The utility of Guillain‐Barré syndrome prognostic models in Malaysian patients

Guillain‐Barré syndrome (GBS) is an acute immune‐mediated neuropathy that has variable disease course and outcome. The Erasmus GBS outcome score (EGOS), modified EGOS (mEGOS), and Erasmus GBS respiratory insufficiency score (EGRIS) are prognostic models designed to predict the functional outcome of GBS patients at 6 months (EGOS and mEGOS) and the need for mechanical ventilation within a week of admission (EGRIS). The models were primarily developed in the Dutch GBS population, and thus the usefulness of these models in other GBS cohorts is less clear. In the current study, we aimed to validate mEGOS, EGOS, and EGRIS in Malaysian GBS patients. A total of 107 patients with GBS and its variants were consecutively recruited. Patients with GBS and Miller Fisher syndrome (MFS) were analysed separately. In the GBS cohort, high mEGOS and EGOS scores were significantly correlated with poor outcome at 6 months (mEGOS on admission: r = .381, P = .005; mEGOS at day 7 of admission: r = .507, P < .001; EGOS: r = .484, P < .001). However, there were no significant correlations between mEGOS or EGOS and outcome in patients with MFS (mEGOS on admission: r = .152, P = .523; mEGOS at day 7 of admission: r = .008, P = .973; EGOS: r = .110; P = .644). The score of EGRIS for GBS patients with mechanical ventilation was significantly higher than those patients without mechanical ventilation (4 ± 2 vs 3 ± 1; P < .001). We conclude that mEGOS and EGOS are clinically useful and relevant to the Malaysian GBS population but not in patients with classic MFS. EGRIS could be used to predict the need for mechanical ventilation in our local GBS patients.     

Bioequivalence study of two perindopril erbumine tablet formulations in healthy volunteers

The present study was performed to compare the bioavailability of two perindopril erbumine (CAS 107133-36-8) 4 mg tablet formulations (test formulation and reference formulation). This study was a randomized, single-blind, two-period, two-sequence cross-over study which included 20 healthy adult male and female subjects under fasting conditions. In this study, one subject withdrew from the study and one reserve subject did not appear at both periods. The pharmacokinetic parameters were assessed based on the concentrations of perindopril (CAS 82834-16-0) and perindoprilat (CAS 95153-31-4) because perindopril has litte pharmacologic activity until hydrolized in the liver into its active metabolite, perindoprilat. The blood samples from 18 subjects were analyzed for plasma concentrations of perindopril and perindoprilat. In each of the two study periods (separated by a washout of three weeks) a single dose of test or reference drug was administered. Plasma concentrations of the drug were determined by LC-MS/MS method. The pharmacokinetic parameters assessed in this study were area under the plasma concentration-time curve from time zero to 192 h (AUC), area under the plasma concentration-time curve from time zero to infinity (AUCinf), the peak plasma concentration of the drug (Cmax time needed to achieve the peak plasma concentration (tmax), and the elimination half-life (t(1/2)). The geometric mean ratios (90% CI) of the test drug/reference drug for perindopril and perindoprilat were 106.59% (92.97-122.20%) and 100.56% (94.11-107.46%) for AUC,, 106.64% (93.39-121.77%) and 100.88% (95.30-106.80%) for AUCinfo, and 101.23% (87.39-117.27%) and 99.30% (90.42-109.05%) for Cmax, respectively. The 90% confidence intervals calculated for AUCt and Cmax of perindopril and perindoprilat were within the standard bioequivalence range (80-125% for AUC and Cmax). It was concluded that the two perindopril erbumine tablets (test and reference drug) were bioequivalent in terms of the rate and extent of absorption.     

Effects of Stereocomplex Nuclei or Spherulites on Crystalline Morphology and Crack Behavior of Poly(L‐lactic acid)

Introduction of sc‐PLA crystals as small nuclei or large sc‐PLA spherulites has great influence on patterning the inter‐phase boundaries and reducing the cracks in crystallized PLLA in mixtures with PDLA. Unmelted sc‐PLA crystals as nuclei induce cracks in later‐crystallized PLLA, whereas co‐crystallization of PLLA with PDLA to develop simultaneous PLLA and sc‐PLA spherulites is effective in altering the inter‐phases for minimizing the cracks. PLLA co‐crystallized with sc‐PLA spherulites tends to be more compact than PLLA spherulites crystallizing on sc‐PLA nuclei. In general, the sc‐PLA spherulites suppress the occurrence of a stressed interphase in PLLA spherulites and the depth of cooling‐induced cracks is also decreased.

     

Absence of p53 Gene Expression in Selenium Molecular Prevention of Chemically Induced Hepatocarcinogenesis in Rats

Background/Aim:

p53 pathway is thought by many researchers to be critically involved in selenium''s chemoprevention or in hepatocarcinogenesis. The aim of this study was to investigate the gene expression of p53, p21 and B-cell lymphoma-2 (bcl-2) using preventive and therapeutic approaches of selenium in chemically induced hepatocarcinogenesis in rats.

Materials and Methods:

Rats were divided randomly into six groups: Negative control, positive control (diethyl nitrosamine +2-acetylaminofluorene), preventive group, preventive control (respective control for preventive group), therapeutic group and therapeutic control (respective control for therapeutic group). p53, p21 and bcl-2 genes on liver tissues were measured using real-time polymerase chain reaction.

Results:

The expression of p53 was only significant in the therapeutic control. The expression of bcl-2 was insignificant in all the groups. p21 expression was significant in all the groups except the preventive group.

Conclusions:

The selenium molecular mechanism for liver cancer prevention is not through the p53 pathway. Also, the absence of p53 is not necessary for chemically induced liver cancer in rats.     

Labisia pumila protects the bone of estrogen-deficient rat model: a histomorphometric study

Ethnopharmacological relevance

Labisia pumila var. alata (LP) is a phytoestrogenic herb with potential as an alternative to Estrogen Replacement Therapy (ERT) in the treatment of postmenopausal osteoporosis. LP has been reported to produce similar effects to ERT on the bone markers, but could not match ERT in terms of maintaining the bone calcium in postmenopausal osteoporosis rat model. This study aimed to examine in detail the effects of LP on the bone of postmenopausal osteoporosis rat model using bone histomorphometry.

Materials and methods

Thirty two female rats were randomly divided into groups of: Sham operated (Sham), ovariectomized control (OVXC), ovariectomized with Labisia pumila var. alata (LP) and ovariectomized with ERT (Premarin^®) (ERT). The LP and ERT were administered through the route of oral gavage daily at the dose of 17.5 mg/kg and 64.5 μg/kg respectively. Following 2 months of treatment, rats were euthanized and the left femurs were dissected out and prepared for bone histomorphometry.

Results

Histomorphometric analysis revealed osteoporotic changes for the ovariectomized rats. Supplementation of LP to ovariectomized rats could prevent these osteoporotic changes, as effective as ERT.

Conclusion

This confirmed that LP has potential as an alternative to ERT for prevention of postmenopausal osteoporosis.     

免疫功能正常少年患早期表现为复视的隐球菌脑膜炎1例

目的:报告免疫力正常少年的隐球菌脑膜炎1例,早期表现为复视和双眼视力低下。方法:病例报告。结果:男,17岁,两眼视物模糊并复视3wk,伴随严重的搏动性头痛、恶心、呕吐及低热。经体格检查无发热及假性脑膜炎迹象。双眼视力为6/15并视野缩窄。双眼前段正常。眼外肌运动表明双侧第六神经麻痹。眼底检查显示双侧视盘充血和轻度隆起。CT扫描大脑正常,无颅内肿块或脑室异常。腰椎穿刺发现高开放压>300mmH2O。脑脊液显微镜下及培养均存在新型隐球菌。本例由神经医疗组联合处理。患者开始静脉注射两性霉素B和氟康唑,神经症状1wk后恢复,双眼视力提高到6/6,同时周边视野恢复。随着第六神经麻痹的康复双眼复视得到好转。结论:本例强调了隐球菌脑膜炎进展缓慢的性质。即使免疫功能正常,也不会存在明显的假性脑膜炎特征,复视可能是脑膜炎患者的早期表现之一。     

Messages of the Newly Proposed Malaysian Dietary Guidelines (MDG): Do Adults in Kuala Lumpur Understand Them?

The Malaysian Dietary Guidelines (MDG) with eight key messages were first published in 1999. An updated version consisting of 14 key messages is being developed. The objective of this study was to evaluate the understanding of five key messages of the updated MDG among adults aged 18-59 years in Kuala Lumpur. A total of 773 adults comprising 330 Malays, 364 Chinese and 79 Indians were included in the study. A self-administrated questionnaire was used to obtain demographic data and to determine the level of understanding of key words and messages to be included in the new MDG. The results showed that 63% of the subjects were not aware of the existence of the MDG published in 1999. Overall, the understanding of the five messages in the updated MDG was moderate with a mean score of 60.0 ± 16.5. Between 52% to 93% of the subjects did not understand such key words as serving size, sedentary habits, blended vegetable oil and shortenings. The mean scores of understanding were significantly higher (p< 0.05) among the Chinese subjects (61.3 ± 17.8) than Malays (58.6 ± 14.2) and Indians (60.0 ± 18.9). The younger subjects (61.2 + 16.0) scored significantly (p< 0.05) higher than the older (58.7 ± 17.0) counterparts. There was also a significant association between the level of understanding of MDG with education level (p< 0.001) and occupational status (p< 0.001), respectively. This study suggests that some key words and messages in the updated MDG should be simplified to ensure that they are understood by Malaysians.     

XPC Lys939Gln polymorphism,smoking and risk of sporadic colorectal cancer among Malaysians

AIM: To investigate the risk association of xeroderma pigmentosum group C (XPC ) Lys939Gln polymorphism alone and in combination with cigarette smoking on colorectal cancer (CRC) predisposition. METHODS: Peripheral blood samples of 510 study subjects (255 CRC patients, 255 controls)were collected. DNA was extracted and genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism. The association between polymorphic genotype and CRC predisposition was determined using the OR and 95%CI. RESULTS: The frequency of the homozygous variant (Gln/Gln) genotype was significantly higher in cases compared with controls (16.0% vs 10.2%, P = 0.049). The Gln/Gln genotype of XPC showed a significantly higher association with the risk of CRC (OR = 1.884; 95%CI: 1.082-3.277; P = 0.025). In the case of allele frequencies, variant allele C was associated with a significantly increased risk of CRC (OR = 1.375; 95%CI: 1.050-1.802; P = 0.020). Moreover, the risk was markedly higher for those who were carriers of the Gln/Gln variant genotype and were also cigarette smokers (OR = 3.409; 95%CI: 1.061-10.949; P = 0.032). CONCLUSION: The XPC Gln/Gln genotype alone and in combination with smoking increases the risk of CRC among Malaysians.