A Review of Occupational Injury Research In Malaysia

A literature review of 16 papers on occupational injury research in Malaysia published during a 13-year period from 2000-2013 was carried out. The objective of this review and article selection was based on relevance to the research theme and mention of areas for future research. Most of the publications have focused on descriptive epidemiology, management practices, worker’s knowledge, attitude, training, and rehabilitation services. The transportation, agriculture and construction sectors were found to be the most hazardous sectors and would benefit the most from Occupational Safety & Health (OSH) research and interventions. There is a strong need to develop a national injury surveillance system and also a mechanism to ensure adherence to the Occupational Safety & Health Act(OSHA) 1994. Detailed description and identification of risk factors for occupational injury in the environment, including machinery and equipment used was generally lacking. Future research on occupational injury should focus on surveillance to determine the magnitude of occupational injuries, determination of risk factors, identifying costeffective interventions (such as enforcement of OSHA regulations), and assessment of rehabilitation services. Relevant government agencies, universities, corporate sector and occupational safety organizations need to play a proactive role in identifying priority areas and research capacity building. Funding for occupational injury should be commensurate with the magnitude of the problem.

Varicella-zoster virus transverse myelitis in an immunocompetent patient.

Transverse myelitis is one of the rare neurological complications of Varicella-Zoster Virus (VZV) infection in immuno-competent. We report a 26-year-old immuno-competent gentleman who developed virologically confirmed myelopathy caused by VZV which improved with steroids and acyclovir leaving no residual neurological deficits.

Chromosome 7 aneuploidy in clear cell and papillary renal cell carcinoma: Detection using silver in situ hybridization technique.

Background: Chromosome 7 aberrations in renal cell carcinoma (RCC) have been reported in papillary renal cell carcinoma (pRCC) and clear cell renal cell carcinoma (ccRCC). However, the implication of these anomalies on prognosis and survival is still unclear. RCC Chromosome 7 aberrations have commonly been detected by fl uorescent in situ hybridization and chromogenic in situ hybridization but not silver in situ hybridization (SISH). Aim: The purpose was to report chromosome 7 aberrations in ccRCC and pRCC using SISH in paraffi nembedded tissues and determine the association between the anomalies with clinical and pathological features. Materials and Methods: Cases of ccRCC and pRCC from University Malaya Medical Centre (2001-2009) were analyzed. Chromosome 7 staining was performed using an automated SISH method and association tests between chromosomal anomalies, clinical features and survival were performed. Results: SISH is a feasible technique to detect chromosome 7 aberration in RCC. Chromosome 7 aberrations with nuclear grading, staging and survival yielded no signifi cant correlation. Surprisingly, there was a signifi cant association between gender and chromosome 7 expressions. Though grade did not reach statistical signifi cance for survival in our RCC cases, there was a signifi cant correlation between overall survival with race and stage. Conclusion: Chromosome 7 aberrations in ccRCC showed no prognostic signifi cance. Nevertheless, staging and grading systems that include prognostic variables could hold better promise.

Survival Difference between Surgery Versus Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia

Hepatic resection, the only treatment that offers long term survival for patients with Hepatocellular carcinoma (HCC), have shown significant improvement in results over the past decades. The aim of the study was to compare the survival between patients receiving and not receiving surgery. A retrospective cohort study measured the survival of newly diagnosed cases of HCC patients who underwent treatment in Selayang Hospital from 1 January 2003 till 31 December 2006. Survival time was measured from the date of diagnosis until the subjects died or until the end of study period (31 December 2007). Overall survival was significantly longer in surgery group in comparison with non-surgery group with a median survival of 43 and 20 months, respectively (p<0.001). The following factors were noted to have improved survival duration with surgical resection; Child Pugh Class B patients, tumor size less or more than 4cm and number of nodules less than 3. Subgroup analysis showed improved survival duration with surgical resection among patients with Child Pugh Class B with tumor size less than 4cm or with nodule less than 3 and patients who had less than 3 nodules, even with tumor size of less or more than 4cm. Multivariate Cox Re-gression showed surgical intervention significantly improved survival time for overall patients (Adjusted HR: 1.5) while non-surgery improved survival in patients with tumor size less than 4cm (Adjusted HR: 0.4). Surgical resection significantly improved the survival duration in overall patients while non-surgical procedure improved survival if the tumor size was less than 4cm.

Fine needle aspiration cytology of neuroendocrine carcinoma of the breast--a case report and review of literature

Neuroendocrine carcinomas of the breast are uncommon tumors known to occur in the elderly. While focal neuroendocrine differentiation may be noted in many ductal and lobular carcinomas, the term neuroendocrine carcinoma is to be applied when more than 50% of the tumor shows such differentiation. This case report details the cytological features of a neuroendocrine carcinoma that was encountered in our hospital. The fine needle aspiration (FNA) smears showed discohesive polygonal cells with abundant cytoplasm, many of which contained eosinophilic granules located at one pole. Histology of the mastectomy and axillary lymph nodes specimen from this patient showed features of neuroendocrine carcinoma--solid type, with metastasis, confirmed with immunohistochemistry. The patient is disease free seven months after surgery. This case highlights the need to closely observe cytological details to identify this rare tumor that may otherwise appear to be invasive duct carcinoma--not otherwise specified on FNA. The implications of diagnosing neuroendocrine differentiation for prognosis and management are also discussed.

Follicular dendritic cell sarcoma of inguinal lymph node--a case report

Follicular dendritic cell sarcomas (FDCS) are rare neoplasms that involve lymph nodes or extranodal sites. They show varied histological features and thus can be mistaken for carcinoma or sarcoma. Correct identification is important for further management. A 43-year-old Indian female presented with a three-month history of progressive swelling at the right inguinal region. It was excised completely and was reported as lymph node with metastatic poorly differentiated carcinoma based on Haematoxylin and eosin (H&E) stain findings. Computerized tomography (CT) scans of thorax, abdomen and pelvis were normal and did not reveal a primary site. Following this, the case was referred to one of the authors. The slides were reviewed and a variety of immunocytochemical markers were done. The tumour cells were negative for epithelial, melanocytic, neural, leucocyte and soft tissue tumour markers. They were immunopositive for CD21, CD35 and negative for CD68. Based on the immunocytochemical findings, a final diagnosis of FDCS was made. This case highlights the histological and immunophenotypical profile of a rare tumour which requires a high index of suspicion for diagnosis.

A rare cause of heart failure--primary hypoparathyroidism.

We report a patient who presented with congestive heart failure (ejection fraction 24.4%) and who had previous history of convulsions. Our investigations found him to be a case of primary hypoparathyroidism. He showed a dramatic response with the addition of calcium infusion therapy with almost full recovery of left ventricular function (67% ejection fraction after 16 days of the initial echo). We conclude that in a young patient a thorough investigation for heart failure is never complete without looking for endocrine and metabolic causes. The prognosis in these cases is much better, identification and treatment of the same will yield dramatic results.

A comparative study on the physicochemical and bacterial analysis of drinking, borewell and sewage water in the three different places of Sivakasi.

The drinking, borewell and sewage water in the Sanmugasikamani Nadar (S.N) street, Naivatti Nadar (N.N) street and Thiruthangal area of Sivakasi has been studied. The various constituents monitored include the physicochemical characters like pH, total solids, total dissolved solids, total suspended solids; chemical parameters like total alkalinity acidity free CO2, dissolved oxygen, total hardness, calcium, magnesium, chloride, salinity and bacterial parameters like standard plate count (SPC), total coliform count (TCC), faecal coliform count (FCC), faecal streptococcal count (FSC). Most of the physicochemical characters of drinking and borewell water were within the ISI permissible level. However in water samples from all the sites, bacterial count exceeded the recommended permissible level of WHO. Introduction of sewage into the drinking and borewell water was the main reason for the bacterial contamination. The boiling of water is therefore advisable before consumption. The physicochemical and bacterial characters of the sewage water were unworthy. The sewage water recycling was necessary to minimize the water born diseases.

Fetus in fetu or differentiated teratomas?

Two cases of congenital teratoma were operated upon. In view of the high degree of organoid differentiation of the teratomas with rudimentary limbs, intestine, brain-like and pulmonary tissues, it was difficult to distinguish it from fetus-in-fetu. In the light of the data obtained and extensive review of related literature, we consider that fetus-in-fetu and teratoma may not be unrelated entities. Our cases support the view held that fetuses in fetu are highly differentiated teratomas.

Effect of anti-Helicobacter pylori therapy on outcome of iron-deficiency anemia: a randomized, controlled study.

BACKGROUND: Helicobacter pylori infection may play a role in iron-deficiency anemia. METHODS: In 52 patients with iron-deficiency anemia, H. pylori status was determined using rapid urease test and histology. H. pylori -positive patients were randomly assigned to receive anti- H. pylori treatment either immediately (Group I) or after a delay of one month (Group II); in addition, all patients received oral ferrous sulfate for three months. Patients testing negative for H. pylori (Group III) received only oral ferrous sulfate. Hematological parameters were tested every month. RESULTS: Of 52 patients, 32 (61.5%) had H. pylori infection. At the end of one month, median increase in hemoglobin level was lower in Group II than in Groups I and III (1.1 g/dL vs. 3.6 g/dL and 1.9 g/dL, respectively; p=0.025), as were that in serum iron (19 mcg/dL vs. 55.5 mcg/dL and 41 mcg/dL; p=0.019). During the second month, after H. pylori infection in Group II had been treated, median increase in hemoglobin in this group was comparable to those in Groups I and III (3.7 g/dL vs. 2.5 g/dL and 2.5 g/dL. CONCLUSION: In patients with iron-deficiency anemia, presence of H. pylori infection is associated with a poorer response to oral iron therapy, which improves with treatment for H. pylori infection.

PUO due to Langerhans Cell Histiocytosis.

Langerhan Cell Histiocytosis (LCH) is a disorder in which cells with a phenotype similar to that of epidermal langerhans cells cause tissue damage possibly through excessive cytokine production. The clinical spectrum of the disease is wide. We are reporting a case of LCH who presented with prolonged pyrexia and a clinically benign bony swelling of mandible of long duration, which was otherwise ignored as being unrelated. The biopsy from the swelling confirmed the diagnosis of LCH. Another biopsy from lower end of tibia where he had pain also demonstrated typical findings. There was no evidence of other system involvement. There was good remission of the swellings and the symptoms with steroid alone initially but later relapsed and is now on treatment as per LCH III protocol. The case is being reported for its rarity and for the unusual presentation as PUO.

Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: a study in mastectomy specimens using simulation lumpectomy.

BACKGROUND: The response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NACT) offers these patients previously treated by mastectomy, the chance for breast conservation. AIM: This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor < or =5 cm. SETTINGS, DESIGN: Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS: Thirty patients with LABC whose tumors reduced with NACT to 5 cm were included. Simulation lumpectomy was performed on the mastectomy specimens to achieve 1 to 2 cm clearance from tumor and hence margin negativity. Multiple sections of the inked margin were studied. STATISTICAL ANALYSIS: Margin positivity was correlated with patient factors. Chi square test and Fisher's exact test used as appropriate. P value 0.05 was considered significant. RESULTS AND CONCLUSIONS: After three cycles of NACT, 4 patients (13%) had complete clinical response including 2 with complete pathological response. Twenty-two (73%) showed partial response and 4, no response. Fourteen out of thirty (47%) had tumor involvement of margins. Tumors with post-chemotherapy size> 4 cm were margin positive in 10/13 (77%). Tumors with post-chemotherapy size>3 cm were margin positive in 13/24 (54%). Tumors with post-chemotherapy size 3 cm were margin negative in 5/6 (83%). Pre-chemotherapy tumor size and post-chemotherapy tumor size were significantly associated with margin positivity (P=0.003). Tumors in the subareolar location had significantly higher incidence of residual tumor in the nipple areola complex. (P=0.04). Margin positivity of lumpectomy on downstaged tumors can be reduced by removing the nipple areola complex in subareolar tumors and by limiting breast conservation to tumors with post-chemotherapy size < or =3 cm.

Restrictive cardiomyopathy due to primary plasma cell leukemia.

The causes of restrictive cardiomyopathy are numerous, of which neoplastic infiltration is also known. Plasma cell leukemia is considered as the, most severe form of multiple myeloma, is an extremely rare condition. Among them, primary plasma cell leukemia has got an incidence of one in one million only. We report a case summary of a patient who was admitted with clinical features suggestive of restrictive cardiomyopathy, the underlying disorder was primary plasma cell leukemia. With chemotherapy the restrictive physiology was relieved supporting the diagnosis of plasma cell infiltration in the myocardium. We report this case due to rarity of the disease itself and its rare presentation.

Complete axillary conversion after neoadjuvant chemotherapy in locally advanced breast cancer: a step towards conserving axilla?

OBJECTIVES: This study was designed to assess the clinical, sonographic and histopathological response of axillary lymph node metastasis to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIAL AND METHODS: Forty patients with locally advanced breast cancer (LABC) with clinically palpable or sonographically detectable axillary nodes were studied. FNAC of the primary tumor and axillary nodes was done and patients were started on neoadjuvant chemotherapy. Axillary nodes were assessed clinically and sonographically for response after 3 cycles of chemotherapy. All patients underwent total mastectomy with axillary clearance and the lymph nodes in the specimen were examined for metastasis. RESULTS: 47% patients had complete clinical nodal response, while 19% showed complete sonographic response. Complete pathological nodal response was documented in 22% of patients. Ultrasonography was found to be more sensitive than clinical examination in assessing complete nodal response. 10% of the patients had complete pathological response of both primary tumor and axillary nodes. There was significant correlation between pathological response of primary tumor and lymph nodes (P=0.004). Patients with complete sonographic or clinical response were found to have no or minimal residual disease in axilla and hence axillary dissection may be avoided in them.

A study of fibroepithelial tumours of the breast.

Cytological parameters were studied in 18 fibroepithelial tumours of the breast including 8 benign phyllodes, 1 malignant phyllodes, and 9 fibroadenomas between 1999 to 2001. Cytology smears were studied without knowledge of previous cytodiagnosis by 3 different observers. Histopathologic parameters were studied in 18 fibroepithelial tumours by 3 observers. Cyto-histological correlation was carried out. Cytological criteria by Chinoy et al (1999) were utilized to give revised cytodiagnosis. Initial cytodiagnosis and revised cytodiagnosis were correlated with histopathological diagnosis. 8/9 cases of fibroadenoma (88%) studied were correctly diagnosed on FNAC after semiquantitative team approach as opposite to 44% initial cytodiagnosis. Cytological distinction between benign phyllodes and fibroadenoma was improved after semiquantitative approach to various parameters. Diagnosis of malignant phyllodes posed no problems in cytodiagnosis. Present study supports the role of FNAC in distinguishing benign from malignant phyllodes and distinguishing fibroadenoma from phyllodes tumour. The latter being a rare fibroepithelial tumour, its study is interesting.

Ontogeny of solasodine-containing mucilage layer in solanum viarum Dunal, ploidy types.

Berries of steroid-bearing Solanum viarum Dunal are exploited commercially in India as raw material by steroid industries for solasodine, a glycoalkaloid, present in the mucilaginous exotesta of the seed. Comparative ontogeny of exotesta studied through histochemical studies in diploid, autotetraploid and trisomic plants indicated similarity in the histochemical changes occurring during ontogeny of the outermost seed coat layer which culminated in the transformation of this layer into the mucilage layer. The increased cell size in this layer in the autotetraploid plants probably accounts for the higher steroid content reported. Corroborative evidences for histochemical changes observed in the mucilage layer were obtained from studies of ultrastructure using transmission electron microscopy.

Gastric strongyloidiasis in a Malaysian patient.

Strongyloides stercoralis infection is of low prevalence in Malaysia. We report an unusual case presenting primarily with gastric symptoms. The patient was a 72 years old Chinese male admitted for progressive weight loss and abdominal bloating. Gastroscopic examination revealed mucosal prepyloric elevations in the gastric mucosa. Gastric strongyloidiasis was confirmed by the presence of adult forms, as well as ova and larval rhabditiform stages of the worm in the gastric mucosal crypts. We believe that this is the first histologically documented case of gastric strongyloidiasis in Malaysia.

Immunoscintigraphy of MCF7 rat mammary tumour xenograft using monoclonal antibody.

A transplantable, ER+ mammary carcinoma has been induced in virgin female Wistar rats by an 'air-pouch' technique by xenografting MCF7 cells. An air pouch induced by injecting sterile air subcutaneously into the mammary fat pad was primed with pristane and 17 beta estradiol (10 micrograms) in peanut oil prior to injection of 2-5 x 10(7) MCF7 cells fresh from culture. Solid tumours developed within 1-3 months (0.5-3.4 cm diam.) well encapsulated, pediculated tumours with histology of adenocarcinoma (> 80%) and fibroadenoma (< 10%), the former tumour being estrogen-dependent and transplantable. Monoclonal antibody 15C3 generated against MCF7 cells in this laboratory has been used for Tc-99m immunoscintigraphic studies by "SPECT" analysis of this mammary carcinoma and revealed selective localization of Tc-99m resulting in highly distinct tumour images.