Entamoeba infections and associated risk factors among migrant workers in Peninsular Malaysia

@#The influx of low skilled migrant workers to Malaysia from low socio-economic countries where gastrointestinal parasitic infections are prevalent has raised concerns about transmission to the local population. Three methods for detection (serology, microscopy and molecular techniques) were utilized to identify Entamoeba infections amongst the targeted cohort and determine risk factors associated with infection. Serological screening of 484 migrant workers from five working sectors in Peninsular Malaysia using IgG4 ELISA based on the rPPDK antigen showed an overall seroprevalence of 7.4% (n = 36; CL95 = 5.3–10.1%) with only one factor statistically associated with seropositivity of anti-amoebic antibodies, i.e. years of residence in Malaysia (χ2 1 = 4.007, p = 0.045). Microscopic examination of 388 faecal samples for protozoan cysts and trophozoites showed a slightly higher prevalence (11.6%; n=45; CL95: 8.4–14.8%). Meanwhile, amplification of the 16S rDNA gene detected two species i.e. Entamoeba dispar (23/388; 5.9%; CL95: 3.6–8.3%) and E. histolytica (11/388; 2.8%; CL95: 1.2–4.5%) and mixed infections with both parasites in only three samples (3/388; 0.8%; CL95: 0.2–2.2%). Entamoeba dispar infection was significantly associated with those employed in food and domestic services (χ2 4 = 12.879, p = 0.012). However, none of the factors affected the prevalence of E. histolytica infection. Despite the low prevalence of E. histolytica in faecal samples of the study cohort, the presence of this pathogenic parasite still poses potential public health risks and calls for tighter control strategies based on better availability of chemotherapeutic treatment and accessibility to appropriate health education.

Post-treatment impact and needs of prostate cancer survivors in Malaysia; a qualitative study

Introduction and Objectives There are limited studies conducted on the needs of cancer survivorsin developing countries like Malaysia. This qualitative study aimed at exploring the post-treatmentimpact and needs of prostate cancer survivors.Method: A qualitative study design was used. One in-depth interview and four focus groupdiscussions were conducted with 24 prostate cancer survivors (age range: 58–79 years) fromgovernment and private hospitals in Malaysia in 2013. Trained researchers used a topic guide toguide the interviews, which were audio-recorded, transcribed verbatim, checked and managed withNvivo 10 software. A thematic approach was used to analyse the data.Result: Three main themes emerged from the analysis: (a) impact of prostate cancer on thesurvivors, (b) support needed for coping and (c) information needs. Prostate cancer has animportant impact on the survivors’ lifestyle after treatment. Some of them have to live with thepost-treatment side effects. They were anxious about the possibility of relapse. In addition tofamily and peer support, there were participants who felt that spiritual support was important inhelping them cope with the possibility of relapse. The survivors felt that they did not receive enoughinformation about post-treatment care, dietary measures and supplements for relapse prevention,treatment and prognosis.Conclusion: Prostate cancer has a significant impact on the survivor’s lifestyle, emotional andphysical health. They need information and emotional support from the healthcare professionals,family and peers. Therefore, it is important for healthcare providers to explore the needs of prostatecancer survivors and provide the necessary support.

Toxoplasmosis sistémica en un canguro rojo (Macropus rufus) cautivo / Systemic toxoplamosis in a captive red kangaroo (Macropus rufus)

Los objetivos del estudio fueron presentar y documentar los hallazgos histopatológicos de toxoplasmosis sistémica en un canguro rojo (Macropus rufus) mantenido en cautiverio donde se describen los hallazgos macro y microscópicos encontrados y los análisis adicionales realizados. En el laboratorio de histopatología animal (Universidad de los Llanos) se recibieron muestras de tejidos fijados en formol tamponado, al 10% que procedían de un ejemplar macho de Macropus rufus, de ocho años de edad y 50 kg de peso corporal. Las muestras se procesaron mediante métodos rutinarios para microscopía óptica. Los cortes histológicos de 3-4 mm de grosor se colorearon con Hematoxilina-Eosina (H&E) y se realizó en algunos cortes la tinción de Ácido Periódico Schiff (PAS), PCR e IHQ. Al análisis histopatológico se encontró una toxoplasmosis sistémica asociada a quistes de protozoarios con inmunoreactividad positiva para T. gondii. La detección de T gondii en tejidos en formalina fue hecha usando dos ensayos de PCR que señalaban segmentos de ADN de diferentes secuencias repetitivas encontradas en T gondii y la IHQ confirmo lo hallado por PCR. Histopatológicamente se diagnosticó infección crónica por protozoarios eucoccideos de la familia Sarcocystidae. El diagnóstico etiológico fue de toxoplasmosis.

The objetives of this study were to present and document the hystopathologycal findings of systemic toxoplamosis in a captive red kangaroo (Macropus rufus) which described macro and microscopic findings of the hystopathological analysis. In the laboratory of animal histopathology (Universidad de los Llanos) formalin fixed tissue specimens were received, from a captive male Macropus rufus, who was eight years old and weighed 50 kg. The samples were processed by usual methods for optical microscopy. The histological sections of 3-4 mm thick were colored with Hematoxilin-Eosin (H&E) and then some samples stained with Periodic Acid Schiff (PAS), and processed by PCR and IHQ. Once the histopathological analysis was performed systemic toxoplasmosis was associated to protozoa cysts immunoreactives to T. gondii. The molecular detection of T. gondii in formalin fixed tissues was made using two PCR tests and confirmated by IHQ. Histopathologically a chronic infection by an eucoccideo protozoa from the Sarcocystidae family was diagnosed. The etiologic diagnosis was toxoplasmosis.

Accuracy of intraoperative frozen section in diagnosis of ovarian tumors.

OBJECTIVE: To determine the accuracy of intraoperative frozen section diagnosis of ovarian tumors according to malignancy status. MATERIAL AND METHOD: From May, 1999 to October, 2004 at Songklanagarind Hospital, a total of 229 ovarian specimens were transferred from the operating room to the Department of Pathology for intraoperative frozen section. All cases of deferred diagnosis and disagreement between frozen and permanent paraffin section were reviewed. RESULTS: Intraoperative frozen section diagnosis of all 229 ovarian specimens revealed 54.1% benign tumors, 8.3% borderline tumors, 30.6% malignant tumors, and 7% deferred diagnoses. The final paraffin section diagnoses revealed 52.4% benign tumors, 9.2% borderline tumors, and 38.4% malignant tumors. Mean tumor diameter of the agreement cases were 12.58 +/- 5.39 cm, disagreement cases were 17.64 +/- 6.83 cm, and deferred cases were 19.33 +/- 6.50 cm. The mean diameter of mucinous tumors was significantly different comparing between disagreement cases to agreement cases and deferred cases to agreement cases. The overall accuracy was 89.7%. Sensitivity was highest in the benign group at 98.2% and lowest in the borderline group at 57.1%. The sensitivity and specificity for benign, borderline, and malignant tumors were 98.2%, 57.1%, 86.1%, and 87.0%, 96.4%, 98.5%, respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for benign, borderline, malignant tumors were 89.5%, 63.2%, 97.1% and 97.8%, 95.4%, 92.3%, respectively. CONCLUSION: Intraoperative frozen section diagnosis appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors. However, limitations in use of frozen section must be recognized such as large specimens, especially mucinous subtype. Regular re-evaluation or consultation concerning disagreements between frozen section diagnosis and final permanent paraffin diagnosis should be conducted by both surgeons and pathologists as part of quality assurance to determine the most appropriate intraoperative management for patients with ovarian tumors.

Misdiagnosis in vertebral osteomyelitis: problems and factors.

One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for misdiagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range, 0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis, herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiagnosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI:1.07-11.94), 3.47 (95%CI:1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically significantly associated with the result of treatment. This paper emphasizes that the elderly age group, absence of fever and positive SLRT are the independent factors which increase the risk of misdiagnosis of vertebral osteomyelitis.

Clinical manifestation of tuberculous and pyogenic spine infection.

The authors compared clinical and baseline parameters between patients with tuberculous spondylitis (67 patients) and pyogenic vertebral osteomyelitis (34 patients). The average age was 50.8 (range, 1 to 82 years). Males were slightly more predominant in both pyogenic and tuberculous infections. Seventy per cent of patients with pyogenic infection had had symptoms for less than 3 months, while this was the case for only 44 per cent of the tuberculous patients. Lumbar spine was the most common site of involvement. Associated infections were more commonly found in tuberculous infection. Thirty per cent of tuberculous spondylitic patients were initially misdiagnosed, while 44 per cent of patients with pyogenic vertebral osteomyelitis had delayed diagnosis. Only 20 per cent and 30 per cent of tuberculous and pyogenic patients had fever, respectively. Neurological deficit occurred more frequently in pyogenic than in tuberculous infection (79% vs 59%), while bowel bladder involvement was more commonly found in tuberculous spondylitis. Kyphosis was significantly more common in tuberculosis than in pyogenic infection (50.8% vs 26.5%, respectively). Sinus tract formation, subcutaneous abscess formation and positive for SLRT (straight-leg-raising test) were found in only a small percentage of the patients. Duration of symptoms, site, associated infection, kyphosis and neurological deficit could be used for differentiation of spinal infection.

Follow up of water use in a tin mining area affected with arsenic poisoning.

Ron Phibun district in southern Thailand has been known as an endemic area for arsenic contamination. The government has been trying to improve the situation by encouraging the use of rainwater and piped water. This study aimed to document the change of water use and to identify factors associated with safe water use in 1997 compared to that in 1994. Home visits and face-to-face questionnaire interviews were undertaken. Information on water use for drinking, cooking, washing food and washing utensils in 1994 and 1997 was obtained. Among 3,849 households from which data could be obtained (estimated 79% of total households), the percentages of using safe water (including water from bottled rain water, piped and artesian well water) for drinking and cooking rose from 72.5 and 57.9 in 1994 to 93.6 and 80.9 in 1997, respectively. The percentages for washing foods and for washing utensils rose from 28.6 and 20.5 to 59.1 and 53.8, respectively. In 1997, percentage of households using piped water for drinking and cooking was still low (3.6 and 12.3) compared to those using piped water for washing food and utensils (39.1 and 43.6). Multivariate analysis shows that independent factors of the household predicting safe water use are: high arsenic area, near main road and having piped water installed. The influence of these factors (as judged by the level of odds ratio) operates more or less equally on water use for all purposes, except that installation of piped water has more influence on washing water than drinking and cooking water. We conclude that safe water supply in the area is still inadequate. Even if piped water is installed, it is often not used for drinking and cooking. The reasons for not using piped water for drinking and cooking need to be identified.

A study of pollen prevalence in relation to pollen allergy in Malaysian asthmatics.

In this paper we report results of skin prick tests (SPT) using pollen extracts on 200 patients with clinical symptoms of asthma, and results of a parallel study in which pollen was collected and classified over a period of 18 months. The patients were outpatients from the University Hospital in Kuala Lumpur, Malaysia, while the pollen grains were collected with a spore trap placed in the campus of the University of Malaya, approximately one kilometer from the University Hospital. Pollen extracts of 3 grasses (Bahia, Bermuda, rough pigweed) and 2 flowering trees, Acacia and Melaleuca, were used in the SPT. Of the 29.5% asthmatics with positive SPT reactions, 21.5% were to one or more of the grass pollens, 21.5% to Acacia and 7.5% to Melaleuca pollen. Acacia and Bermuda grass extracts were the most allergenic, which agreed with results of the pollen collection which showed grass and Acacia pollen grains to be the two most commonly found pollens.

A study of the prevalence of and risk factors for ear diseases and hearing loss in primary school children in Hat Yai, Thailand.

2,184 primary school children in Hat Yai Municipality, Southern Thailand were screened for ear diseases and hearing loss using screening audiometry, portable tympanometry and otoscopy to identify children with possible ear problems, 754 children failed the initial screen, 728 were retested and a group of 243 were referred for ENT examination and standard audiometry-tympanometry. Children with hearing loss and otitis media were thus identified. A questionnaire to identify possible risk factors was administered. The prevalence of otitis media in this population was found to be 3.25 per cent (AOM 0.69%, OME 1.14%, COM 1.74%). No risk factor identified as significant were found. Non-significant factors included sex, age, URI last month, father smoking, mother smoking and method of transport to school as an indication of social status. This study contrasts with a previous study in 1990 which showed a 3.5 per cent prevalence of COM.