“A Double-Edged Sword”: a case report on liver injury side-effect of Anti-Tuberculosis drug on liver Tuberculosis patient

Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection

A Case Report on Cholestatic Jaundice Secondary to Adverse Effect of Phaleria macrocarpa (Mahkota Dewa)

Drug induced cholestatic liver injury can posed a great diagnostic difficulty as a result of its long non-exhaustive list of potential offending causes which can be either prescribed or over-the-counter medications, such as medicinal herbs and remedies. Phaleria macrocarpa, or more commonly known as the ‘God’s crown’ by the local people of South East Asia, is not listed as one of the causes. This medicinal plant extract has been increasingly used for traditional treatment for various ailments. Here, we report a case of a young man who has no known medical illness presented with cholestatic pattern of liver injury which caused by chronic ingestion of Phaleria macrocarpa. The objective of this case report is to share the uncommon side effect of taking this traditional product which may have been under-reported due to the unknown effect

An Uncommon Cause of Leg Swelling After Exercise: A Case Report on An Unprovoked Deep Vein Thrombosis in Young Healthy Man

Antiphospholipid syndrome is a hypercoagulable autoimmune condition that predominantly affect the female and commonly manifest as arterio-venous thrombosis and recurrent miscarriage. Here, we present a unique case of a healthy young man who developed sudden onset of right leg swelling after exercise which was then found to be due to deep vein thrombosis via Doppler ultrasound. His blood investigations showed thrombocytopenia and prolonged coagulation profile. Therefore, antiphospholipid syndrome was suspected and later confirmed by positive autoimmune antibodies. He was treated with long term moderate intensity oral warfarin. The objective of this case report is to share the uncommon occurrence of an unprovoked deep vein thrombosis secondary to antiphospholipid syndrome in a healthy young man so that the possibility of deep vein thrombosis should be suspected in selected cases of non-resolving leg swelling after exercise as it can lead to fatal pulmonary embolism

“Two Stones on One Bird”: A Case Report on Severe Biphasic Anaphylaxis Masquerading as Life-Threatening Acute Asth

BACKGROUND: Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode. CASE REPORT: Here, we present a case of a young man who has childhood asthma with the last attack more than 10years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation. CONCLUSION: The objective of this case report is to emphasis the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it

Airborne fine particulate emissions from construction activities

Construction activities contribute a significant source of airborne particulate matter (PM) which causing substantial impact on air quality. This study is conducted to investigate the ambient particulate matter concentration at the construction jobsite for newly shop lot 5-storeys building in Kota Kinabalu, Malaysia. The study focusing on coarse and fine airborne particulate sizes which involved PM0.3, PM0.5, PM1 and PM2, thus to evaluate the meteorological factors namely on relative humidity, temperature and wind speed around the construction site during construction activities on PM concentrations. The study is carried out within two different construction phases to evaluate the PM emissions that sourced from the construction activities. Phase 1 is the preliminary stage of the project plan where site preparation activities are carried out, while Phase 2 is the early stage of the project plan where the superstructure construction activities will be involved. Results showed that the concentration of particulate matter collected in Phase 2 is found higher than in Phase 1, as more extensive construction activities are being carried out in Phase 2. The meteorological conditions including temperature, relative humidity and wind speed are also found to be able influenced the characterization of PM according to their sizes. Mitigation and controlling measures to alleviate the emissions of construction activities can be adopted and improved in order to reduce the atmospheric pollution that elicited by PM

Impact of school traffic on outdoor carbon monoxide levels

This paper aims to determine the relationship between carbon monoxide levels with vehicles, including types and motions of vehicles in a school traffic environment. Children are more vulnerable as they spend most of their time in school and their still-developing respiratory system makes them more susceptible to air pollution compared to adults. The research was carried out by direct measurement of carbon monoxide using MultiRAE Lite PGM-6208 and counting of vehicles manually using tally counter with different traffic flow scenarios, type of vehicles, school days, locations and in schools. From the findings, it is found that the measurements of carbon monoxide exposures were significantly greater in town schools compared to rural area; weekdays recorded much higher carbon dioxide levels compared to weekends; moving vehicles had stronger effects compared to idle vehicles; and light-duty vehicles (LDV) had highest among other types of vehicles. The results show a large impact of traffic management and transport mode on carbon monoxide exposures to school children in the schools

A Case Report on Cholestatic Jaundice Secondary to Adverse Effect of Phaleria macrocarpa (Mahkota Dewa)

Drug induced cholestatic liver injury can posed a great diagnostic difficulty as a result of its long non-exhaustive list of potential offending causes which can be either prescribed or over-the-counter medications, such as medicinal herbs and remedies. Phaleria macrocarpa, or more commonly known as the ‘God’s crown’ by the local people of South East Asia, is not listed as one of the causes. This medicinal plant extract has been increasingly used for traditional treatment for various ailments. Here, we report a case of a young man who has no known medical illness presented with cholestatic pattern of liver injury which caused by chronic ingestion of Phaleria macrocarpa. The objective of this case report is to share the uncommon side effect of taking this traditional product which may have been under-reported due to the unknown effect

Effect of heavy metal contamination on the DNA Mutation on Nepenthes plant from abandoned mine

Objective: Heavy metal contamination on water, soil, crops and including to the other living organisms, including their effects on DNA mutation in abandoned mine is highlighted in this study Methodology: In this study, 6 toxic metals, Zn, Pb, Fe, Cd, Cr and Mn in Nepenthes plants at an abandoned copper mine site were investigated. A total of 20 Nepenthes plants were collected from different sites of the abandoned mine. Metal concentration was determined using the Inductively Coupled Plasma/Optical Emission Spectrometry (ICP/OES) technique and electrophoresis gel and Inter Simple Sequence Repeat (ISSR) amplification processes for DNA mutation analysis. The total concentration trend of metal concentrations recorded with Cu (up to 88.797 mg kg–1)>Mn (39.018 mg kg–1)>Zn (30.260 mg kg–1)>Pb (8.206 mg kg–1)>Cd (0.168 mg kg–1). Results: The results also showed that concentration of heavy metals in Nepenthes plants collected from the abandoned mine were much higher than in control plants. However, the concentrations were still under the tolerance limit of heavy metals in plants except for Cu concentration. Besides, the concentration of heavy metals generally is higher in the flowers of the plants. For DNA analysis, based on the image obtained the result showed the DNA bands were located at the same location with the control Nepenthes which indicated there is no mutation occurred for the Nepenthes collected from the abandoned mine. Conclusion: From the result it is suggested that pitcher plant such Nepenthes may act as a potential phytoextraction of heavy metal from contaminated soil or water compounds at the abandoned mine

Tahap Celik Alam Sekitar Dalam Kalangan Pelajar Tingkatan Lima di Sabah

Kajian ini bertujuan untuk mengenal pasti tahap ‘Celik Alam Sekitar’ dalam kalangan pelajar di negeri Sabah. Sampel adalah terdiri daripada 110 orang responden yang dipilih secara rawak mudah dalam kalangan pelajar tingkatan 5 di sebuah sekolah menengah di daerah Tawau, Sabah. Pendekatan kuantitatif dengan teknik tinjauan digunakan dalam kajian ini. Data deskriptif yang diperolehi menunjukkan bahawa tahap elemen pembangunan mampan pada Celik Alam Sekitar adalah lebih tinggi berbanding elemen lain dalam konstruk ini. Data ini juga menunjukkan tahap Celik Alam Sekitar responden berada pada tahap tinggi (skor min= 4.20, SP= 0.30). Manakala Ujian-t menunjukkan tidak terdapat perbezaan yang signifikan bagi celik alam sekitar dalam kalangan pelajar sekolah menengah harian berdasarkan jantina walaupun perbezaan min menunjukkan pelajar perempuan melebihi daripada pelajar lelaki. Kesimpulannya, tahap celik alam sekitar bagi pelajar adalah pada tahap yang boleh dibanggakan dan responden menyetujui elemen pembangunan mapan dimasukkan dalam definisi ‘Celik Alam Sekitar’