Oral histoplasmosis in Malaysia: A retrospective analysis of cases reported in Stomatology Unit, Institute for Medical Research during 1995-2016.

Histoplasmosis is a systemic fungal infection caused by inhalation of Histoplasma capsulatum, which is mainly found in bird and bat droppings. Oral manifestation of histoplasmosis may be the only initial manifestation of the disease or associated with chronic disseminated histoplasmosis. The first review of oral histoplasmosis among Malaysian population from 1967 to 1994 (27 years) revealed the occurrence of 37 cases, reported by Ng and Siar in 1996. This current study is the updated overview of oral histoplasmosis cases in Malaysia. The objective of the study was to review and describe clinical and demographic profile of oral histoplasmosis in Malaysia and to correlate histopathological features of oral histoplasmosis with patient's immunity status. We reviewed oral histoplasmosis cases diagnosed in Stomatology Unit, Institute for Medical Research (IMR), Kuala Lumpur from 1995 until 2016. The data was retrieved from the Oral Pathology Information system (OPIS) Stomatology Unit, IMR, which is the largest oral pathology database in Malaysia. Information regarding patients' sociodemographic data, medical illness, clinical presentation, histopathological features, and referring healthcare institutions was extracted from the clinical information which accompanied the biopsy request form. A total of 39 cases of oral histoplasmosis were identified from 1995-2016. Majority of them were male (89.7%). The age ranges from 29 to 85 years with mean age of 57.8 years. Almost half of them were Malays (51.3%), followed by Chinese (33.3%), Indians (7.7%), and other races (7.7%). The most common sites of oral histoplasmosis were tongue, gingiva, palate, and alveolar ridge. The main clinical presentation was ulcer (61.5%) whereas 38.5% presented clinically as swelling. 17.9% of patients were seropositive for human immunodeficiency virus (HIV), 12.8% had tuberculosis, 10.3% had diabetes mellitus, and 2.6% with hepatitis C. The incidence of oral histoplasmosis should raise suspicion of hidden immunodepression and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). Early recognition and diagnosis is crucial to reduce risk of morbidity and mortality.

Oral histoplasmosis in Malaysia: A retrospective analysis of cases reported in Stomatology Unit, Institute for Medical Research during 1995-2016

@#Histoplasmosis is a systemic fungal infection caused by inhalation of Histoplasma capsulatum, which is mainly found in bird and bat droppings. Oral manifestation of histoplasmosis may be the only initial manifestation of the disease or associated with chronic disseminated histoplasmosis. The first review of oral histoplasmosis among Malaysian population from 1967 to 1994 (27 years) revealed the occurrence of 37 cases, reported by Ng and Siar in 1996. This current study is the updated overview of oral histoplasmosis cases in Malaysia. The objective of the study was to review and describe clinical and demographic profile of oral histoplasmosis in Malaysia and to correlate histopathological features of oral histoplasmosis with patient’s immunity status. We reviewed oral histoplasmosis cases diagnosed in Stomatology Unit, Institute for Medical Research (IMR), Kuala Lumpur from 1995 until 2016. The data was retrieved from the Oral Pathology Information system (OPIS) Stomatology Unit, IMR, which is the largest oral pathology database in Malaysia. Information regarding patients’ sociodemographic data, medical illness, clinical presentation, histopathological features, and referring healthcare institutions was extracted from the clinical information which accompanied the biopsy request form. A total of 39 cases of oral histoplasmosis were identified from 1995-2016. Majority of them were male (89.7%). The age ranges from 29 to 85 years with mean age of 57.8 years. Almost half of them were Malays (51.3%), followed by Chinese (33.3%), Indians (7.7%), and other races (7.7%). The most common sites of oral histoplasmosis were tongue, gingiva, palate, and alveolar ridge. The main clinical presentation was ulcer (61.5%) whereas 38.5% presented clinically as swelling. 17.9% of patients were seropositive for human immunodeficiency virus (HIV), 12.8% had tuberculosis, 10.3% had diabetes mellitus, and 2.6% with hepatitis C. The incidence of oral histoplasmosis should raise suspicion of hidden immunodepression and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). Early recognition and diagnosis is crucial to reduce risk of morbidity and mortality.

An observational study of trigeminal neuralgia patients taking carbamazepine during the fasting month of Ramadan.

INTRODUCTION: Trigeminal neuralgia is an agonising orofacial pain affecting unilaterally the distribution of the trigeminal nerve and it usually occurs in the middle and older age groups. Carbamazepine which is an anti-neuralgic as well as an anti-convulsant medication is the first line drug for treatment of trigeminal neuralgia. It is commonly taken as one tablet (200 mg) three times a day. MATERIALS AND METHODS: This is an observational study carried out from April to September 2014 to determine how Muslim patients on carbamazepine treatment for trigeminal neuralgia cope with their neuralgic pain. The pattern of how the medication was taken during the fasting month of Ramadan was also observed. RESULTS: A total of 29 patients participated in this study and 27(93%) observed the fast. Ten of them adjusted the carbamazepine dose from three times pre-Ramadan to twice daily during the fasting month. Three patients continued fasting despite feeling the pain during the daytime while five patients had their pain under control with the newly adjusted dose. CONCLUSION: Medical professionals should advise trigeminal neuralgia patients on how to take and adjust their carbamazepine dose during the fasting month.

Duplication of lower lip and mandible--a rare diprosopus.

Diprosopus or duplication of the lower lip and mandible is a very rare congenital anomaly. We report this unusual case occurring in a girl who presented to our hospital at the age of 4 months. Surgery and problems related to this anomaly are discussed.

A retrospective clinicopathological study of 59 osteogenic sarcoma of jaw bone archived in a stomatology unit.

OBJECTIVES: To determine the clinicopathological features of osteogenic sarcomas of the mandible and maxilla. MATERIALS AND METHODS: A retrospective study was carried out on all osteosarcoma from the jaw diagnosed in the Stomatology Unit, Institute for Medical Research, Kuala Lumpur from 1967 to 2008. All data regarding the age at presentation, gender, race, clinical presentation, radiographical findings and diagnoses were retrieved from computerized records. RESULTS: There were 59 cases (36 males and 23 females) with ages ranging from 7 to 68 years. The patients comprised 28 Malays, 16 Chinese, 2 Indians and 13 of other ethnicity. Forty cases involved the mandible and 19 the maxilla. The main complaint was painless or painful bony swelling. Nine cases presented with numbness of the associated region. Four patients had history of prior radiotherapy. The radiographic findings which varied from radiolucent to radiopaque lesions were mentioned in only 26 cases. Histologically, the majority (30) were osteoblastic, 19 chondroblastic, 6 fibroblastic and 4 telangiectatic in type. No small cell type osteosarcoma was identified. CONCLUSION: Osteogenic sarcoma of the jaws is a rare malignant bone tumour. Over 40 years, there were only 59 cases diagnosed by our institution and to date this is the first report of jaw osteosarcoma in Malaysia.

The use of immunohistochemistry in an oral pathology laboratory.

Immunohistochemistry has become part of normal routine diagnostic work in the Stomatology Unit, Institute for Medical Research, Kuala Lumpur. Of 9523 cases received from the year 2000 to 2005, 197 cases (2.1%) required immunohistochemical staining. These cases ranged from benign to malignant lesions. They include lymphomas (n=41), epithelial tumours (n=29), neural lesions (n=21), fibroblastic/myofibroblastic tumours (n=16), small round cell tumour (n=11), vascular tumours (n=4), smooth muscle tumours (n=4), myxomatous tumours (n=4) and skeletal muscle tumours (n=1). In most of the cases (69.5%), immunohistochemical staining was mandatory to reach a definite diagnosis, while 60 cases (30.5%) required immunohistochemistry in confirming the diagnosis. In 32 cases (16.2%), definitive diagnosis could not be made due to the small size of the specimens received or the results of immunohistochemistry were inconclusive. Standardization of techniques, competent medical laboratory technologists and sufficient budget allocation are important in producing a high quality immunohistochemistry service.