Poster Presentation Abstracts
IDENTIFICATION OF CIRCULATING CYTOKINE BIOMARKER CANDIDATES FOR LATERAL FLOW–BASED PROGNOSTIC STRATIFICATION IN RHEUMATOID ARTHRITIS
Ali A1, Arifuddin N1, Shaharir SS2
1Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia
2Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia
Purposes of Study To identify circulating cytokine biomarkers suitable for development into a lateral flow based prognostic assay for Rheumatoid Arthritis (RA) to enable practical, biomarkerguided treatment stratification.
Materials and Method Baseline plasma samples from 43 RA patients (classified as good or poor responders) were analyzed using the Olink® Target 48 Cytokine panel. The analytical workflow included signal filtering (>1 pg/mL), log transformation, and Mann–Whitney U testing with Benjamini–Hochberg correction. Predictive modeling utilized L1-regularized logistic regression with cross-validation and pathway composite scoring of inflammatory modules.
Results Five biologically relevant candidate biomarkers were identified and ranked by their relative impact on treatment response prediction: IL-6 (Rank 1), TNF (Rank 2), CXCL11 (Rank 3), CCL2 (Rank 4), and MMP1 (Rank 5). IL-6 showed the strongest predictive contribution, reflecting systemic inflammatory signaling. Pathway-level analysis revealed distinct inflammatory endotypes: TNF/Th17 signaling was enriched in good responders, while interferon1- and IL-6- associated pathways were elevated in poor responders.
Conclusion Multiplex cytokine profiling identified a ranked set of biomarkers namely IL-6, TNF, CXCL11, CCL2, and MMP1 that capture key inflammatory and tissue- remodeling pathways. These candidates represent promising targets for lateral flow- based point-of-care assays to guide personalized RA therapy
SHINE NAVIGATOR: A CLINICAL DECISION-SUPPORT TOOL FOR INTERPRETATION OF QPCR- BASED EXPANDED NEWBORN SCREENING RESULTS FOR SCID, SMA AND XLA IN MALAYSIA
Ali A, Zainudin A
Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia
Purposes of Study Newborn screening for severe genetic disorders such as Severe Combined Immunodeficiency (SCID), Spinal Muscular Atrophy (SMA) and X-Linked Agammaglobulinemia (XLA) increasingly utilizes quantitative PCR (qPCR) assays targeting T-cell receptor excision circles (TREC), Kappa-deleting recombination excision circles (KREC), and SMN1 gene detection. Although laboratory platforms generate quantitative screening outputs, interpretation of abnormal or inconclusive results often requires standardized clinical decision pathways to guide follow-up management. This study aimed to develop SHINE Navigator, a prototype clinical decision-support platform designed to assist healthcare professionals in interpreting expanded newborn screening (ENBS) results and guiding appropriate follow-up actions.
Materials and Method SHINE Navigator was developed to interpret qPCR screening outputs generated using the ImmunoIVD assay and analyzed via SPOT-it software (ImmunoIVD, Sweden). The platform evaluates laboratory measurements for TREC, KREC and SMN1 markers against predefined screening cut-off values. A dataset comprising simulated normal, out-of-range and inconclusive screening results was used to evaluate the interpretation framework. Based on established newborn screening algorithms, the system automatically classifies screening outcomes and generates recommended follow-up actions including repeat dried blood spot (DBS) testing, clinical monitoring and referral pathways.
Results The SHINE Navigator prototype successfully categorized screening outputs into normal, out-of-range and inconclusive groups and generated corresponding follow-up recommendations. For out-of-range results, the system recommended repeat testing, urgent confirmatory investigations and appropriate clinical referral. Inconclusive results triggered recommendations for repeat DBS sample collection prior to further evaluation. The system demonstrated the feasibility of integrating laboratory screening outputs with structured clinical interpretation algorithms within ENBS workflows.
Conclusion SHINE Navigator demonstrates the potential of a digital clinical decision- support tool to standardize interpretation of qPCR-based ENBS results for SCID, SMA and XLA. Integration of structured interpretation algorithms with laboratory outputs may enhance clinical workflow efficiency, reduce variability in result interpretation and facilitate timely follow-up within expanded newborn screening programs.
EVALUATION OF AN AUTOMATED IMAGE ANALYZER IN ANTINUCLEAR ANTIBODY INDIRECT IMMUNOFLUORESCENCE PATTERN RECOGNITION
Asrul Abdul Wahab, Muhammad Asyraf MK, Jauhary EJ
Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia
Purposes of Study Indirect immunofluorescence (IIF) is widely regarded as the gold standard for antinuclear antibody (ANA) testing and is essential for screening patients suspected of systemic autoimmune rheumatic diseases. Automation of the ANA IIF test through image analysers has been implemented to enhance the identification of ANA IIF patterns. This study evaluates the performance of an automated ANA IIF pattern recognition analyser.
Materials and Method This prospective study included routine laboratory ANA requests collected between May and July 2025. Only positive samples exhibiting a single pattern, as determined by manual readers, were included. These patterns were also analysed using the EUROPattern Suite (EUROIMMUN, Lübeck, Germany), and the results were compared.
Results In total, 129 positive samples with a single pattern identified by manual observation were analysed with the automated analyser. The overall agreement between manual and automated methods was 50.4%. The centromere pattern demonstrated the highest concordance, while more common patterns, such as homogeneous and speckled, showed moderate agreement (61.1% and 65.8%, respectively). Notably, 46.5% of samples were discordant with manual readings because the analyser classified them as mixed patterns. When mixed patterns that included the true pattern were considered acceptable, overall agreement increased to 90.7%.
Conclusion These findings indicate that the automated system frequently overinterprets patterns, highlighting the need for caution in reporting. However, its ability to identify the true pattern amid mixed results may help laboratory personnel improve diagnostic accuracy.
HEALTH-RELATED QUALITY OF LIFE OF CHILDREN WITH HOUSE DUST MITE ALLERGY IN HOSPITAL SULTAN ABDUL AZIZ SHAH, UNIVERSITI PUTRA MALAYSIA
Wahab NLA1,2, Lim SC,2, Mahendran S1,2, Ramasamy Ravi1,2, Ang GX,2, Zainal Abidin MA1,2, Ismail IH1,2 , Mohamed Nashrudin KN1,2
1Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
2Advanced Medical Research in Allergy and Clinical Immunology (AMRAC), Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Malaysia
Background:
House dust mite (HDM) allergy is one of the most common causes of allergic disease in children, particularly in tropical regions where exposure is continuous. Despite its high prevalence, the impact on health-related quality of life (HRQoL) remains underexplored. Understanding this burden is essential to guide clinical management and health policy.
Methods:
This case-control study included 83 children with confirmed HDM allergy and 83 non-allergic controls attending at a tertiary pediatric centre in Selangor, Malaysia. HRQoL was parent-reported using the Pediatric Quality of Life Inventory (PedsQL 4.0). Clinical severity was assessed using international guidelines (GINA, ARIA, POEM). Sociodemographic and environmental data were collected. Statistical analysis was performed using SPSS 30.0.
Results:
Children with HDM allergy had significantly lower HRQoL scores across all domains compared with nonallergic controls. Psychosocial composite scores (emotional, social, school functioning) and total HRQoL scores were significantly reduced (p < 0.05). Within the allergic group, poorer HRQoL were associated with younger age and greater atopic dermatitis (AD) severity, while other sociodemographic and environmental factors showed weaker associations.
Conclusion:
Malaysian children with HDM allergy experienced significant HRQoL impairment, particularly in psychosocial domains. Holistic care and improved access to AIT are essential to reduce disease burden and enhance long-term outcomes.
Keywords:
House dust mite allergy, health-related quality of life
ROUND PNEUMONIA CAUSED BY ERYSIPELOTHRIX RHUSIOPATHIAE IN CHRONIC GRANULOMATOUS DISEASE: AN UNUSUAL ZOONOTIC INFECTION
Mahendran S1,2, Wahab NLA1,2, Lim SC1,2, Ang GX1,2, Mohamed Nashrudin KN1,2, Zainal Abidin MA1,2, Ismail IH1,2
1Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
2Advanced Medical Research in Allergy and Clinical Immunology (AMRAC), Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Malaysia
Purposes of Study
Chronic granulomatous disease (CGD) predisposes patients to recurrent and severe infections, particularly by catalase-positive organisms and fungi. This report aims to describe a case of prolonged pneumonia with persistent round consolidations in a child with CGD.
Materials and Method
This is a retrospective case report of a single patient, a 10-year-10-month-old boy with CGD presenting with prolonged pneumonia. Data were obtained through a comprehensive review of the patient’s electronic health record at Hospital Sultan Abdul Azizh Shah. Investigations included chest radiography, sputum cultures,
inflammatory markers, CT thorax, blood cultures, and echocardiography. Antibiotic therapy was guided by culture sensitivity, with ongoing clinical and radiological monitoring.
Results
Chest radiograph revealed persistent rounded opacity in the right middle zone. Sputum cultures on two occasions grew Erysipelothrix rhusiopathiae, sensitive to penicillin and ceftriaxone. Despite initial targeted therapy, inflammatory markers worsened, and repeat imaging demonstrated progression to bilateral pulmonary
consolidations. CT thorax confirmed multiple round consolidations suggestive of infective changes. Incidentally, his Serum Galactomannan was inconclusive thus bringing into question a possibility of Fungal infection. Due to no biochemical and radiographic improvement, the child was subsequently treated with Voriconazole. Blood cultures were negative, and echocardiography showed no vegetations. The patient completed multiple courses of antibiotics that are directed by positive sputum culture. He continues to show improvement with PO Voriconazoleand IV Imipenem.
Conclusion
Persistent pulmonary lesions in CGD require a high index of suspicion for staphylococcal and fungal infections. This case highlights the discordance between clinical stability and radiological progression, emphasizing the need for prolonged therapy and broad antimicrobial and empiric antifungal coverage. Early consideration of fungal and atypical pathogens is essential to optimize outcomes in CGD patients with refractory pneumonia.
Oral Presentation Abstracts
VITAMIN D SUPPLEMENTATION IMPROVES CLINICAL OUTCOMES AND MODULATES SPECIFIC IGE SENSITIZATION IN PEDIATRIC ALLERGIC RHINITIS: A 6-MONTH RANDOMIZED CONTROLLED TRIAL
Ali A1, Arifuddin N1, Vester R1, Zahedi FD2
1Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia 2Department of Otorhinoloaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia
Purposes of Study To evaluate the clinical and immunological impact of oral cholecalciferol (Vitamin D) supplementation as an adjunctive therapy for house dust mite (HDM)-sensitized children with allergic rhinitis (AR) and concurrent Vitamin D insufficiency.
Materials and Method A double-blind, randomized, placebo-controlled trial was conducted involving 65 children (ages 6–18) with confirmed HDM-sensitized AR and baseline serum 25(OH)D levels <30 ng/mL. While all participants received standard intranasal corticosteroids, the intervention group received daily oral cholecalciferol for six months. Primary endpoints included RQLQ scores, nasal symptom scores, endoscopic findings, and HDM-specific IgE levels assessed at baseline, 3, and 6 months.
Results Vitamin D supplementation yielded significant clinical improvements compared to the placebo group. The intervention group achieved a 56.7% reduction of mean RQLQ scores by 3 months (60 to 26; p < 0.001) and reached a further 83.3% reduction by 6 months, showcasing an improvement in the quality of life. Objective nasal endoscopic scores also improved by 59% in the intervention group (5.4 to 2.2; p < 0.001). Immunologically, the Vitamin D group demonstrated a significantly more pronounced reduction in HDM-specific IgE levels, indicating a favorable shift in the allergic inflammatory response compared to the placebo group, which showed symptomatic worsening.
Conclusion Adjunctive Vitamin D supplementation significantly enhances the efficacy of standard AR therapy. These findings highlight Vitamin D as a highly effective, low- cost strategy for optimizing management and improving the quality of life in pediatric patients with HDM-sensitized AR.
CLINICAL CHARACTERISTICS PREGNANCY-INDUCED RHINITIS: AN EVIDENCE BASED CASE REPORT
Afrina Yanti
Department of Otorhinolaryngology Head and Neck Surgery, Kariadi Hospital, Semarang, Indonesia
Purpose of study Pregnancy-induced rhinitis (PIR) is a hormonal rhinitis condition with non-infectious nasal symptoms that arise during pregnancy, yet often remain underdiagnosed or misclassified. Untreated rhinitis may adversely affect maternal health, fetal health and delivery outcomes although direct causation has not been demonstrated. How to identifying clinical features pregnancy-induced rhinitis (PIR) among pregnant women?
Material and Methods A 38-year-old woman, 36 weeks pregnant was diagnosed with (PIR). Literature study was conducted through database PubMed and ScienceDirect within last 5 years. An article has been retrieved base on the critical appraisal that was subjected to exclusion and inclusion criteria.
Results PIR is clinical entity characterized by one of more symptoms of rhinitis, with the most prevalent symptom is nasal obstruction.
Conclusion PIR is known to negatively impact quality of life and sleep for pregnant patient although typically has mild to moderate and self-limited symptoms. A multidisciplinary approach is needed to better understand and manage this condition. Future research should focus understanding pathophysiology underlying this condition and targeted threrapies that are safe and effective during pregnancy.
SUBCUTANEOUS VERSUS INTRAVENOUS IMMUNOGLOBULIN FOR PRIMARY IMMUNODEFICIENCY: A COST-MINIMISATION ANALYSIS IN MALAYSIA
Mashitah Abdullah1 Hafiz Jaafar2 , Amirah Azzeri2, Hakimah Ismail3,4, Mohd Azri3,4, Intan Juliana Abd Hamid5
, Marina Sham6 , Lokman Mohd Noh8 , Adli Ali1,7* (corresponding author)
1Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia.
2Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
3Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
4Advanced Medical Research in Allergy and Clinical Immunology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor, Malaysia.
5Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Pusat Kanser Tun Abdullah Ahmad Badawi, Universiti Sains Malaysia, Kepala Batas 13200, Pulau Pinang, Malaysia.
6Pediatric Infectious Disease and Immunology Unit, Department of Pediatric, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
7 Research Center and Clinical Immunology Unit, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
8 Medical Advisory Board, MyPOPI