Background. In the past the occurrence of neuromyelitis optica in Malaysia was thought to be uncommon and the frequency of anti-aquaporin-4 Ig G antibody was unknown. Objective. To evaluate the frequency of anti-aquaporin-4 Ig G antibody (Anti-AQP4 antibody) amongst patients with neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) and the differences between the seropositive and seronegative groups. Methods. Retrospectively, 96 patients with NMO/high risk syndromes for NMOSD (HRS-NMOSD) were identified out of 266 patients with idiopathic inflammatory demyelinating disease from a single center hospital based registry. Anti-AQP4 seropositivity was found in 38/48 (79.2%) with NMO, 12/21 (57.1%) with brain involvement at high risk for NMOSD, 12/15 (80%) with transverse myelitis (i.e., 11/15 with relapsing transverse myelitis and one with monophasic transverse myelitis), and 3/7 (42.8%) with relapsing optic neuritis. Sixty-five out of 96 patients, that is, 67.7%, with NMO/HRS for NMOSD were seropositive. Seropositivity was significantly associated with female gender, a higher number of mean relapses, that is, 5.15 ± 4.42 versus 2.10 ± 1.68, longer length of spinal cord lesions, that is, 6.6 ± 4.9 versus 2.9 ± 2.5, vertebral bodies, higher EDSS, 4.5 ± 2.4 versus 2.4 ± 2.6, presence of paroxysmal tonic spasms, and blindness (unilateral/bilateral); P < 0.001. Longitudinally extensive cord lesions (contiguous or linear), presence of lesions in the cervical and thoracic regions, and involvement of the central gray matter or holocord regions on axial scans, were also significantly associated with seropositivity; P < 0.001. Conclusion. NMO and HRS for NMOSD are present in larger numbers than previously thought in Malaysia. More than 2/3rds are seropositive. Seropositive and seronegative NMO/NMOSD have differences that are useful in clinical practice.

Antibody-mediated rejection (AMR) still persists as the major hurdle towards successful renal allograft survival. This paper aims to report on the HLA antibody landscape of renal transplant candidates in Malaysia. A total of 2,219 adult samples from 2016 to 2019 were analysed for anti-HLA antibodies using solid-phase assay. Our findings highlight the prevalence and risk factors for antibodies against HLA antigens in renal transplant settings, which could be beneficial for selecting compatible recipients from deceased organ donors. To the best of our knowledge, this study is the first to demonstrate that ethnic Malay and Chinese showed significantly higher prevalence of anti-HLA antibodies. Based on our multivariate analysis: (i) female gender was associated with higher risk for panel reactive antibodies (PRAs) against Class I, Class II, and Class I and II (p < 0.001); (ii) older patients (≥ 38 years old) were associated with higher risk of positivity against Class I, Class II and Class I and II (p < 0.001); (iii) Malays showed significant association with Class II antibodies (p = 0.035); Chinese patients presented with higher risk of PRA positivity against Class II (p < 0.001) and Class I and II (p = 0.01); Indians were significantly associated with higher risk of HLA antibody sensitization against Class I (p = 0.022), Class II (p = 0.026) and Class I and II (p = 0.05). Thus, our findings suggested that female gender, older age (≥ 38 years old) and ethnicity may serve as independent risk factors for HLA antibody sensitization in adult renal transplant candidates.

Background: Bronchiectasis is a chronic condition which can result in significant physical and social morbidity. The exact prevalence in Malaysia is unknown although several studies have shown a higher prevalence in the Asian population. Several causative factors have been identified but there are many patients with unknown aetiologies. This study looks into the level of serum immunoglobulins and antipenumococcal antibody in bronchiectasis patients where they were not part of prior routine investigations. Methodology: Four hundred fifteen bronchiectasis patients were screened and 26 patients who fulfilled the inclusion and exclusion criteria were enrolled for this study. The serum immunoglobulins (IgG, IgA and IgM) concentrations were measured using nephelometry and interpreted according to age-matched reference range. The integrity of antibody production against specific antibody to capsular polysaccharides of Streptococcus pneumoniae were assessed using ELISA method and the level of ≥ 10mg/L is considered as reactive. Results: The twenty six bronchiectasis patients have the mean age of 62 years and a predilection of female gender. Majority of patients presented with typical bronchiectasis symptoms which were further supported by radiological findings. One of 26 patients (4%) had low total serum IgG level. The vaccinated group has higher anti-pneumococcal capsular polysaccharide antibody level (median: 224.2 mg/L) compared to the unvaccinated group (median: 100.4 mg/L). However there is no statistical difference between the anti-PCP levels of both groups (p> 0.05). All of the selected patients had reactive specific antibody to capsular polysaccharides of Streptococcus pneumoniae regardless of the vaccination status, which may reflect the natural acquisition of anti-pneumococcal immunity. Conclusion: Although immunoglobulin deficiency is an uncommon aetiological cause of bronchiectasis, the immunoglobulin parameters can be helpful in selecting patients who should receive the appropriate treatment of immunoglobulin therapy for the prevention of subsequent complications and better quality of life. Bangladesh Journal of Medical Science Vol.19(2) 2020 p.200-207

Ocular syphilis is one of the clinical presentation or complication of syphilis. Uveitis is the most common ocular diagnosis of the condition but any component of the eyes can be affected. Serology test that include both treponemal and non-treponemal antibody detections play an important role for supporting the diagnosis. This condition is considered as part of neurosyphilis and the recommended treatment follows the treatment for neurosyphilis. We reported a 47-year-old man presented with chronic episode of blurring of vision associated with floaters involving both eyes. Both eyes showed abnormal visual acuity with involvement of optic disc on the left eye. Serology tests for non-treponemal antibody and treponemal antibody test were positive. He was diagnosed as a case of bilateral posterior uveitis with left eye neuroretinitis. He was successfully treated with intravenous aqueous crystalline penicillin 3 million unit every four hour daily for 14 days. J MEDICINE JUL 2019; 20 (1) : 52-54