Monoclonal gammopathy with systemic amylodosis: an evaluation of diagnostic elements

Monoclonal gammopathies result from an overproduction of a single abnormal clone of plasma cell or B lymphocyte that produce an immunologically homogenous immunoglobulin (Ig) commonly referred to as paraprotein or monoclonal (M) protein. The circulating M-protein may consist of an intact immunoglobulin, the light chain only, or (rarely) the heavy chain only. The heavy chain is from one of the five immunoglobulin classes G, A, M, D or E, while the light chain is either kappa (κ) or lambda (λ) in type. Accurate detection and quantitation of monoclonal immunoglobulins is important for the diagnosis and management of monoclonal gammopathies. We report a case of a 71 year old lady with a history of chronic gastritis and recurrent lower respiratory tract infection whereby no specific diagnosis was made until a computed tomography (CT) guided lung biopsy and orogastroduodenoscopy

A case of familial phaechromocytoma- was it?

With advancement in genetic studies, familial phaeochromocytoma (PCC) and paraganglioma (PGL) are increasingly being recognized. Characteristically, correlations exist between genotypes and clinical and biochemical phenotypes. We report a phaeochromocytoma in a young patient with intriguing family histories, raising the possibility of his being a familial case

A case of hyperosmolar hyperglycaemic state with involuntary movements – diagnostic dilemma and clinical considerations

Hyperosmolar hyperglycaemic state (HHS) is a medical emergency which needs immediate medical intervention. A 37-year-old Chinese woman with a history of hypertension attended the Emergency Department. She had a two-day history of involuntary movement, i.e. chorea of the upper limbs, preceded by a one-week history of upper respiratory tract infection. She also had polyuria and polydipsia, although she was never diagnosed as diabetic. The main aim of reporting the present case was to highlight the importance of biochemical investigations involved in the diagnosis of involuntary movements

Anaemia and cognitive function among Chinese elderly in Old Folks Homes

The relationship between anaemia and cognitive function was evaluated among 35 Chinese elderly (24 men and 11 women) aged 60 to 85 years (mean age 70.1 ± 6.7 years) from five old folks homes in Klang Valley. They were interviewed to obtain information on social and health status, habitual dietary intake and cognitive function. Hodkinson’s Abbreviated Mental Test was used to measure the cognitive function. Haematological indices which included Full Blood Count (FBC), serum iron, serum ferritin, Total Iron Binding Capacity (TIBC), serum folate and serum cobalamine (vitamin B12) weremeasured using an automated analyzer. Anthropometric measurements and clinical signs of anaemia were also examined. The findings indicated that the prevalence of anaemia as assessed using haemoglobin alone was 22.9%, while iron deficiency anaemia based on low serum iron, microcytic and hypochromic criterion was detected among 5.7% of the sample. Subclinical folate and vitamin B12 deficiencies were diagnosed among 34.3% and 8.6% of the subjects. However, there was no occurrence of megaloblastic anaemia. There was a positive correlation between cognitive score with mid upper arm circumference (MUAC) (r=0.547, p<0.01) and body mass index (BMI) (r=0.501, p < 0.01). All subjects with low haemoglobin and serum iron and approximately three quarter of subjects with folate and vitamin B12 deficiencies were classified as having cognitive impairment. In conclusion, subclinical malnutrition and anaemia may play a role in the deterioration of cognitive function in the elderl

Subclinical hypothyroidism among patients with depressive disorders

Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti-thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings

Serum soluble transferrin receptor concentration as a biomarker of erythropoietic activity: surrogate marker of adequate transfusion in adult Beta-thalassaemia intermedia patients

Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron deficiency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be significantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were significantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevate sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens

Efficacy of Ganoderma lucidum on plasma lipids and lipoproteins in rats fed with high cholesterol diet

Purpose – The purpose of this paper is to report on the anti-cholesterol activities of Ganoderma lucidum on Sprague–Dawley white rats. Design/methodology/approach – Rats were divided into four groups with a sample size of six rats per groups. Different formula diets were given to each group for a period of six months. At regular intervals, blood samples were taken and analysed for the total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein (LDL-C) levels. Findings – Administration of hyperlipidemia diet in rats fed with 1 per cent cholesterol diet caused an increase in the TC, TG, as well as LDL-C level as compared to the control. A decrease of 23.6 per cent in the HDL-C level was also noted. However, supplementation of the feed with G. lucidum (0.1 per cent) in rats decreased the TC, TG and LDL-C level significantly (P < 0.05) while further increased the plasma concentration of HDL-C. In the case of rats fed with diet containing a mixture of 1 per cent cholesterol and 0.1 per cent of Ganoderma, the lipid profile showed much higher readings (p < 0.05) compared to the chol group. Practical implications – The possible efficacy of G. lucidum in reducing the deposition of cholesterol in the wall of the blood vessels was indicated. Originality/value – This article provides useful information to health care providers and consumers

The nature of apoptosis of human breast cancer cells induced by three species of genus Ganoderma P. Karst. (Aphyllophoromycetideae) crude extracts

The cytotoxic effect of crude extracts of three Ganoderma species (G. lucidum, G. tropicum, and G. tsugae) was screened against the human estrogen-independent cell line, MDA-MB-435 using a microculture tetrazolium (MTT) assay. The crude extract obtained from the fruiting body of Ganoderma lucidum by hot water extraction procedures had IC50 values ranging from 140 to 350 μg mL−1. Acridine-orange/propidium iodine staining, electron microscopy, and transmission electron microscopy showed that the crude extract caused both apoptosis and necrosis. The G. lucidum mycelial crude extract was most effective, with an IC50 value of 148 μg mL−1

Ultra-Morphological Changes of Trichophyton Rubrum Treated with Hydroxychavicol

Trichophyton rubrum is a common pathogenic fungal species that is responsible for causing infection on human skin, hair and nail. The antifungal-resistant strains complicate the treatment regime. Hydroxychavicol (HC) is one of the main compounds from Piper betel leaf that have antifungal potential and its mechanism of action has not been studied yet. The objective of this preliminary study to determine the antifungal properties of HC against T. rubrum using transmission electron microscope (TEM) on gross and ultrastructure of T. rubrum hypha. T. rubrum was treated with HC and miconazole (MI) at concentrations of 1.25, 2.5, 5 and 10 mg/mL for 1, 3, 5 and 7 days continuously. Generally, fungi structures became more severely damaged at increasing treatment duration. Microscopically, the fungi’s cell wall treated with HC showed a rough surface, shrinkage and demolition similar to the MI treated group. The fungi organelles were also demolished and disorganized. This study revealed that HC has the ability to inhibit T. rubrum growth and has potential to be an antifungal agent for skin infections

Alteration in the functional organization of the default mode network following closed non-severe traumatic brain injury

The debilitating effect of traumatic brain injury (TBI) extends years after the initial injury and hampers the recovery process and quality of life. In this study, we explore the functional reorganization of the default mode network (DMN) of those affected with non-severe TBI. Traumatic brain injury (TBI) is a wide-spectrum disease that has heterogeneous effects on its victims and impacts everyday functioning. The functional disruption of the default mode network (DMN) after TBI has been established, but its link to causal effective connectivity remains to be explored. This study investigated the differences in the DMN between healthy participants and mild and moderate TBI, in terms of functional and effective connectivity using resting-state functional magnetic resonance imaging (fMRI). Nineteen non-severe TBI (mean age 30.84 ± 14.56) and twenty-two healthy (HC; mean age 27.23 ± 6.32) participants were recruited for this study. Resting-state fMRI data were obtained at the subacute phase (mean days 40.63 ± 10.14) and analyzed for functional activation and connectivity, independent component analysis, and effective connectivity within and between the DMN. Neuropsychological tests were also performed to assess the cognitive and memory domains. Compared to the HC, the TBI group exhibited lower activation in the thalamus, as well as significant functional hypoconnectivity between DMN and LN. Within the DMN nodes, decreased activations were detected in the left inferior parietal lobule, precuneus, and right superior frontal gyrus. Altered effective connectivities were also observed in the TBI group and were linked to the diminished activation in the left parietal region and precuneus. With regard to intra-DMN connectivity within the TBI group, positive correlations were found in verbal and visual memory with the language network, while a negative correlation was found in the cognitive domain with the visual network. Our results suggested that aberrant activities and functional connectivities within the DMN and with other RSNs were accompanied by the altered effective connectivities in the TBI group. These alterations were associated with impaired cognitive and memory domains in the TBI group, in particular within the language domain. These findings may provide insight for future TBI observational and interventional research