Trisomy X and myelodysplastic syndrome (MDS) with eosinophilia

We reported a young patient with myelodysplastic syndrome (MDS) with eosinophilia, in which her chromosomal analysis revealed the presence of trisomy X and a marker chromosome at chromosome 11. The technique used to detect the chromosomal abnormalities is a multicoloured –fluorescent in situ hybridization technique (M-FISH). Our observation suggested that these underlying chromosomal abnormalities were probably responsible for her development of MDS with eosinophilia. Myelodysplastic syndrome (MDS) is a condition whereby there is ineffective production of haematopoietic stem cells and poor quality of cells produced. The cause can either be a primary bone marrow problem, de novo or therapy related. Most MDS cases are secondary rather than primary. Many chromosomal abnormalities have been found in cases of myelodysplastic syndrome. We described a case of MDS with eosinophilia in association with presence of trisomy X and a marker chromosome in chromosome 11

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

Thrombosis at unusual sites in reproductive age group-a case series

Thrombosis is one of the causes of morbidity and mortality in women of reproductive age group. Thrombosis at unusual sites may pose diagnostic and management dilemma for health care personnel. Teamwork and good communication provide the best modalities for maximum benefits to patients. Here with, we presented case a series of thrombosis at unusual sites seen and managed in our clinic. A 35 year-old Malay lady presented with left hemiparesis while she was on oestrogen based combined contraception pills (C-OCP). Imaging studies showed extensive venous thrombosis with bilateral acute cortical infarct. Thrombophilia screening of antiphospholipid syndrome were negative. She was put on anticoagulant and stopped 2 years after the incident. A 40 year-old Malay lady presented with abdominal discomfort, lethargy and massive splenomegaly. Bone marrow and trephine examination revealed primary myelofibrosis with positive JAK2617F. Imaging study showed chronic portal vein thrombosis with portal vein hypertension, complicated by gastro-oesophageal varices. She was put on hydroxyurea and later started on ruxolitinib with banding done over her gastro-oesophageal varices. A 26 year-old Malay lady presented with serositis, mouth ulcer and anaemia symptoms. Laboratory studies were positive for systemic lupus erythematosus and negative for antiphospholipid study. Imaging study showed long segment thrombosis of right internal jugular vein with surrounding subcutaneous oedema. She is currently stable on anticoagulants and steroid. Teamwork and holistic approach is practiced in the investigation and management to provide maximum benefits for patients

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

Evaluation of Dichlorophenolindophenol (DCIP) test for Haemoglobin E (Hb E) in normal red cell indices individuals

The current cut-off value for thalassaemia screening is based on a mean corpuscular haemoglobin (MCH) level of less than 27 pg. Samples with MCH 27 pg are considered normal. However, there is a possibility of missing some types of haemoglobinopathy such as haemoglobin (Hb) E trait, by using this cut-off value. This study aimed to evaluate the dichloroindophenol (DCIP) test for Hb E carriers within healthy individuals. Methods: In total, 200 leftover blood samples with normal full blood count (FBC) results and MCH ≥ 27 pg were collected from students who were involved in the thalassaemia screening program. Blood samples were screened for Hb E by the DCIP test and subjected to haemoglobin analysis using capillary electrophoresis (CE) and gel electrophoresis. Results: Of the 200 leftover blood samples with normal FBC indices, 10 were positive for the DCIP test of which 8 had Hb E trait and 2 had Hb Constant Spring. The DCIP test showed 100% sensitivity and 98.96% specificity with a 100% negative predictive value (NPV) and an 80.0 % positive predictive value (PPV). Conclusion: The DCIP test was an excellent screening tool that, when combined with FBC parameters can produce better results, particularly in areas with a high Hb E incidence

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

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

Clinical utility of extended monocytes parameters as a screening tool in suspected dengue infection

Introduction: Increased monocyte percentage and monocyte anisocytosis were suggested as new markers for dengue fever detection. This study aims to investigate and evaluate monocyte volume standard deviation (MoV-SD) and monocyte percentage (Mono %) parameters using Coulter automated haematology analyser as screening parameters in discriminating between dengue infection and other febrile illness. Methods: A cross-sectional laboratory analysis using suspected dengue fever patients were included in this study. The study was conducted in the Department of Pathology, Hospital Tuanku Jaafar Seremban from June 2016 until June 2017. Patients were classified into dengue positive and dengue negative based on dengue IgM and NS1 result. The diagnostic performance of MoV-SD and Mono % was analysed by receiver operating characteristic (ROC) curve analysis. The cut-off value of the MoV-SD and Mono % was determined and evaluated with the validation group. Chi-square test was used to assess the association between the parameters. Results: 88 (48.4%) from 182 samples were confirmed to have dengue infection. ROC curve analysis showed Mono % at cut off value of 10.5 % with area under the curve (AUC) of 0.869 with 84.1% sensitivity and 84% specificity (95% CI: 0.812-0.925) and MoV-SD cut off value at 22.2 (AUC 0.776, 80.7% sensitivity, 61.7% specificity, 95% CI: 0.709-0.843) are an excellent parameters in separating dengue positive and dengue-negative patients. A cut-off value of 10.5 of Mono % and 22.2 of MoV-SD were applied to the validation group showed 83.1%, 66.4% sensitivity and 84.9%, 77.3% specificity respectively. Conclusion: MoV-SD and Mono % parameters are a potential parameter for the screening of dengue infection in acute febrile illness patients with good specificity and sensitivity

Thrombosis at unusual sites in reproductive age group: a case series

Thrombosis is one of the causes of morbidity and mortality in women of reproductive age group. Thrombosis at unusual sites may pose diagnostic and management dilemma for health care personnel. Teamwork and good communication provide the best modalities for maximum benefits to patients. Here with, we presented case a series of thrombosis at unusual sites seen and managed in our clinic. A 35 year-old Malay lady presented with left hemiparesis while she was on oestrogen based combined contraception pills (C-OCP). Imaging studies showed extensive venous thrombosis with bilateral acute cortical infarct. Thrombophilia screening of antiphospholipid syndrome were negative. She was put on anticoagulant and stopped 2 years after the incident. A 40 year-old Malay lady presented with abdominal discomfort, lethargy and massive splenomegaly. Bone marrow and trephine examination revealed primary myelofibrosis with positive JAK2617F. Imaging study showed chronic portal vein thrombosis with portal vein hypertension, complicated by gastro-oesophageal varices. She was put on hydroxyurea and later started on ruxolitinib with banding done over her gastro-oesophageal varices. A 26 year-old Malay lady presented with serositis, mouth ulcer and anaemia symptoms. Laboratory studies were positive for systemic lupus erythematosus and negative for antiphospholipid study. Imaging study showed long segment thrombosis of right internal jugular vein with surrounding subcutaneous oedema. She is currently stable on anticoagulants and steroid. Teamwork and holistic approach is practiced in the investigation and management to provide maximum benefits for patients

Anticoagulant activity of polyphenolic-polysaccharides isolated from Melastoma malabathricum L.

Melastoma malabathricum Linn. is a perennial traditional medicine plants that grows abundantly throughout Asian countries. In this study, M. malabathricum Linn. leaf hot water crude extract with anticoagulant activity was purified through solid phase extraction cartridge and examined for the bioactive chemical constituents on blood coagulation reaction. The SPE purified fractions were, respectively, designated as F1, F2, F3, and F4, and each was subjected to the activated partial thromboplastin time (APTT) anticoagulant assay. Active anticoagulant fractions (F1, F2, and F3) were subjected to chemical characterisation evaluation. Besides, neutral sugar for carbohydrate part was also examined. F1, F2, and F3 were found to significantly prolong the anticoagulant activities in the following order, F1 > F2 > F3, in a dose dependent manner. In addition, carbohydrate, hexuronic acid, and polyphenolic moiety were measured for the active anticoagulant fractions (F1, F2, and F3). The characterisation of chemical constituents revealed that all these three fractions contained acidic polysaccharides (rhamnogalacturonan, homogalacturonan, and rhamnose hexose-pectic type polysaccharide) and polyphenolics. Hence, it was concluded that the presence of high hexuronic acids and polysaccharides, as well as polyphenolics in traditional medicinal plant, M. malabathricum, played a role in prolonging blood clotting in the intrinsic pathway