Clinicopathological study of gastric cancer in a Malaysian tertiary public health care centre.

INTRODUCTION: Gastric cancer (GC) is one of the leading causes of all new cancer cases globally. Although it is no longer reported in the top 10th most common cancer in Malaysia, geographical distribution and ethnic influences still obviously exist. MATERIALS AND METHODS: This is a retrospective analysis of histopathological records in a public tertiary health care centre in Malaysia. The computerised laboratory information system from the histopathology department of the hospital was retrieved for the period of 2005-2018. Descriptive analysis was done using Microsoft Excel. RESULTS: There was a total of 233 histologically confirmed GC cases. The burden of GC was observed to be an increasing trend from 2016 onwards. Among them, 64% were male and 36% were female. The youngest age of diagnosis was 19, while the oldest one was 93. Malaysian Chinese were found to have the highest incidences (41.63%), followed by Malays (32.19%) and Malaysian Indians (23.61%). All cases were of adenocarcinoma cell types and were found to have poorly differentiated in majority at the time of diagnosis. CONCLUSION: Although this report only represents one tertiary health care centre in Malaysia, the Indian Enigma was still observed, as stated in other literatures. Over time, the incidence of GC in Malays has increased. Consideration of lifestyle modifications, health education and Helicobacter pylori eradication in various nations' National Health Insurance plans, are encouraged as prevention is always better than treatment or cure, including the cost load.

A 5-year clinicopathological study on microscopic colitis at a Malaysian tertiary hospital.

INTRODUCTION: Microscopic colitis (MC) is a well-recognised cause of chronic diarrhoea in Western countries. It is classically associated with normal endoscopic findings and a higher prevalence among patients with autoimmune disease. Local information regarding this disease remains scarce. We identified patients diagnosed with MC over a five-year period, and then proceeded to analyse the clinical characteristics of these cases. MATERIALS AND METHODS: A retrospective study was conducted by identifying all histologically confirmed colitis cases diagnosed at Hospital Universiti Sains Malaysia from January 2015 until December 2019. Clinicodemographic data was retrieved from case notes of patients. RESULTS: Of the 299 cases with histological colitis, 23 (7.7%) were initially identified as MC. Two cases had incomplete data, while two others were excluded as the diagnoses were revised to inflammatory bowel disease. An incidence of 14 MC cases/1000 case-year was obtained using the 21 MC cases seen within the five-year period. MC subtypes for the 19 analysed cases i.e., lymphocytic colitis and collagenous colitis accounted for 13 (68.4%) and 6 (31.6%) cases, respectively. Eleven patients (57.9%) were females (M:F ratio 1:1.5) with a median age of 51 years. Only nine (47.3%) presented with diarrhoea; one subject (5.4%) had an autoimmune condition (Hashimoto thyroiditis). Normal endoscopic findings were found in 89.5% of patients. CONCLUSION: Approximately half of the subjects in our study who had histologically confirmed MC did not present with diarrhoea. Adequate biopsy samples despite normal colonoscopy findings are important in order to not miss the diagnosis of MC.

The effect of a consortium of Penicillium sp. and Bacillus spp. in suppressing banana fungal diseases caused by Fusarium sp. and Alternaria sp.

AIMS: This study sought to utilize indigenous soil micro-organisms to suppress wilt-causing fungal pathogens of the banana. METHODS AND RESULTS: Fungal pathogens were isolated from wilt-affected rhizospheric soil, and potential antagonistic bacterial strains were isolated from healthy rhizospheric soil in the same area from which fungal pathogens were isolated. The antifungal activity of isolated micro-organisms against fungal pathogens was studied both in vitro and in vivo against fungal pathogens. It was found that Fusarium oxysporum and Alternaria sp. were pathogenic, while Penicillium sp., Bacillus velezensis and Bacillus subtilis were antagonistic. Moreover, it was seen that B. velezensis, B. subtilis and Penicillium sp. inhibited the growth of the two fungal pathogens in both in vitro and in vivo experiments. Further investigation indicated that B. velezensis, B. subtilis and Penicillium sp. were able to produce enzymatic antifungal compounds (chitinase and ß-1,3-glucanase). The spray application around rhizome revealed that a combination of Bacillus spp. and Penicillium sp. in greenhouse conditions gave the highest reduction in disease severity by up to 60% to both fungal pathogens among the treatments. CONCLUSIONS: Banana disease is seen to be induced not only by F. oxysporum but also by Alternaria sp. The isolated indigenous micro-organisms can effectively control both the pathogens. The combination of isolated antagonistic micro-organisms has thus demonstrated substantial potential for suppressing banana disease. SIGNIFICANCE AND IMPACT OF THE STUDY: An antagonistic consortium isolated in this study has demonstrated remarkable potential for controlling fungal diseases caused by Fusarium sp. and Alternaria sp. Therefore, the use of indigenous microflora to improve disease suppression of banana plants against soil-borne pathogens is a preferable approach.

Biosecurity in endemic foot and mouth disease settings: a case study of foot and mouth disease vaccination in South-East Asia.

Foot and mouth disease (FMD) is a highly contagious viral infection affecting cloven-hoofed animals including cattle, buffalo, sheep, goats and pigs. The disease is endemic in several parts of Asia, as well as most of Africa and the Middle East. In 1997, the World Organisation for Animal Health (OIE) established the South-East Asia Foot and Mouth Disease Campaign with the aim of increasing livestock sector productivity and economic output through the control and eradication of FMD in South-East Asia. Large-scale vaccination of livestock against FMD has in the past led to the successful eradication (or control) of the disease, for example in the Philippines. However, despite the benefit associated with large-scale vaccination, biosecurity risks can be created by vaccination teams moving between locations. It is therefore recommended that biosecurity measures are used by vaccination teams to prevent inadvertent disease spread. The majority of existing guidelines are focused on high-risk situations such as exotic animal disease outbreaks in developed countries, or agents posing a risk to human health. This paper describes the development of novel biosecurity guidelines for vaccination teams in South-East Asia. To achieve this, available literature was scanned followed by in-country workshops and field-testing of draft materials. Entry and exit procedures are laid out within the context of five core rules that follow the biosecurity principles of situational awareness, segregation, cleaning and disinfection. Guidelines and accompanying fact sheets were translated into local languages and included in a comprehensive vaccination training programme for all vaccination teams undertaking cattle FMD vaccination programmes in the New Zealand OIE FMD control project target countries (Myanmar and Laos). The material developed has wide practical relevance to veterinarians, traditional healers and village or community animal health workers, who all pose a heightened risk of spreading infectious agents.

La fièvre aphteuse est une maladie virale extrêmement contagieuse affectant les artiodactyles (dont les bovins, les buffles, les ovins, les caprins et les porcins). La maladie est présente à l'état endémique dans plusieurs régions d'Asie, dans presque toute l'Afrique et au Moyen-Orient. En 1997, l'Organisation mondiale de la santé animale (OIE) a lancé la Campagne de lutte contre la fièvre aphteuse en Asie du Sud-Est afin d'améliorer la productivité et la rentabilité économique du secteur de l'élevage à travers la lutte contre la fièvre aphteuse voire son éradication de la sous-région. Grâce à la vaccination à grande échelle du bétail, certains pays ont pu éradiquer (ou du moins contrôler) la fièvre aphteuse dans le passé, par exemple les Philippines. Si la vaccination à grande échelle est en soi bénéfique, elle comporte certains risques de biosécurité, liés aux déplacements des équipes de vaccination d'un site à l'autre. Il est donc recommandé que ces équipes appliquent des mesures de biosécurité visant à prévenir toute propagation accidentelle de la maladie. La plupart des lignes directrices existantes sont axées sur les situations présentant un niveau de risque élevé, par exemple la survenue de foyers de maladies animales exotiques dans les pays développés, ou d'agents pathogènes qui constituent un risque pour la santé publique. Dans cet article, les auteurs décrivent la méthodologie suivie pour élaborer des lignes directrices innovantes de biosécurité en Asie du Sud-Est, destinées aux équipes de vaccination. Ces lignes directrices ont été rédigées en passant en revue la littérature sur le sujet lors d'ateliers nationaux et en testant sur le terrain les projets de documents. Les procédures d'entrée et de sortie ont été établies en suivant cinq règles fondamentales fondées sur les grands principes de la biosécurité, à savoir la connaissance de la situation, la ségrégation, le nettoyage et la désinfection. Les lignes directrices et les fiches explicatives qui les accompagnent ont été traduites en langues locales et utilisées dans le cadre d'un programme complet de formation à la vaccination destiné à l'ensemble des équipes de vaccination participant aux programmes de vaccination du cheptel bovin contre la fièvre aphteuse dans les pays couverts par le projet Nouvelle-Zélande­OIE de lutte contre la fièvre aphteuse (Myanmar et Laos). Les matériels proposés présentent une utilité concrète pour les vétérinaires, les guérisseurs traditionnels et les auxiliaires communautaires ou villageois de santé animale, qui sont tous particulièrement exposés au risque de propager involontairement des agents de maladies infectieuses.

La fiebre aftosa es una infección vírica muy contagiosa que afecta a animales biungulados como el ganado vacuno, el búfalo, la oveja, la cabra o el cerdo. La enfermedad es endémica en varias zonas de Asia y en la mayor parte de África y Oriente Medio. En 1997, la Organización Mundial de Sanidad Animal (OIE) instituyó la «Campaña de lucha contra la fiebre aftosa en el Sudeste asiático¼ con el objetivo de que el control y la erradicación de la enfermedad en la región se tradujeran en un aumento de la productividad y la rentabilidad económica del sector ganadero. En ocasiones anteriores la vacunación a gran escala del ganado ya ha resultado eficaz para erradicar (o controlar) la fiebre aftosa, por ejemplo en Filipinas. Sin embargo, pese a los beneficios que depara la vacunación a gran escala, los equipos que la llevan a cabo, al desplazarse de una a otra localidad, también pueden vehicular nuevos riesgos biológicos. Por ello se recomienda que esos equipos apliquen medidas de seguridad biológica destinadas a impedir la propagación accidental de la enfermedad. La mayoría de las directrices existentes al respecto están centradas en situaciones de gran riesgo, como brotes de enfermedades animales exóticas en países desarrollados o presencia de agentes infecciosos que entrañan peligro para la salud pública. Los autores describen la elaboración de nuevas directrices de seguridad biológica dirigidas a los equipos de vacunación que operan en el Sudeste asiático. Para empezar se hizo un repaso de la bibliografía existente, tras lo cual se celebraron talleres nacionales y se ensayaron sobre el terreno las medidas preconizadas en un primer borrador. Como parte de las directrices se instauran procedimientos de entrada y salida encuadrados en cinco reglas básicas que se ajustan a los grandes principios de seguridad biológica: conocimiento de la situación, segregación, limpieza y desinfección. Las directrices y las fichas descriptivas que las acompañan, una vez traducidas a los idiomas locales, fueron incluidas en un programa integral de formación en vacunaciones dirigido a todos los equipos que se disponían a intervenir en programas de vacunación antiaftosa del ganado en Myanmar y Laos, países beneficiarios del proyecto Nueva Zelanda­OIE de lucha contra la fiebre aftosa. El material elaborado reviste gran utilidad práctica para los veterinarios, curanderos tradicionales y trabajadores zoosanitarios de aldeas y comunidades, todos ellos portadores de un riesgo especialmente importante de propagar agentes infecciosos.

Primary mediastinal large B-cell lymphoma and its mimickers: a rare case report with literature review.

Primary mediastinal large B-cell lymphoma (PMLBL) is an uncommon non-Hodgkin lymphoma with a distinct clinicopathological entity in the WHO classification of lymphoid malignancies. It is known to originate from B-cells of the thymus. It mimics thymic neoplasms and other lymphomas clinically and histopathologically. We reported a 33-year-old obese man who presented with shortness of breath off and on for 4 years. Radiologically, there was a huge anterior mediastinal mass. Tru-cut biopsy was initially diagnosed as type-A thymoma. Histopathological examination of the excised specimen revealed PMLBL with stromal fibrosis and sclerosis which created a diagnostic difficulty. The neoplastic cells varied from medium-sized to large pleomorphic cells, including mononuclear cells with centroblastic and immunoblastic features as well as bi-lobed Reed Sternberg (RS)-like cells and horse-shoe like hallmark cells. Some interlacing spindle cells and epithelioid cells were also present. Immunohistochemically, tumour cells expressed diffuse positivity for LCA, CD20, CD79a, CD23, Bcl2, MUM-1 and heterogenous positivity for CD30 and EMA, and were negative for CD10, CD15 and ALK. Ki67 scoring was very high. Tumour cells infiltrated into peri-thymic fat and pericardium. No malignant cells were detected in the pleural fluid and there was no bone marrow infiltration. The patient showed partial response to 6 cycles of RICE chemotherapy, and was planned for second line chemotherapy using hyper-CVAD regimen followed by autologous stem cell transplantation. This case illustrates the importance of thorough sampling and immunohistochemistry in differentiating PMLBL from its differential diagnoses.

Strongyloides stercoralis induced bilateral blood stained pleural effusion in patient with recurrent Non-Hodgkin lymphoma.

Infections and malignancies are common causes of pleural effusion. Among infectious causes, hyperinfection syndrome of Strongyloides stercoralis may occur in immunosuppressive patient. A 62-year-old man, known case of Non-Hodgkin lymphoma (NHL) was presented with recurrent NHL stage IV and had undergone salvage chemotherapy. Patient subsequently developed pneumonia with bilateral pleural effusion and ascites. We reported rhabditiform larvae of S. stercoralis in pleural fluid of both lungs without infiltration by lymphoma cells. Stool for microscopic examination also revealed rhabditiform larvae of S. stercoralis. This patient was a known case of NHL receiving chemotherapy resulting in immunosuppression state. Although S. stercoralis infection is not very common compared to other parasitic infections, it is common in immunosuppressive patients and may present with hyperinfection. Therefore, awareness of this parasite should be kept in mind in immunosuppressive patients.

Wide distribution of Plasmodium ovale in Myanmar.

The presence of Plasmodium ovale has never been previously reported in Myanmar. Using blood samples obtained in many villages across the country between 1996 and 2000, molecular diagnosis of Plasmodium species was made with semi- or full-nested polymerase chain reaction (PCR) with species-specific primers, followed by agarose gel electrophoresis to detect amplification products. The presence of P. ovale was also confirmed with the another PCR-based diagnosis, the microtiterplate hybridization (MPH) method using species-specific probes. Both methods target the A type of the small subunit ribosomal RNA gene of the four human malaria parasites. Plasmodium ovale DNA was amplified in samples from 65 (4.9%) of 1323 PCR-positive patients, with perfect agreement between results obtained by nested PCR and MPH. Only four P. ovale-infected patients had single-species infection; all others were coinfected with P. falciparum, P. vivax and/or P. malariae. Quadruple infections were observed in six subjects. Parasites with typical P. ovale morphology were found in only 19 patients by conventional microscopy of Giemsa-stained thin smears or fluorescence microscopy of acridine orange-stained thin smears. Plasmodium ovale infections were found in villages situated in the southern, central and western regions of Myanmar, suggesting that P. ovale may be widely distributed in this country.