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

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

Malaysia tourism demand forecasting using box-jenkins approach

Tourism industry in Malaysia is crucial and has contributes a huge part in Malaysia’s economic growth. The capability of forecasting field in tourism industry can assist people who work in tourism-related-business to make a correct judgment and plan future strategy by providing the accurate forecast values of the future tourism demand. Therefore, this research paper was focusing on tourism demand forecasting by applying Box-Jenkins approach on tourists arrival data in Malaysia from 1998 until 2017. This research paper also was aiming to produce the accurate forecast values. In order to achieve that, the error of forecast for each model from Box-Jenkins approach was measured and compared by using Akaike Information Criterion (AIC), Mean Absolute Deviation (MAD), Mean Square Error (MSE) and Mean Absolute Percentage Error (MAPE). Model that produced the lowest error was chosen to forecast Malaysia tourism demand data. Several candidate models have been proposed during analysis but the final model selected was SARIMA (1,1,1)(1,1,4)12. It is hoped that this research will be useful in forecasting field and tourism industry

Primary plasma cell leukaemia

Plasma cell leukemia (PCL) is a rare form of malignant plasma cell dyscrasia. It can occur as a primary form without prior evidence of multiple myeloma or as a secondary form which is a terminal event in multiple myeloma. It is characterised by a proliferation of plasma cells in blood and the bone marrow. The outcome of plasma cell leukemia is poor with conventional therapy. Here we illustrate a case of primary plasma cell leukemia complicated by paraplegia. The patient initially responded to combination chemotherapy but succumbed to the disease two months after presentation

In vitro antiatherothrombotic effects of extracts from Berberis vulgaris L., Teucrium polium L., and Orthosiphon stamineus benth

Coronary artery disease is the leading cause of mortality and morbidity worldwide. The pathogenesis is mainly due to atherosclerosis, plaque rupture, and platelet thrombus formation. The main risk factors for coronary artery disease include obesity, hypercholesterolemia, smoking, diabetes, and high blood pressure. As a part of disease management, treatment options using anticoagulant and antiplatelet drugs can be applied with addition to lipid-lowering medication. However, medicinal plants comprising antiatherothrombotic effects can be used as options to combat the disease rather than drug therapies with lesser adverse effects. Therefore, the haematological effect of Berberis vulgaris L., Teucrium polium L., and Orthosiphon stamineus Benth extracts was studied using in vitro model to prevent and to treat coronary atherothrombotic disease. The aqueous, methanol, and polysaccharide extracts of B. vulgaris, T. polium, and O. stamineus, respectively, were studied for their anticoagulant and antiplatelet effect on human whole blood. Extracts were subjected to the prothrombin time (PT) and activated partial thromboplastin time (APTT) test for anticoagulant activity. The antiplatelet activity was investigated using an electrical impedance method. B. vulgaris aqueous extract (BVAE), B. vulgaris polysaccharide extract (BVPE), T. polium aqueous extract (TPAE), and T. polium polysaccharide extract (TPPE) significantly prolonged the coagulation time in a concentration-dependent manner (p<0.05). The administration of BVAE demonstrated the most effective antiplatelet activity against platelet aggregation caused by arachidonic acid (AA) and collagen. These antiplatelet activities may correspond to the presence of higher total phenolic compound, which thus inhibit the platelet aggregation activity. In conclusion, these findings provide strong evidence on the antiatherothrombotic effect of BVAE and TPAE

Antiplasmodium and chloroquine resistance reversing effects of embelin against Plasmodium falciparum K1

Background: Emergence of chloroquine (CQ) resistance among different strains of Plasmodium falciparum is the worst catastrophe that has ever perplexed efforts to eradicate malaria. This behooved the scientists to search for new alternatives or sensitizers that augment its action. Method: In this experiment, the potential of embeline, a quinonoid phytochemical obtained from the Indian plant Embelia ribes, to inhibit the growth and sensitize CQ action was screened using SYBRE green-1 based drug sensitivity assay and isobologram technique respectively. Its effect on both RBCs and Vero cells stability and RBCs fragility was screened to assess its safety. To depict its molecular mechanism, its effect on hemozoin formation and the new permeation pathway (NPP) of the host RBCs membrane were screened. Furthermore, its anti-oxidant activity was measured using the conventional in vitro tests and its molecular characters were obtained using Molispiration program. Results: The results showed that its antiplasmodial effect was weaker than CQ but synergism was obtained when they were combined together. Its low anti-plasmodial potency and poor selectivity toward RBCs reduces its eligibility to be introduced as an antimalarial. Nevertheless, it synergized CQ at a concentration within the safe limit. Embelin did not produce any impact on NPP but its impact on hemozoin formation was pronounced. Its antiplasmodium effect can be attributed to the latter or to its effect on RBCs membrane but further investigations are required to detect its CQ resistance. Conclusion: Overall, embelin is not ideal to be used as antiplasmodium but can be suggested as CQ resistance reversing agent

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

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

Platelet aggregation pattern on light transmission aggregometry among Malaysian healthy individuals

Introduction: Platelet aggregation test using light transmission aggregometry (LTA) is considered as the gold standard for evaluation of platelet function. Variations of platelet aggregation had been reported in apparently healthy individuals whereby a normal cut–off value established locally is highly recommended. This study aims to determine the platelet aggregation pattern and the preliminary findings on reference values for multiple agonists–induced platelet aggregation among Malaysian healthy individuals in a single centre. Method: A total number of 63 informed consented healthy individuals consisted of Malay, Chinese and Indian were recruited among staff and blood donors at National Blood Centre, Kuala Lumpur. Platelet aggregation was measured using LTA against adenosine diphosphate 10 µM (ADP10), collagen 0.19 mg/mL (COL), ristocetin 1.5 mg/mL (RIS), arachidonic acid 1 mM (AA) and epinephrine 10 µM (EPI). Results were expressed as percent final aggregation (%FA). Reference values were calculated from mean±2SD. Results: Age, gender and ethnic groups had no significant effect on platelet aggregation. A variability of platelet aggregation response to EPI was observed among the healthy individuals. Ten of 33 respondents (30%) had impaired aggregation with <20% FA in response to EPI. The local population showed a slightly higher aggregation pattern in response to COL, RIS, AA and EPI (excluding non-responders) compared to manufacturer’s reference values. Conclusion: This study has provided a glimpse of the aggregation pattern of the local nationality showing considerable differences in the reference values from manufacturer’s; thus highlighting the need of establishing local reference values

Flow cytometric analysis of platelets mepacrine-labelled dense granules among individuals with mild bleeding symptoms

Introduction: Mild bleeding symptoms are commonly encountered in the general population & amongst individuals with platelet disorders. One of the possible causes is due to reduced number of dense granules synthesis in platelets and defective release of its contents. This study was aimed to evaluate platelets mepacrine-labelled dense granules storage and release using flow cytometry in healthy individuals and those presenting with mild bleeding symptoms. Methods: This study was conducted at the National Blood Centre (NBC) and Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM). Thirty- four individuals were recruited as controls (n=24) and patients (n=10). ADP-activated platelets and mepacrine-labelled dense granules was detected using flow cytometry. Results were expressed as mean fluorescent intensity (MFI) of mepacrine in resting and activated platelets; representing dense granules storage and release, respectively. Statistical analysis was considered significant if p ≤ 0.05. Results: There was a significant difference of mean MFI between resting (1284.3 ± 91.8) and activated platelets (1233.8 ± 107.8) of overall respondents with mean difference of 50.5 (p<0.01). However, there was no significant difference of mean MFI in resting and activated platelets between controls and patients was observed. Conclusion: Results indicated there is no secretion defects in platelet dense granules among patients in comparison with controls. Flow cytometry provides alternative way of dense granule assessment in patients presented with mild bleeding symptoms