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INTRODUCTION: Acute myeloid leukaemia is a haematological malignancy with diverse cytogenetic abnormalities and molecular mutations. Amongst the important mutations are FMS-related tyrosine kinase 3 (FLT3) and nucleophosmin 1 (NPM1) gene mutations. These mutations have been shown to be of prognostic significance. A cross-sectional study to examine the frequency of these mutations and their association with the haematological and cytogenetic characteristics of the cases was carried out in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: A total of 43 cases were included in the study. Polymerase chain reaction-based assays were employed for mutation detection from the retrieved trephine biopsy tissue blocks. Mutation positivity was subsequently validated by Sanger DNA sequencing. RESULTS: Six of the 43 cases (14.0%) of the acute myeloid leukaemia were positive for FLT3-type internal tandem duplications (FLT3-ITD) and a similar proportion (6/43, 14.0%) were positive for NPM1 mutations. FLT3 mutations at codon D835 (FLT3-D835) mutation was identified in three of the cases (7.0%) while concurrent mutations of NPM1 and FLT3-ITD were seen in two of the mutation-positive cases (4.7%). The total white cell count was found to be significantly higher in patients with FLT3 mutations (p=0.001). Other haematological parameters and the cytogenetic results did not reveal any significant association with the mutational status. CONCLUSION: The frequency of FLT3-ITD, FLT3-D835, and NPM1 mutations among AML patients were 14%, 7%, and 14% respectively. Follow-up studies to include the clinical parameters and the treatment outcomes are advocated.

Atherosclerosis is a chronic inflammatory disease and high serum cholesterol proven as the main trigger of its pathogenesis. Development of atherosclerotic lesions is closely related to the level of serum cholesterol. Expression of adhesion molecules has been correlated with the extent of aortic lesions. Serum circulating forms of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) have been detected in high levels in vascular inflammatory diseases. Honey has been shown to diminish the expression of VCAM-1 in vascular endothelium. Thirty-six male New Zealand white (NZW) rabbits were grouped into: normal diet (C), normal diet with 0.6 g/kg/ day of Trihoney (C+H), 1% cholesterol diet (HCD), 1% cholesterol diet with 0.3 g/kg/day of Trihoney (HCD+H1), 1% cholesterol diet with 0.6 g/kg/day of Trihoney (HCD+H2) and 1% cholesterol diet with 2 mg/kg/day of atorvastatin (HCD+At). Animals were sacrificed after 12 weeks of treatment. Serum was analysed for lipids, ICAM-1 and VCAM-1. Atherosclerotic plaques in the aorta were quantified. Serum ICAM-1 and VCAM-1 were significantly elevated in the HCD group when compared to the control groups. Groups Supplemented with Trihoney showed a significant suppression of serum ICAM-1 and VCAM-1 in comparison to the HCD group. Serum ICAM-1 and VCAM-1 exhibited a significant positive correlation with serum cholesterol. Serum VCAM-1 showed a significant positive correlation with the percentage of aortic lesions. Results of this study showed that Trihoney has anti-atherosclerotic potential through suppression of adhesion molecules. Trihoney was comparable to atorvastatin and may be suggested as an adjuvant remedy for protection against atherosclerosis.

Madura foot or mycetoma pedis is a chronic granulomatous disease of the foot caused by fungus or gram-positive aerobic bacteria. It is commonly encountered in tropical and subtropical countries but is rare in Malaysia. We reported a 40-year-old Rohingya refugee who has been resident in Malaysia for the past 11 years presented with a long-standing left foot mass that was proven to be a eumycetoma. A wide local excision of the mass and full-thickness skin graft were done, followed by a course of 6-month postoperative itraconazole. He subsequently recovered well without sequela. A high index of suspicion should be raised in a patient presenting with a chronic mass and discharging sinus in order to diagnose and treat mycetoma as early initiation of therapy leads to better outcomes. Based on literature review, we propose a new classification of eumycetoma and its treatment guideline.

Primary non-Hodgkin lymphoma arising from the spine is exceedingly rare. Spinal cord compression can be the first presentation of a patient with primary spinal non-Hodgkin lymphoma. Due to its rarity and vague clinical presentation, the diagnosis can be confused with tuberculosis of the spine, a more common disease in this country. We present a case of primary thoracic spine B-cell lymphoma in a 45-year-old lady who presented with spinal cord compression. This case highlights the importance of obtaining histopathological samples for examination and the treating physician should be vigilant on this rare cause of spinal cord compression. Treatment can be initiated promptly once the diagnosis is established as primary spinal non-Hodgkin lymphoma carries a dire prognosis.

Aquilaria malaccensis or commonly known as ‘gaharu’ is a species of Aquilaria genus and belongs to the Thymelaeaceae family. It is widely distributed in Malaysia, Indonesia, and the Borneo Islands. Traditionally, its leaves were used to relieve bruises and studies have shown that they function as an antioxidant, aphrodisiac, and tranquilizer. Despite its proven beneficial medicinal properties, information regarding its toxicity is limited. Therefore, we performed a safety evaluation on the aqueous A. malaccensis leaves extract (AMAE) in Sprague Dawley rats. The assessment of acute toxicity based on the Organization for Economic Cooperation and Development (OECD) Guideline 420 revealed that AMAE did not influence mortality, clinical appearance, body weight gain, or necropsy findings at a dose of 2000 mg/kg body weight. In the sub-acute toxicity, all doses did not significantly modify the body weight and food and water intake. In male rats treated with 2000 mg/kg, there was a significant reduction in the relative weight of liver. Not only that, an increase in alkaline phosphatase and alanine transaminase was also observed in different groups among the female rats. A significant decrease in the creatinine level was also seen among male rats administered with different doses of AMAE. In both sexes, histopathological analysis had shown abnormalities in the liver and kidney of rats treated at the dose of 2000 mg/kg. In conclusion, the 50% lethal dose (LD50) of AMAE was estimated to be greater than 2000 mg/kg. In sub-acute duration, the findings suggested that AMAE administered orally is slightly toxic at higher doses (2000 mg/kg) and could provoke functional and structural changes in the kidney and liver of rats. Thus, the extract should be used with caution.

INTRODUCTION: The deficient mismatch repair (dMMR) status of colorectal cancer (CRC) is the hallmark of a defective DNA mismatch repair (MMR) system. Immunohistochemistry (IHC) indirectly detects the affected gene by the loss of its protein product. This study aimed to assess the frequency of different types of dMMR status and associate them with the clinicopathological characteristics of CRC patients diagnosed at Hospital Tengku Ampuan Afzan (HTAA) and the Sultan Ahmad Shah Medical Centre (SASMEC) using an immunohistochemical method. MATERIAL AND METHODS: Formalin-fixed paraffin-embedded (FFPE) tissue blocks of 123 CRC cases were retrieved from the Pathology Department of HTAA and SASMEC for patients diagnosed between 1 January 2017 and 31 December 2018. IHC was performed manually using an Envision Flex Polymer detection kit (Dako) along with four primary anti-mouse antibodies (MLH1, PMS2, MSH2, and MSH6) for the MMR proteins to assess dMMR status. RESULTS: Out of 123 cases, 21 (17.07%) showed the loss of one or more MMR protein expression and were dMMR. There was no statistically significant association between pMMR (proficient Mismatch repair) and dMMR cases with regards to clinicopathological factors (age, sex, race, site of the tumour, TNM (Tumour Node Metastasis) staging, bowel wall invasion, lymph node metastasis, lymphovascular invasion, histological type, and tumour differentiation). CONCLUSION: IHC is the preferred method and most reproducible test for assessing dMMR status in CRC patients in the histopathology diagnostic laboratory.

Introduction: Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery.

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disorder worldwide with no curative therapy. The aim of this study was to investigate the hepatoprotective effects of a novel Trihoney against biochemical and histological manifestations of NAFLD in hypercholesterolemic rabbits. Methodology. Forty-eight male New Zealand white (NZW) rabbits were grouped into normal diet (C), normal diet with 0.6 g/kg/day of Trihoney (C + H), 1% cholesterol diet (HCD), 1% cholesterol diet with 0.3 g/kg/day of Trihoney (HCD + H1), 1% cholesterol diet with 0.6 g/kg/day of Trihoney (HCD + H2), and 1% cholesterol diet with 2 mg/kg/day of atorvastatin (HCD + At.). Animals were sacrificed after 12 weeks of treatment. Serum lipids and liver function test (LFT) were measured prior to and at the endpoint of the experiment for total cholesterol (TC), low-density lipoprotein (LDL-c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total bilirubin (T. Bil.). Liver was processed for histopathology study. Liver homogenate was analysed for oxidative stress parameters: superoxide dismutase (SOD), glutathione peroxidase (GPx), and malondialdehyde (MDA). Results. Lipid analysis approved the induction of hypercholesterolemia. A significant elevation (p<0.01) of serum AST and ALT levels showed by the HCD group was compared to C and C + H groups. Trihoney exhibited a significant reduction (p<0.001) of AST and ALT compared to the HCD group. Likewise, AST and ALT reduced significantly in the HCD + At. group (p<0.001). Trihoney supplementation induced significant (p<0.05) enhancement of SOD and GPx activities. Atorvastatin treatment was associated with significant (p<0.05) reduction of SOD and GPx activities in the liver. Trihoney and atorvastatin showed marked (p<0.001) reduction of hepatic lipid peroxidation. Trihoney showed histological protection against progression of NAFLD to nonalcoholic steatohepatitis (NASH). Atorvastatin exhibited no beneficial impact on hepatic architecture. Conclusion. Trihoney was able to maintain normal liver function and showed hepatoprotection against progression of NAFLD to NASH probably through hypocholesterolaemic and antioxidant functions.

Introduction: The Transfusion Unit of International Islamic University Medical Centre (IIUM MC) performs screening for red cell antibodies for all patients who are to be or might be transfused with red cell components. There are two types of red cell antibodies, the alloantibodies and autoantibodies. While the red cell autoantibodies are produced against self-antigen, the alloantibodies are the results of sensitization through transfusion or pregnancies. These antibodies are implicated in haemolytic transfusion reactions. This retrospective study examines the prevalence of red cell antibodies among patients of IIUM MC. Materials and Methods: All group cross matching and group screen and hold testing performed in IIUM MC from January 2017 to June 2018 were reviewed. Results: In total, samples of 3,712 patients were subjected to antibody screening using gel card. Twelve patients (0.32%) had positive antibody screening tests. The age ranged from 17 to 77 years. Nine (75%) patients were females. Four patients had positivity with Screening Cell I, one patient with Screening Cell II and III respectively. In the remaining patients (6/12) the antibody screening was positive for both Screening Cell I and II. In nine patients (0.24%) alloantibodies were identified, with six exhibiting multiple antibodies. The alloantibodies identified include anti-Le(a), anti-Le(b), anti-Kp(a), anti-C, anti-c, anti-E and anti-e. In three patients autoantibodies with no specificities were detected. Conclusion: Although the prevalence of red cell antibodies, specifically the alloantibodies is lower compared to other studies, the finding further reiterates the need to screen for unexpected red cell antibodies prior to red cell transfusion.

Introduction: Human are exposed to arsenic threats in several ways. Our drinking water for instance, can be hazardous due to the contamination of arsenic-based pesticide and herbicide into our water supply. The most vulnerable part of our body due to ingestion of arsenic is our gastrointestinal system. Thus, the aim of this study was to determine the effects of chronic exposure to organic arsenic (Monosodium methylarsonate, MSMA) on the surface topography of rat's colonic mucosa by using scanning electron microscope (SEM). Materials and Methods: 30 Sprague Dawley rats were given daily oral gavage of MSMA 42.13 mg/kg, which is 1/30 LD50, and 30 Sprague Dawley rats acted as control. 10 exposed rats and 10 control rats were sacrificed at regular intervals (2 months, 4 months and 6 months) and their colon specimens were examined by SEM. Results: In the control group, the colonic mucosa appeared normal with uniform size individual glandular units and has a central crypt orifice. The goblet cells were located in between the absorptive cells to produce mucous. In the exposed group, the rat's colonic mucosa showed increasing features of surface alterations such as haphazard shape of glandular units, slit-like crypt opening and less goblet cells with reduced number of microvilli. Conclusion: There were topographical changes of colonic mucosa of rats exposed to chronic low dose of organic arsenic.