and behavioral misconduct and inconsiderate drivers of larger vehicles are some of the problems that cause accidents. In Malaysia, motorcycle fatal accidents (60%) warrant a high degree of concern. Young children and senior citizens are found to be in the vulnerable age group. In Malaysia, in 1999 alone, general insurers paid RM1.67 billion or an average of RM4.6 million a day on motor claims. It is now recognized that road traffic accidents represent a major public health problem, because of the high number of victims involved and because of the seriousness of the consequences for themselves and for their families.
Sixty primary school children, were measured for for accommodation and, vergence facility, accommodation accuracy, relative accommodation, fusional vergence / reserve and heterophoria.Analysis of Variance revealed that no - single factor was significant by involved among the six age groups for all the above (p>0.05). However, a significant age difference (p<0.05) was found in the fusional reserve. The mean and standard deviation was 20.08 (±6.43) cpm for the monocular accommodation facility, 19.77 (±6.26) cpm for the binocular accommodation facility, 20.18 (±5.00) cpm for the vergence facility, 0.44 (±0.27) D for the accommodation accuracy, -0.28 (±0.82) PD for the heterophoria at distance, -1.84 (±3.9) PD for the near heterophoria, 3.25 (±0.79) D for the negative relative accommodation, and -3.90 (±1.32) D for the positive relative accommodation.There was no age difference in the accommodation and the vergence status between years the ages of 7 and 12 years old but the fusional reserve component of the vergence system varied with age. The vergence and the accommodation findings in our subjects were discussed and compared with previous studies to serve as a guideline in clinical data interpretation and diagnosis for binocular vision problems in Malay children.
Sensitivity, specificity and accuracy of laboratory data in diagnosis of acute pyelonephritis 
Comparison of the results of diagnostic tests in relation to positive urine culture 
The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran. This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children's hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results. Within the study population, 72 patients (56.7%) were younger than two years old 9.86 months (SD 4.56) and 55 (43.3%) were older than two years old 63.58 months (SD 30.96). One hundred and two patients (80.3%) were female. There were 100 cases that had a positive U/C. Of the patients with a positive U/C, 81 had pyuria (WBC more than 5/hpf), 71 had a peripheral WBC count of more than 10 000 /mL, 95 had a CRP of more than 10 mg/L and 82 had an ESR > 10 mm/h. The sensitivity and specificity as well as the positive and negative predictive values and the accuracy of CRP when using U/C as the gold standard were, respectively, 96%, 11.1%, 80.2%, 50%, and 78%; when using ESR as the gold standard were, respectively, 55%, 40%, 77.6%, 17.2%, and 52%; and when using WBC counts as the gold standard were, respectively, 69%, 52%, 86.6%, 35.6%, and 65%. The accuracy of CRP, ESR and WBC counts when considering the DMSA as the gold standard were 58.3%, 62.8%, and 64.5%, respectively. Although acute phase reactants can help in the diagnosis of a UTI, they are not pathognomonic. CRP, ESR and WBC were neither completely sensitive nor specific for detecting a UTI and its localisation site in Iranian children. Therefore, in a country where advanced clinical diagnostic tests are available, the advanced test should be used in conjunction with CRP, ESR and WBC analyses. Finally, a combination of laboratory tests along with history and exact clinical examination are needed for the diagnosis of a UTI and its localisation site.
President Obama of the United States of America announced this April the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN for short) investment, while Professor Henry Markram's team based in the European Union will spend over a billion euros on the Human Brain Project, breaking through the unknowns in the fifth science of the decade: Neuroscience. Malaysia's growth in the same field needs to be augmented, and thus the Universiti Sains Malaysia's vision is to excel in the field of clinical brain sciences, mind sciences and neurosciences. This will naturally bring up the level of research in the country simultaneously. Thus, a center was recently established to coordinate this venture. The four-year Integrated Neuroscience Program established recently will be a sustainable source of neuroscientists for the country. We hope to establish ourselves by 2020 as a global university with neurosciences research as an important flagship.
Both vocal cords were in a paramedian position on inspiration and fixed on palpation. There were areas of granuloma on both sides of the posterior vocal cord, more notably on the left side (white arrow).  
Histology of the laryngeal biopsy (4X magnification)  
Bilateral vocal cord palsy is almost always caused by neck surgery, particularly surgery of the thyroid. We report a case of bilateral vocal cord palsy requiring emergency surgery to relieve the airway obstruction as the sole presentation of acquired syphilis. As the incidence of syphilis worldwide is rising, this unusual presentation may give clinicians a different perspective on the disease.
Amplification of the hspX gene using specific primers. Lane 1 indicates a band of 500 bp corresponding to the hspX gene. Lane 2 shows 100 bp DNA ladder.  
Recovery of the immunopurification cycles 
(a) Purification of rAcr protein: SDS-PAGE analysis of rAcr protein, purified by IMAC. Soluble fraction (Lane 1), flowthrough fraction (Lane 2), washing fraction (Lane 3), elution fraction (Lane 4). (b) Purification of rAcr protein: Western blot analysis of rAcr protein, purified by IMAC. Soluble fraction (Lane 1), flowthrough fraction (Lane 2), washing fraction (Lane 3), elution fraction (Lane 4).  
(a) SDS-PAGE analysis of the purified TBA61. Ascites (Lane 1), flowthrough fraction (Lane 2) and purified TBA61 (Lane 3). (b) Western blot analysis of the purified TBA61 employing different anti heavy chain specific mouse immunoglobulins (α IgA, α IgG, α IgM). Purified TBA61 under non reducing conditions (Lane 1), purified TBA61 under reducing conditions (Lane 2).  
(a) Reactivity of the purified TBA61 against Acr by Western blot. Purified TBA61 (Lane 1), TBG65 MAb as positive control (Lane 2), 9A11D6 MAb as negative control (Lane 3). (b) Reactivity of the purified TBA61 against Acr by indirect ELISA. TBG65 mAb as positive control, NR: 9A11D6 MAb as negative control.  
A monoclonal antibody (mAb) of the IgA isotype, designated TBA61, is specific for the Acr protein of Mycobacterium tuberculosis (MTB). TBA61 has been used in studies exploring protection against tuberculosis (TB), and its efficacy has been proven using different challenge models. To purify the mouse IgA isotype, a combination of methods, such as globulin precipitation, ion exchange, and gel filtration, is usually required to achieve a satisfactory degree of purity. To minimise the number of chromatographic steps, we proposed to employ immunoaffinity chromatography using the Acr protein of MTB as a specific ligand for this mAb. For this purpose, the HspX gene was cloned and expressed in Escherichia coli, and recombinant Acr (rAcr) was coupled to a cyanogen bromide-activated Sepharose 4B matrix, which was used to purify TBA61 mAb from ascites produced in mice in a single step. The recovery from the purification procedure was 1.46 mg per mL of ascites. Analysis by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blot showed a high purity. The purified mAb retained its reactivity against the Acr protein based on enzyme-linked immunosorbent assay (ELISA) and western blot. The purification method used is rapid, simple, and specific and can be easily scaled up.
Histopathology of the synovium (H&E) shows central area of sulphur granule containing aggregate of branching, pleomorphic rods ,surrounded by intense reaction of leucocytes. 
We report a case of actinomycosis presenting as a knee swelling in a 34 year-old man. Knee actinomycosis poses a diagnosis challenge to clinicians as it is rare, often mimics knee tuberculosis and culture of the causative microbes is technically difficult. The classic microscopic appearance of this Gram-positive bacteria often forms the basis of diagnosis.
Top-cited authors
Muhamad Saiful Bahri Yusoff
  • Universiti Sains Malaysia
Mohd Jamil Yaacob
  • Universiti Islam Antarabangsa Sultan Abdul Halim Mu'adzam Shah (UniSHAMS)
Azian Abd Aziz
  • International Islamic University Malaysia
Radhiana Hassan
Mohammed Kazem Gharib-Naseri
  • Ahvaz Jundishapur University of Medical Sciences