No apparent association between beta-amyloid deposition and apolipoprotein E genotype in the non-demented aging brain in a Malaysian population

Little is known about the relationship between cerebral beta amyloid (Aβ) deposition and apolipoprotein E (ApoE) genotype in either Alzheimer disease or the aging brain in multi-ethnic Southeast Asia. We prospectively examined Aβ deposition in relation to ApoE genotype in 50 normal, non-demented, aging brains drawn from a Malaysian population, aged 52-92 years, using immunohistochemistry to detect Aβ and direct PCR sequencing for genotyping. The prevalence of Aβ deposition was 8%. There was no apparent association between Aβ deposition and possession of the ApoE ε4 allele in our cohort. Out of 4 cases with Aβ deposition, only one case was heterozygous for the ε4 allele; 3 cases did not have the ε4 allele. The Aβ deposition appears to increase with age and is more likely to be vascular-type deposition (cerebral amyloid angiopathy) rather than parenchymal deposition in the form of diffuse and neuritic plaques. A larger sample size with more cases of ApoE ε4 and Aβ deposition is needed to provide conclusive evidence for the apparent non-association between ApoE ε4 and Aβ deposition in the aging brain in our multi-ethnic local population.

Quality assurance in forensic pathology

One of the requirements for proper running of a pathology laboratory is implementation of a quality assurance programme. Forensic pathology is not exempted, especially so when cases are increasing in complexity. It is not difficult to introduce a quality assurance programme even in a small forensic centre. Among the steps that can be implemented including introduction of a set of minimal standards in performance of the autopsy, timeliness and report writing, a vigorous peer review process either internally or externally and participation in external quality programmes. Proper documentation of the post-mortem process (photography, slides and blocks and various imaging modalities) is to be encouraged. There should be limits set on workload of pathologists as overburden is known to lower standards. A pleasant work environment is also essential. Personal continuous medical education should be made mandatory. Introduction of a quality assurance programme will not only improve standards but minimise possible negligence. The post-mortem reports will be seen to carry more weight in court.

A retrospective study of the accuracy between clinical and autopsy cause of death in the University of Malaya Medical Centre

It is well known that diagnostic accuracy of the clinical cause of death has not improved despite advances in diagnostic techniques. We aimed to investigate the accuracy of the clinical cause of death compared with the autopsy cause of death and to see if the Coroner's autopsy can play a role in clinical audit. Our study population consisted of all autopsies where the deceased was hospitalised or resuscitated at the Accident and Emergency Unit of the University of Malaya Medical Centre before death, performed during the period July 1998 to June 2000. The cases were subdivided according to natural and unnatural causes of deaths. Natural deaths were further subdivided in relation to the main organ systems involved while unnatural deaths were subcategorised into trauma, poisoning and burns. The rate of agreement between clinical and autopsy cause of death was further compared with duration of survival in the hospital. Of 132 autopsies included in this study, 115 were Coroner's autopsies. 78% of cases showed agreement between clinical and autopsy cause of death. The agreement rate in Coroner's cases was 80.0%. For natural and unnatural causes, the agreement rate was 56.7% and 84.3% respectively. There were 6 cases (4.5%) where an initial accurate diagnosis might have altered the prognosis of the deceased. In general, the rate of agreement increased with duration of survival of patients. However, this was no longer observed after a survival of more than 28 days. Our findings agree with other similar studies. The diagnostic accuracy of cause of death has not improved despite the modernisation in medical technology. The autopsy still plays an important role in clinical audit and medical education.