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Aggressive variant large granular lymphocytic leukaemia: a case report

Clonal disorders of LGL may either be CD3+ CD56- or CD3- CD56+ phenotype and these have been designated as T-cell leukaemia (T-LGL) or natural killer cell (NK)-LGL leukaemia respectively. Clonality is usually demonstrated by clonal rearrangement of T-cell receptor gene rearrangement or identified by flowcytometry analysis. Most patients with T-LGL will have an indolent course. In this report we described an aggressiveness of disease in a patient with clonal CD3+ LGL leukaemia whose cells also co-expressed CD56 diagnosed by flowcytometry. The patient responded well to interrupt all standard risk protocol however succumbed to her disease while waiting for upfront stem cell transplant. This case highlights on both the classical laboratory findings of rare entity of disease as well as a review of the literature pertaining particularly on its management

Tips on housemanship you wish you knew before

Understanding what it feels like to go through the hard, challenging life as a young house officer equipped with knowledge but with zero experience, we strive to come up with the best tips and important highlights to ensure your journey through housemanship is less painful. Chapters covers all the major postings as well as providing useful insights into radiology, anaesthesiology and pathology-related matters. We have also incorporated a chapter on how to cope with housemanship. Knowing how stressful it can be - fear of the unknown, unexpected, unfamiliar working conditions in the hospital may be detrimental to those who do not posses good survival skills. This book is specially dedicated to our students who are just about to venture out into the thrilling and challenging world of housemanship

Adiponectin SNP45TG is associated with gestational diabetes mellitus

INTRODUCTION: Diabetes and pregnancy can be associated in two ways: pregnancy that occurs in women who are already diabetic (diabetes of pre-gestational origin); and diabetes that occur in women who are already pregnant [gestational diabetes mellitus (GDM) (O'sullivan 1961)]. Patients with previous GDM history have higher risk of developing diabetes outside of pregnancy. Accumulating literature had suggested that adiponectin plays a role in the pathophysiology of this metabolic syndrome, and several of the common single nucleotide polymorphisms (SNP) in adiponectin gene have been identified in type 2 diabetes. Thus, one of the commonly found SNP was studied to determine its association with GDM. OBJECTIVE: To identify the association of SNP45TG with GDM. METHODS: This is a cross-sectional study involving pregnant mothers of <18 gestational weeks, who were recruited from three local antenatal clinics in Selangor, Malaysia. Their genomic DNA was extracted from EDTA treated whole blood using commercialized kit. Adiponectin gene was amplified through conventional PCR and SNP was detected using restriction enzyme SmaI. Plasma adiponectin level, fructosamine level and HbA(1c) percentage were also examined. RESULTS: Among the 79 antenatal patients recruited, 53 patients were normal and 26 were diagnosed with GDM. Among the 53 normal patients, 18 carry TG/GG genotype. Meanwhile, among the 26 patients that were diagnosed with GDM 15 carry TG/GG genotype. Significant association was found between SNP45TG with GDM ( χ(2) = 4.038; P < 0.05). In addition, normal patients with TT genotype have significantly higher plasma adiponectin level compared to other groups. CONCLUSION: We concluded that SNP45TG in adiponectin gene is associated with the occurrence of GDM

Adiponectin and hemoglobin levels in overweight and obese pregnant mothers in early pregnancy

Introduction: Body mass index (BMI) has constantly been associated with adverse health outcomes and, to a certain extent, adverse pregnancy outcome. The combination of increased maternal adiposity and reduction in insulin sensitivity influenced by hormonal products appears to be the causative factors in insulin resistance during gestational period. Adiponectin, which is one of the adipocyte-secreted hormones, was reported to possess insulin-sensitizing properties and appears to play a role in this metabolic syndrome. Accumulating literatures also suggested that high maternal hemoglobin level has an association with increased in incidence of adverse pregnancy outcomes which included the occurrence of gestational diabetes mellitus.Objective: The main objective of our study is to evaluate the relationship between patients' BMI, which is the risk factor for most metabolic disorders, with plasma adiponectin and hemoglobin levels among the antenatal subjects in the local population.Methods: This is a cross-sectional study involving 104 pregnant mothers that were recruited from the Bangi, Kajang and Seri Kembangan polyclinics, sosiodemografic and antenatal data were collected through a simple questionnaire after informed consent taken. All patients were in their first trimester of pregnancy. Patients were subcategorized according to their BMI into 4 categories: underweight, normal weight, overweight and obese. A volume of 3ml peripheral blood aspiration was taken by trained phlebotomist. Blood plasma was separated and stored at -80°C prior to tests. Plasma adiponectin level was measured using commercialized ELISA assay kit. Hemoglobin level was determined using Sysmex KX-21 Hematology Analyzer. Results were analyzed using SPSS version 15.Results: A total of 104 patients enrolled in the study, 12 patients (11.54%) were underweight; 57 patients (54.81%) were normal weight; 25 patients (24.04%) were overweight; and 10 patients (9.62%) were obese. A significant difference in hemoglobin level was found between underweight and obese pregnant mothers, as well as between normal weight and obese pregnant mothers. A significant difference in plasma adiponectin level was found between underweight and overweight pregnant mothers, as well as between underweight and obese pregnant mothers. Significant difference in plasma adiponectin level was also found between normal weight and obese pregnant mothers.Conclusion: We concluded that increased early pregnancy BMI, is highly associated with low plasma adiponectin level and increased hemoglobin level in our local population

Prevalence, sociodemographic and clinical characteristics of G6PD deficient blood donors in Terengganu and the effects of storage on their donated blood

Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency causes red blood cell destruction due to oxidative stress. G6PD is essential for NADPH conversion; which is critical for glutathione reductase to prevent damage to cellular structures. In Malaysia, blood donors are not routinely screened for G6PD deficiency. We hypothesise that G6PD-deficient red blood cells are more likely to haemolyse during storage due to increased oxidative molecules. The objectives of this study were to determine the prevalence of G6PD deficiency among blood donors, describe their characteristics and to evaluate the effects of storage on G6PD-deficient donated blood. Methods: This study was conducted at selected mobile donation centres in Terengganu. Consented blood donors were screened for G6PD status using fluorescent spot tests (FST). G6PD enzyme activities were measured for donors who were G6PD deficient. Effects of storage on haemolysis from G6PD-deficient donors were compared with non G6PD-deficient group. Sixty ml of blood was collected from blood unit to transfer pouch for estimation of haemoglobin (Hb), plasma Hb, percentage of haemolysis and plasma potassium. Serial sampling with a 7-day interval was done from Day 1 to Day 35. Statistical analysis was considered significant if p ≤0.05. Results: A total of 440 blood donors were screened and 12 male donors were found to be G6PD deficient by FST. Enzymatic activities were measured in 11 donors as one donor sample failed to be sent to the centre due to logistic problem. Their enzymatic activities ranged from 1.66-2.93 U/g Hb whereby 6 have severe deficiency and the other 5 were categorised as partial deficiency. Donors were asymptomatic for haemolytic episode. Serial sampling showed there was no significant difference of haemolytic parameters in blood units of G6PD-deficient donors as compared to control (p>0.05). Conclusion: Prevalence of G6PD blood donors in Terengganu mobile centres was 2.7%. G6PD enzyme activities did not correlate with clinical symptoms. Haemolytic parameters were not affected in blood units which were G6PD-deficient

Usefulness of red blood cell size factor (RSf) in screening genetic variants of alpha thalassaemia thalassaemia trait regardless of iron status

Introduction: Screening for alpha (α) thalassaemia trait (TT) is challenging especially in the presence of iron deficiency (ID). Red blood cell size factor (RSf) is a parameter introduced by Beckman Coulter capable of detecting acute and chronic changes to cellular haemoglobin status and iron supply. The research aimed to investigate the clinical usefulness of RSf as screening parameter for α TT and the effect of concomitant ID to RSf mean values (m.v) among respondents with α TT. Methods: A cross-sectional retrospective laboratory analysis involved 55 respondents’ data selected from January 2014 to December 2015 in Pathology Department, Hospital Tuanku Ja’afar Seremban, Negeri Sembilan. The significant difference at p <0.05 in the RSf m.v. among respondents with α0 TT, α+ TT, and ID groups and the effect concomitant ID to RSf m.v. were determined using statistical test, one-way analysis of variance (ANOVA). Results: Significant differences were detected in RSf m.v. i) between α0 TT, α+ TT and ID, F (2, 52) = 18.99, p=0.001. ii) between α TT without ID, α TT with ID and ID cohorts for both a) α0 TT [F (2, 33) = 23.77, p=0.001) and b) α+ TT [F (2, 28) = 5.37, p=0.011]. iii) between α TT and ID group regardless of the presence of ID for both a) α0 TT and b) α+ TT. Conclusion: RSf is a potential screening parameter in evaluating patients with hypochromic microcytosis in identifying possible cases of alpha TT regardless of iron status

Evaluation of anticoagulant property of aqueous and Ethanolic Extracts of Morinda citrifolia

Anticoagulant is an agent used to treat patients with cardiovascular diseases by preventing new clots formation. It works by inhibiting blood from clotting, therefore preventing progression of thrombosis. Heparin, the animal based polysaccharides is a widely used anticoagulant has many adverse effects. This study aimed to evaluate the effects of Morinda citrifolia Aqueous Extract (MCAE) and Ethanolic Extract (MCEE) on plasma coagulation in vitro. Platelet Poor Plasma (PPP) from fifty healthy volunteers was incubated with different concentrations of extracts (10, 20, 30, 40 and 50 mg mL-1) and subjected for clotting assays of Prothrombin Time (PT) and Activated Partial Thrombosplastin Time (APTT). The samples that been incubated by MCAE and MCEE showed prolongation of PT and APTT. These findings indicated that Morinda citrifolia extracts has anticoagulant effect in vitro and also suggest that it may become a potential plant based anticoagulant which is should be effective and safe for clinical need in dealing with patient with cardiovascular disorders

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students’ clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings’ significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development