Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism: An Observational Study among Diabetic Hypertensive Subjects in Malaysia

Purpose: This study investigated the influence of angiotensin-1 converting enzyme (ACE) insertiondeletion (ID) gene polymorphism on the treatment responses of type 2 diabetic subjects at varying stages of nephropathy to ACE inhibitors (ACEI) with regard to blood pressure (MAP) and renal response (GFR). Methods: The pharmacological effect of ACE inhibition on mean arterial pressure (MAP) and glomerular filtration rate (GFR) were observed among a total of 62 subjects for a short-term duration of 15 months. MAP and GFR were calculated by standard mathematical formulae while the ACE ID genotype was determined using triple primer PCR. The general linear model repeated measures were applied to study the modulation of ACE inhibition on these parameters. Results: ACE ID genotyping of the 62 subjects showed that 19 (30.6 %) subjects had the II genotype, while 35 (56.4 %) subjects showed ID genotype and 8 (12.9 %) subjects had the DD genotype. Significant mean MAP reduction (p 0.05) from baseline values were observed among the subjects following antihypertensive treatment. However, when stratified according to ACE genotypes, no significant mean MAP and GFR changes were observed between genotypes following antihypertensive treatment (p > 0.05).Conclusion: ACE ID gene polymorphism does not determine the treatment efficacy of ACE inhibitors in the Malaysian population.Keywords: ACE genotype, ACE inhibitor, Type 2 diabetes mellitus, Diabetic nephropath

BEATING THE OFFSIDE TRAP: BODY EKSTASIS AND NARRATIVES OF RESISTANCE AMONGST MALAY PROFESSIONAL FOOTBALLERS IN SINGAPORE

Bachelor'sBACHELOR OF SOCIAL SCIENCES (HONOURS

Disability among leprosy patients in the lustrum 2016-2020: Retrospective study from a tertiary care centre in Southern Kerala

Background: The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This research was done to estimate the proportion of leprosy patients who had G2D at the time of diagnosis and to identify the clinical and demographic factors that predicted G2D. Materials and Methods: Design -Hospital-based retrospective cross-sectional study. The outcome variable was G2D and the determinants were demographic and clinical characteristics. Results: G2D was seen in 22.3% and G1D in 17.5%. The M:F ratio of G2D was 5:1. G2D was highest in the hands (62.1%), followed by the feet (59.4%), and the eyes (16.2%). The claw hand was the most common deformity in the hand and the plantar ulcer was the most common deformity in the feet. Age >45 (OR 2.27, 95% CI 1.1–4.8), males (OR 3.3,95% CI 1.3–8.5), multibacillary type (OR 6.95,95% CI 1.6–30.6), pure neuritic type (OR 3.6,95% CI 1.1–12.3), and thickened nerves (OR 14.3, 95% CI 1.9–108.7) were the significant determinants. Conclusion: Being male, being older than 45, having multibacillary leprosy, having pure neurotic leprosy, and having a thicker nerve trunk predicted G2D. Training primary care health workers in recognising the subtle early symptoms and raising community awareness are the need of the hour. Frequent leprosy case detection programmes should be held to identify undiagnosed cases

Net case report - The "sign of groove", a new cutaneous sign of internal malignancy

A 36-year-old young male with multiple heterosexual contacts presented with bilateral inguinal bubo and the classical "sign of groove". A diagnosis of lymphogranuloma venereum (LGV) was made and a three-week course of doxycycline was given. Lack of response prompted us to investigate further. A biopsy of the bubo was consistent with non-Hodgkin's lymphoma (NHL). Immunohistochemistry of the lymph node done at the Regional Cancer Center (RCC), Trivandrum, confirmed the diagnosis as NHL of diffuse large B-cell type. The second patient, a 32-year-old male with two unprotected heterosexual contacts presented with a left-sided inguinal bubo of six weeks duration. An empirical course of doxycycline was given even though investigations did not reveal any STI. Lack of response prompted us to do a lymph node biopsy, which was consistent with NHL, which later with immunohistochemistry was confirmed as NHL, diffuse large cell type. We are reporting here that the "sign of groove" is not specific for LGV as thought earlier, but can occur in NHL also

Case Report - Malignant acanthosis nigricans with liver secondaries from an occult primary adenocarcinoma of gastrointestinal tract

A 38-year-old female presented with hyperpigmented velvety plaques on the nape and the sides of the neck with diffuse pigmentation of the face and flexures suggestive of acanthosis nigricans. The dorsa of both the hands showed increased rugosity, hyperpigmentation and hyperkeratosis of the palms, suggestive of tripe palms. Investigations revealed multiple secondaries in the liver. Histopathology showed the secondaries to be from adenocarcinoma of the gastrointestinal tract

Case Report - Chronic granulomatous disease

A 2½-year-old child presented with multiple discrete granulomatous lesions on the face and flexural regions since the age of 2 months along with lymphadenopathy. The patient also had recurrent bouts of pyodermas and respiratory tract infections. Biopsy of the lesion showed necrosis of tissue with suppuration and histiocytes but no evidence of tuberculosis, fungal infections or atypical mycobacteria. Lymph node biopsy also showed necrosis with suppuration but no infective organism. Nitroblue tetrazolium test was negative indicating that the neutrophils failed to oxidize the dye. We are reporting here a rare case of chronic granulomatous disease

Primary mucocutaneous histoplasmosis presents as oral ulcer

We are reporting a rare case of primary mucocutaneous histoplasmosis. A 47-year-old male with a part-time job of rearing pigeons presented with a non-healing oral ulcer with no associated systemic symptoms. Differential diagnosis of oral ulcerative lichen planus, squamous cell carcinoma and mucocutaneous leishmaniasis was considered. Histopathology showed multiple organisms with a peripheral halo, stained strongly with Gomori methenamine silver stain