MANAGEMENT OF RHEUMATOID ARTHRITIS: SPECIAL CONSIDERATION FOR BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Rheumatoid arthritis (RA) is a progressive chronic inflammatory disease affecting 0.5–1.0% of the adult population worldwide. Due to the damages caused by this autoimmune disease, new biologic therapies, particularly the biologic disease-modifying antirheumatic drugs (bDMARDs), are now being the treatment of choice in the management of RA. However, special precaution and prescreening before the usage of bDMARDs are needed to ensure better clinical response and avoiding risk of adverse event during treatment with the selected bDMARDs. In this review paper, we will provide overview on the incidence and pathogenesis of the disease, available pharmacological treatment and emphasizing special consideration in need on initiation of bDMARDs among RA patients. A literature review was performed by searching for relevant articles in Medline database through PubMed using medical subject headings terms and keywords: RA, bDMARDs, special consideration, tumor necrosis factor inhibitor, and non-tumor necrosis factor inhibitor. All papers reviewed were from 1999 to 2017 and were written in English. In this article, use of conventional synthetic DMARDs (csDMARDs), bDMARDs and special consideration to be taken upon initiation of biologic therapies in RA will be reviewed

Clinical Study and Molecular Genetic Analyses of Malaysian GEFS+ Patients

Generalized epilepsy with febrile seizure plus (GEFS+) is a familial epilepsy syndrome characterized by phenotypic and genetic heterogeneity. Neuronal voltage gated sodium channel α-1 subunit gene, SCN1A is the most clinically relevant and associated with GEFS+. The objective was to study the clinical presentations of GEFS+ and analyze the SCN1A gene associated with Malaysian GEFS+ patients. Blood samples were collected from 30 unrelated GEFS+ patients and genomic DNA was obtained using the Qiagen DNA Blood Mini Kit following the manufacturer’s instructions. The 26 exons of SCN1A genes were analyzed by polymerase chain reaction (PCR) and denaturing high performance liquid chromatography (DHPLC). The aberrant profile peak from DHPLC analysis was confirmed by direct sequencing. The spectrum of phenotypes observed in Malaysian GEFS+ patients included febrile seizure (FS), febrile seizure plus (FS+) and afebrile generalized tonic clonic seizure (AGTCS). Direct sequencing of SCN1A revealed seven sequence variants including one novel SCN1A mutation that was associated with GEFS+. This suggests that mutation of the SCN1A gene is one of the prevalent causes of GEFS+ in Malaysia

Cardiovascular risks and primary interventions among treated rheumatoid arthritis patients: Experience from a tertiary care centre in Kuala Lumpur, Malaysia

Purpose: To investigate the cardiovascular risk among treated rheumatoid arthritis (RA) patients to predict the factors associated with high cardiovascular risk and to determine the presence of pharmacotherapy primary prevention among treated RA patients with high cardiovascular disease (CVD) risk.Methods: The study was a prospective cross-sectional study on adult patients diagnosed and treated for RA and without established heart disease/stroke. Cardiovascular risk scoring was based on Framingham Cardiovascular Disease 10-year risk prediction model (BMI model) x 1.5 factor while descriptive and inferential analyses were done using SPSS.Results: High CVD risk was defined as FRS-CVD cardiovascular risk categories (>20%) and 55.9% of patients were at high CVD risk. Use of Hydroxychloroquine (OR: 0.44; 95 % CI: 0.21- 0.92; p= 0.028) and COX-2 inhibitors (OR: 0.31; 95% CI:0.10- 0.95; p = 0.039) were found to be significantly associated with high CVD risk among treated RA patients. Significant number of high CVD risk patients did receive pharmacotherapy primary prevention (p = 0.001).Conclusion: Hydroxychloroquine and COX-2 inhibitors are independent negative risk predictors associated with high CVD risk among treated RA patients. Baseline cardiovascular risk data may be useful in rational use of medications to treat RA, considering that cardiovascular related mortality is the leading cause of death in RA

Pendekatan baharu untuk mengelompok stesen pengawasan kualiti udara menggunakan homologi gigih

Isu pencemaran udara merupakan masalah global yang terus dibincangkan sehingga kini. Seringkali penggunaan pendekatan kuantitatif seperti analisis kelompok, analisis korelasi dan analisis komponen prinsipal digunakan untuk menganalisis keserupaan pencemaran udara antara stesen. Walau bagaimanapun, kajian berkaitan dengan pendekatan kualitatif khususnya pendekatan topologi untuk menganalisis keserupaan pencemaran udara tidak lagi dipelopori dengan meluas di Malaysia. Oleh itu, penyelidikan ini adalah kajian rintis yang dijalankan untuk mengkaji keserupaan pencemaran udara antara beberapa stesen di Malaysia menggunakan teknik dalam analisis data bertopologi yang dikenali sebagai homologi gigih. Sifat topologi pencemaran udara diperihalkan oleh ciri-ciri topologi seperti komponen berkait, lubang dan lompong. Habuk halus (PM10) yang diketahui sebagai pencemar utama digunakan untuk memperihalkan perilaku pencemaran udara di stesen pengawasan kualiti udara Klang, Petaling Jaya dan Shah Alam. Ciri-ciri topologi yang diperoleh daripada PM10 dianalisis menggunakan ukuran jarak (jarak Wasserstein) untuk mendapatkan keserupaan topologi. Darjah keserupaan dicirikan oleh nilai jarak yang kecil dan sebaliknya. Hasil daripada ukuran jarak menunjukkan Petaling Jaya dan Shah Alam adalah stesen yang paling serupa dan Klang adalah stesen yang paling tak serupa. Penentusahan untuk hasil tersebut dijalankan melalui analisis kelompok agglomeratif berhierarki yang mengelompokkan stesen mengikut jarak ketakserupaan dan hasilnya adalah konsisten dengan keputusan kajian ini. Melalui penemuan ini, kajian yang lebih mendalam dengan menggunakan jentera lain dalam bidang analisis data bertopologi boleh dilakukan sebagai kaedah alternatif dalam menganalisis masalah pencemaran udara di Malaysia

Streamflow data analysis for flood detection using persistent homology

Flooding is an environmental hazard that occurs almost everywhere around the world. Analysis of streamflow data can give us important climatic information for flooding events. Persistent homology (PH), a new analysis tool in topological data analysis (TDA) offers a new way to look at the information in a data set using qualitative approach. PH uses topology to extract topological features such as connected components and cycles that exist in the data set. In this paper, we present a new approach for streamflow data analysis for flood detection by using PH. An analysis was conducted at Sungai Kelantan, Malaysia. The result shows that PH gives different pattern of topological features for dry and wet periods. In particular, there are more persistent topological features in the form of connected components and cycles in the wet periods compared to the dry periods. We observed that the time series of the distance measure corresponding to the evolution of the components is consistent with the time series of the streamflow data. As a conclusion, this study suggests that the time series of the distance measure corresponding to the evolution of the components can be used for flood detection at Sungai Kelantan, Malaysia

Characterisation of the corticospinal tract using Diffusion Magnetic Resonance imaging in Unilateral and Bilateral Cerebral Palsy patients

Neuroimaging is increasingly used to locate the lesion that causes cerebralpalsy (CP) and its extent in the brains of CP patients. Conventional structural magnetic resonanceimaging (MRI) does not indicate the connectional pattern of white matter; however, with the helpof diffusion MRI, fibre tracking of white matter can be done.Methods: We used diffusion MRI and probabilistic tractography to identify the putativewhite matter connectivity in the brains of 10 CP patients. We tracked the corticospinal tract (CST)of the patients’ upper and lower limbs and calculated the white matter connectivity, as indexed bystreamlines representing the probability of connection of the CST.Results: Our results show that diffusion MRI with probabilistic tractography, while havingsome relation with the clinical diagnosis of CP, reveals a high degree of individual variation in thestreamlines representing the CST for upper and lower limbs.Conclusion: Diffusion MRI with probabilistic tractography provides the state ofconnectivity from lesioned areas to other parts of the brain and is potentially beneficial to beused as an adjunct to the clinical management of CP, providing a means to monitor interventionoutcomes

Blood pressure lowering mechanisms of Kadukmy™ in essential hypertension

The National Health and Morbidity Survey 2011 estimated that almost half (43.5%) of Malaysian adults aged 30 and older suffer from the multifactorial disease of hypertension. Studies have shown that oxidative stress and low availability of nitric oxide (NO) result in endothelial dysfunction resulting in increase of vasoactive factors such as endothelin 1 (ET 1) and Angiotensin II (Ang II), resulting in blood pressure elevation. Piper sarmentosum (PS) is a traditional Malay herbal plant known for its high total phenolic and flavonoid content. Our previous studies with Kadukmy™, our patented formulation of PS extract, have shown that its active compounds rich in antioxidant properties does not cause subacute toxicity in the haematological profile, liver and kidney in spontaneously hypertensive rats (SHRs). Our previous studies with Kadukmy™ have revealed its blood pressure lowering effects, although the exact mechanism is yet to be established. Thus, this study hopes to identify the anti-hypertensive mechanism of Kadukmy™ supplementation on the various blood pressure regulating pathways associated with the pathogenesis of essential hypertension using the Spontaneous Hypertensive Rat (SHR) model. SHR rats will be divided into 2 control groups and 2 treatment groups (Kadukmy™, Kadukmy™ + Perindopril). Blood pressure indices, biochemical levels and proteomic studies will be conducted to determine Kadukmy mechanism of action. It is hoped that the findings will provide scientific support for the patented Kadukmy to be used in hypertensive patients and encourage the culture of evidence-based medicine with local plants

Depressive, Anxiety, and Stress Symptoms in Parents of Children Being Admitted for Febrile Seizures in a Tertiary Hospital in the East Coast of Malaysia

Febrile seizures in children are an alarming experience for parents. This study aimed to assess the psychological functioning of parents of children when they were being admitted for treatment of febrile seizures in the hospital, the importance of which is clear, since parents are the primary custodian of their children. This is a cross-sectional study conducted on 110 participants whose child had been admitted for a febrile seizure to Hospital Universiti Sains Malaysia from September 2020 until June 2021. The depression, anxiety, and stress levels were determined based on a validated Bahasa Melayu questionnaire of the Depression Anxiety Stress Scale (DASS-21). In addition, multiple logistic regression was used to determine the associated factors related to the participants’ psychological functioning. The mean age of children with febrile seizures were 21 months old, and most children showed features of simple febrile seizures (71.8%). The prevalence of anxiety, stress, and depression were 58.2%, 29%, and 23.6%, respectively. Using multiple logistic regression, child age, family history of febrile seizures, family history of epilepsy, and length of stay in the ward were found to be significantly associated with anxiety when adjusted for other variables. Otherwise, for depression and stress, no significant associated variables were found when adjusted for other variables. Anxiety was highly reported by participants when their children were admitted for febrile seizures. Several factors impacted their anxiety, including the lower the child’s age was, participants with no family history of febrile seizures before, and the longer duration of hospital stay. Therefore, further study and intervention on reducing the parent’s anxiety could be emphasized in the future

Persistent Homology-Based Machine Learning Method for Filtering and Classifying Mammographic Microcalcification Images in Early Cancer Detection

Microcalcifications in mammogram images are primary indicators for detecting the early stages of breast cancer. However, dense tissues and noise in the images make it challenging to classify the microcalcifications. Currently, preprocessing procedures such as noise removal techniques are applied directly on the images, which may produce a blurry effect and loss of image details. Further, most of the features used in classification models focus on local information of the images and are often burdened with details, resulting in data complexity. This research proposed a filtering and feature extraction technique using persistent homology (PH), a powerful mathematical tool used to study the structure of complex datasets and patterns. The filtering process is not performed directly on the image matrix but through the diagrams arising from PH. These diagrams will enable us to distinguish prominent characteristics of the image from noise. The filtered diagrams are then vectorised using PH features. Supervised machine learning models are trained on the MIAS and DDSM datasets to evaluate the extracted features’ efficacy in discriminating between benign and malignant classes and to obtain the optimal filtering level. This study reveals that appropriate PH filtering levels and features can improve classification accuracy in early cancer detection