Progestogens in the management of miscarriage and preterm birth.

Miscarriage affects up to 20% of pregnant women, resulting in substantial psychological repercussions in addition to inherent problems from bleeding and infection. Preterm births constitute about 7-12% of all births but are over represented in terms of perinatal morbidity and mortality. Despite existing trials examining the use of progestogens in both these conditions, there is a dearth of guidelines for the practicing clinician. A systematic review of the literature was performed by an expert panel formed by the Obstetrical & Gynaecological Society of Malaysia from the inception of the databases searched up to February 2020, without language restrictions. The level of evidence and recommendations was determined by the panel and peer-reviewed by local and international experts. The use of progestogens is recommended in women with threatened miscarriages who have experienced previous miscarriage as luteal phase support in women undergoing assisted reproduction and in women with short cervix of <25mm in the midtrimester. In addition, it can be considered in women with recurrent miscarriage, where no other cause is identified. This article reviews the existing evidence including the guideline above and is intended to aid primary care doctors and obstetricians in their prescribing practices when managing these common conditions.

Management of neonatal jaundice in primary care.

The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ) is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB) and total serum bilirubin (TSB) are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

Mutational spectrum of the TYR and SLC45A2 genes in Pakistani families with oculocutaneous albinism, and potential founder effect of missense substitution (p.Arg77Gln) of tyrosinase.

BACKGROUND: Oculocutaneous albinism (OCA) is an autosomal recessive disorder of abnormal melanin formation, which results in hypopigmentation of skin, hair and eyes. OCA is classified into four types based on clinical and genetic findings. OCA1 is the most severe form of albinism, and is caused by mutations in the tyrosinase (TYR) gene, while OCA4 is caused due to mutations in SLC45A2. METHODS: In total, 13 families with ≥ 3 members with OCA were enrolled. Family history was ascertained and pedigrees were drawn up. Blood samples were collected and processed for DNA extraction. Linkage analysis was performed by typing three short tandem repeat markers in candidate regions of TYR and SLC45A2. Sequence analysis was performed of all the coding exons and adjacent intronic sequences of both genes. RESULTS: Eight families showed linkage to OCA1 and one family showed linkage to OCA4. Four missense substitutions (p.Arg239Trp, p.Ser192Tyr, p.Ser44Arg and p.Arg77Gln) were identified in TYR in the families with OCA1 linkage, and another missense substitution (p.Gln272Lys) was identified in the family with OCA4 linkage. One of the identified missense substitution (p.Arg77Gln) in TYR was found in five different families, which had a common haplotype. CONCLUSIONS: We identified four missense substitutions in TYR and a single missense substitution in SLC45A2. One missense substitution (p.Arg77Gln) in TYR was found in five different families that originated from the same geographical area and displayed a common haplotype, suggesting a single origin that then spread to different geographical areas of Azad Kashmir, Pakistan.

Identification of a novel mutation (p.Ile198Thr) in gene TYR in a Pakistani family with nonsyndromic oculocutaneous albinism.

The TYR gene (MIM #6069333) is located at position 11q14.3 on the human chromosome, and encodes tyrosinase, which is expressed in melanocytes and controls the biosynthesis of melanin. Most TYR mutations eliminate the activity of tyrosinase, preventing melanocytes from producing any melanin throughout life. People with this form of albinism have white hair, light-coloured eyes and very pale skin. Some mutations in TYR reduce but do not completely eliminate tyrosinase activity, and allow some melanin to be produced. We report a Pakistani family with four members affected by oculocutaneous albinism (OCA). Blood samples were collected from all affected individuals, normal siblings and their parents. Genomic DNA was extracted, and sequence analysis of all the coding exons and adjacent intronic sequences of TYR was performed, which identified a novel missense substitution (p.Ile198Thr). Sequencing of TYR in 90 unrelated healthy individuals showed no sequence variant at this location. Our study expands the mutational spectrum of OCA1.

Molecular filter on-chip design for drug targeting use.

This paper presents the use of a modified add/drop optical filter incorporating with microring resonators known as a PANDA microring resonator system which can fabricate on small chip. By using an optical tweezer, the required molecules can be trapped and moved to the required destinations at the add/drop ports. The novelty is that the stored molecules in the designed chip can transport via the optical waveguide and can also be used to form molecular filter, which is an important technique for drug delivery, drug targeting, and molecular electronics. Results have shown that the multivariable filter can be obtained by tunable trapping control.

Ultra-short laser pulse generated by a microring resonator system for cancer cell treatment.

A microring resonator (MRRs) system incorporated with a add/drop filter is proposed in which ultra-short single, multi-temporal, and spatial optical soliton pulses are simulated and used to kill abnormal cells, tumors, and cancer. Chaotic signals are generated by a bright soliton pulse within a nonlinear MRRs system. Gold nanoparticles and ultra-short femtosecond/picosecond laser pulses' interaction holds great interest in laser nanomedicine. By using appropriate soliton input power and MRRs parameters, desired spatial and temporal signals can be generated over the spectrum. Results show that short temporal and spatial solitons pulse with FWHM = 712 fs and FWHM = 17.5 pm could be generated. The add/drop filter system is used to generate the high-capacity, ultra-short soliton pulses in the range of nanometer/second and picometer/second.

Characterization of geographically distinct bacterial communities associated with coral mucus produced by Acropora spp. and Porites spp.

Acropora and Porites corals are important reef builders in the Indo-Pacific and Caribbean. Bacteria associated with mucus produced by Porites spp. and Acropora spp. from Caribbean (Punta Maroma, Mexico) and Indo-Pacific (Hoga and Sampela, Indonesia) reefs were determined. Analysis of pyrosequencing libraries showed that bacterial communities from Caribbean corals were significantly more diverse (H', 3.18 to 4.25) than their Indonesian counterparts (H', 2.54 to 3.25). Dominant taxa were Gammaproteobacteria, Alphaproteobacteria, Firmicutes, and Cyanobacteria, which varied in relative abundance between coral genera and region. Distinct coral host-specific communities were also found; for example, Clostridiales were dominant on Acropora spp. (at Hoga and the Mexican Caribbean) compared to Porites spp. and seawater. Within the Gammproteobacteria, Halomonas spp. dominated sequence libraries from Porites spp. (49%) and Acropora spp. (5.6%) from the Mexican Caribbean, compared to the corresponding Indonesian coral libraries (<2%). Interestingly, with the exception of Porites spp. from the Mexican Caribbean, there was also a ubiquity of Psychrobacter spp., which dominated Acropora and Porites libraries from Indonesia and Acropora libraries from the Caribbean. In conclusion, there was a dominance of Halomonas spp. (associated with Acropora and Porites [Mexican Caribbean]), Firmicutes (associated with Acropora [Mexican Caribbean] and with Acropora and Porites [Hoga]), and Cyanobacteria (associated with Acropora and Porites [Hoga] and Porites [Sampela]). This is also the first report describing geographically distinct Psychrobacter spp. associated with coral mucus. In addition, the predominance of Clostridiales associated with Acropora spp. provided additional evidence for coral host-specific microorganisms.

Y-chromosomal STR analysis in the Pashtun population of Southern Afghanistan.

Afghanistan is a landlocked country in the heart of Asia and since the dawn of humankind Afghanistan has faced centuries of turmoil, strife, conflict, warfare, distress, social unrest, difficult climate, harsh terrain and due to its unique geostrategic position in Eurasia which has historically attracted commerce and conflict. It is an important stop along the Silk Road, connecting the far eastern civilizations to the western world. A 5000-year history of constant invasion. Afghanistan has been repeatedly invaded and conquered by rulers and super powers, neighboring interference in this conflict-tattered land for centuries yet rarely leading to the conquest of this rugged and challenging terrain nation. Afghans are not only shepherds, farmers and nomads but also intense fighters and fierce warriors. Currently very limited genetic studies have been performed in Afghan populations. 17 Y chromosomal short tandem repeats (Y-STRs) were analyzed in 125 unrelated Pashtun (in hindi: Pathan) males residing in the Kandahar region of Southern Afghanistan. A total of 92 unique haplotypes were observed. The predominant haplotype reached a frequency of 9.6%. The haplotype diversity was 0.987 and the discrimination capacity 73.6%. Analysis of molecular variance (AMOVA) reveals a considerable regional stratification within the country as well as between different Pashtun (Pathan) groups from Afghanistan, Pakistan and India.

Association of annual hormonal profile with gonad maturity of mahseer (Tor tambroides) in captivity.

Annual gonad hormonal profile of wild, matured mahseer (29 males and 23 female) averaging in weight between 0.95±0.26 and 1.19±0.23 kg for males and females, respectively, were investigated from November 2007 to November 2008 using enzyme-linked immunosorbent assay (ELISA) technique. Blood was collected from caudal vein, monthly and plasma separation by centrifugation was done to measure reproductive hormones: 17ß-estradiol (E(2)), testosterone (T), and 11-keto-testosterone (11KT). Gonads were sampled for histology processing to observe their maturity. Highest T level in females and males was recorded at 0.22±0.016 and 0.88±0.014 ng/ml, respectively. The 11KT showed several peaks and the highest value was noted at 0.7±0.018 ng/ml in November 2008. The female E(2) initially was at 1.48±0.16 ng/ml and significantly increased (P<0.05) to 1.53±0.39 ng/ml in November 2008. Ovaries were laden with oocytes in several stages in all the samples while testes gonad showed a high level of spermatids throughout the year. Changes in plasma level of the gonadal hormones were correlated with the ovarian and testes maturities. In conclusion, the study suggests that mahseer can be categorized as asynchronized and multiple spawner. The information gathered is important for appropriate breeding and conservation programs of the Malaysian mahseer.

Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes.

CONTEXT: Hyperglycemia resolves quickly after bariatric surgery, but the underlying mechanism and the most effective type of surgery remains unclear. OBJECTIVE: To examine glucose metabolism and beta-cell function in patients with type 2 diabetes mellitus (T2DM) after two types of bariatric intervention; Roux-en-Y gastric bypass (RYGB) and gastric restrictive (GR) surgery. DESIGN: Prospective, nonrandomized, repeated-measures, 4-week, longitudinal clinical trial. PATIENTS: In all, 16 T2DM patients (9 males and 7 females, 52+/-14 years, 47+/-9 kg m(-2), HbA1c 7.2+/-1.1%) undergoing either RYGB (N=9) or GR (N=7) surgery. OUTCOME MEASURES: Glucose, insulin secretion, insulin sensitivity at baseline, and 1 and 4 weeks post-surgery, using hyperglycemic clamps and C-peptide modeling kinetics; glucose, insulin secretion and gut-peptide responses to mixed meal tolerance test (MMTT) at baseline and 4 weeks post-surgery. RESULTS: At 1 week post-surgery, both groups experienced a similar weight loss and reduction in fasting glucose (P<0.01). However, insulin sensitivity increased only after RYGB, (P<0.05). At 4 weeks post-surgery, weight loss remained similar for both groups, but fasting glucose was normalized only after RYGB (95+/-3 mg 100 ml(-1)). Insulin sensitivity improved after RYGB (P<0.01) and did not change with GR, whereas the disposition index remained unchanged after RYGB and increased 30% after GR (P=0.10). The MMTT elicited a robust increase in insulin secretion, glucagon-like peptide-1 (GLP-1) levels and beta-cell sensitivity to glucose only after RYGB (P<0.05). CONCLUSION: RYGB provides a more rapid improvement in glucose regulation compared with GR. This improvement is accompanied by enhanced insulin sensitivity and beta-cell responsiveness to glucose, in part because of an incretin effect.

Evaluation of two short tandem repeat multiplex systems for post-haematopoietic stem cell transplantation chimerism analysis.

INTRODUCTION: The follow-up of chimerism status after allogeneic haematopoietic stem cell transplantation (HSCT) is essential to predict successful engraftment to assess the development of graft-versus-host disease, graft rejection and disease relapse. Analysis of short tandem repeats (STR) via polymerase chain reaction is frequently used for chimerism determination. However, most commercially-available kits have been designed for forensic purposes and may not be optimal for chimerism analysis. The present study aims to identify suitable STR markers for patient-donor pairs of predominantly Malay and Chinese ethnicity using two commercially-available forensic kits. METHODS: We analysed six STR loci, namely, CSF1PO, TPOX, TH01 (using the CTT multiplex system) and F13A01, FESFPS and vWA (using the FFv multiplex system) in 33 human leukocyte antigen-matched Malaysian patient-donor pairs to determine the suitability of these two multiplex systems for chimerism analysis in our local population. RESULTS: Informativity (different alleles in donor and recipient) of each individual locus was TH01 73 percent, vWA 73 percent, F13A01 52 percent, CSF1PO 61 percent, FESFPS 39 percent and TPOX 45 percent. When combined, the six STR loci were able to give chimerism results in 31 out of 33 (94 percent) cases. CONCLUSION: We found that TH01 and vWA are informative STR targets for post-HSCT chimerism analysis in predominantly Malay and Chinese patient-donor pairs. The commercially-available kits will also permit laboratories without extensive molecular biology capabilities to perform DNA typing in HSCT recipients.

Xanthones from Garcinia mangostana (Guttiferae).

Studies on the stem of Garcinia mangostana have led to the isolation of one new xanthone mangosharin (1) (2,6-dihydroxy-8-methoxy-5-(3-methylbut-2-enyl)-xanthone) and six other prenylated xanthones, alpha-mangostin (2), beta-mangostin (3), garcinone D (4), 1,6-dihydroxy-3,7-dimethoxy-2-(3-methylbut-2-enyl)-xanthone (5), mangostanol (6) and 5,9-dihydroxy-8- methoxy-2,2-dimethyl-7-(3-methylbut-2-enyl)-2H,6H-pyrano-[3,2-b]-xanthene-6-one (7). The structures of these compounds were determined by spectroscopic methods such as 1H NMR, 13C NMR, mass spectrometry (MS) and by comparison with previous studies. All the crude extracts when screened for their larvicidal activities indicated very good toxicity against the larvae of Aedes aegypti. This article reports the isolation and identification of the above compounds as well as bioassay data for the crude extracts. These bioassay data have not been reported before.

2005 Young Investigator's Award Winner: Assessment of diastolic function in newly diagnosed hypertensives.

INTRODUCTION: The prevalence and severity of diastolic dysfunction (DD) among newly diagnosed hypertensives (NDHT) is not fully established. The aim of this study was to evaluate left ventricular diastolic function (LVDF) in patients with NDHT. MATERIALS AND METHODS: This study involved 396 subjects (198 NDHT, age and gender matched 198 normotensives; age, 30 to 50 years). Parameters of LVDF included Doppler-echocardiographic measurements of peak early (E) and late (A) diastolic velocities, E-wave deceleration time (DT) and isovolumetric relaxation time (IVRT). E/A ratio of <1 was taken as an indicative of DD. RESULTS: Patients with NDHT had reduced E/A ratio (1.27 +/- 0.41 vs 1.37 +/- 0.35, P <0.001) and shortened DT (180.0 +/- 40.0 ms vs 190.0 +/- 30.0 ms, P = 0.025). The peak A velocity and IVRT were increased in the NDHT group [(62.73 +/- 13.82 ms vs 58.26 +/- 12.40 ms, P = 0.002) and (90.0 +/- 20.0 ms vs 80.0 +/- 10.0 ms, P <0.001), respectively]. Peak E velocity was similar in both groups. The prevalence of DD was increased in the NDHT group, 18.6% (32) vs 3.4% (6), P <0.001. Of the 32 NDHT subjects who had DD, 84.4% (27) had no left ventricular hypertrophy (LVH) and 15.7% (5) had LVH. Diastolic function was negatively correlated with age, body mass index, systolic blood pressure, diastolic blood pressure and left ventricular mass index. CONCLUSION: Impairment in LVDF occurs in NDHT which may precede structural abnormalities. Hypertension, obesity, older age and LVH are associated with worsening of diastolic function.

Biochemical polymorphism in yellow catfish, Mystus nemurus (C&V), from Thailand.

Yellow catfish, Mystus nemurus (Cuv. & Val.), is becoming one of the major freshwater species farmed by aquaculturists in Southeast Asia. It was of interest to examine levels of genetic subpopulation differentiation among samples of this species obtained from parts of its range, as well as to compare the genetics of wild and hatchery-bred fish. Horizontal starch gel electrophoresis and histochemical staining techniques were used to examine genetic variation within and among eight wild and one hatchery populations of M. nemurus from northern, northeastern, central and southern Thailand. Four tissues (heart, liver, kidney, and muscle) from individual specimens were used to analyze variations at 23 protein-coding loci. Fifteen of the 23 loci examined (65.22%), namely, ACP*, AAT-1*, EST-1*, EST-2*, GPI*, IDH-1*, IDH-2*, MDH-1*, MDH-2*, MDH-3*, ME*, PGM*, 6PGD*, SOD*, and HB*, were polymorphic at the 0.95 level. Observed heterozygosities ranged from 0.041 to 0.111, with an average of 0.068 +/- 0.028. Genetic distances ranged from 0.005 to 0.164. The greatest genetic distance was found between the Chainat and the Suratthani populations (0.164), a level indicative of subspecific differentiation in M. nemurus from within Thailand.