Lambda light chain myeloma with co-migrating paraprotein at beta region on agarose gel electrophoresis: a case report.

Paraproteinemia is one of the diagnostic features of multiple myeloma. A commonly used method is the detection of paraprotein by agarose gel electrophoresis (AGE) followed by by immunofixation electrophoresis (IFE) to confirm monoclonality. Due to their smaller size, immunoglobulin A (IgA) and light chain only paraproteins may appear at the beta or even alpha 2 protein fractions. Here, we discuss a case report of a 47-year-old man who presented with pathological fracture of third thoracic (T3) vertebra. Serum protein electrophoresis (SPE) was initially reported as no paraprotein detected. However, a bone biopsy was reported to show plasma cell proliferation with light chain restriction. A repeat sample for protein electrophoresis together with IFE revealed lambda light chain paraprotein co-migrating at the beta region. The beta band plus paraprotein was quantitated as 4.3 g/L (7.0%), which was within normal limits of the beta protein fraction. Hence, it has to be remembered that if the SPE is negative, it does not necessarily mean that the paraprotein is absent in cases which are highly suspicious.

Recurrent multiple myeloma presenting as a breast plasmacytoma.

We describe a patient with multiple myeloma, who initially responded to chemotherapy and went into remission. She presented 10 months later with a right breast lump which was confirmed by core biopsy to be a plasmacytoma. Further treatment with radiotherapy, thalidomide and later second line chemotherapy appeared unsuccessful and she showed rapid disease progression with rising paraproteins and new extramedullary plasmacytoma lesions in the forehead, supraclavicular region, nasopharynx, liver, spleen, pancreas and paraaortic lymph nodes.

Serum sex hormone levels in pre- and postmenopausal breast cancer patients.

INTRODUCTION: This study was conducted to determine the association between serum sex hormone levels and breast cancer. METHODS: The study was conducted on newly-diagnosed breast cancer patients who had not received any treatment. Controls were women not known to have any breast disease or hormone-related tumours. Serum hormones were divided into quartiles. Logistic regression adjusting for age and race were done to calculate the odds ratio (OR) and 95 percent confidence interval (CI). RESULTS: A total of 207 subjects were recruited; 73 premenopausal (37 cases, 36 controls) and 134 postmenopausal (68 cases and 66 controls) women. In the premenopausal women, only serum testosterone was positively associated with breast cancer (OR 1.72, 95 percent CI 0.40-7.40), but this was not a significant finding (p-value is 0.468). In the postmenopausal women, oestradiol, progesterone and testosterone were positively associated with breast cancer with a highest to lowest quartile OR of 1.48, 2.35 and 4.23 (95 percent CI 0.59-3.69, 1.11-4.95 and 1.52-11.78, respectively). The OR was significant for both progesterone and testosterone (p-values of 0.025 and 0.006, respectively). CONCLUSION: There were no statistically significant findings among the premenopausal cases. In postmenopausal women, serum progesterone and testosterone levels were significantly associated positively with the odds of having breast cancer.

A preliminary study on the prevalence of intestinal microsporidiosis in patients with and without gastrointestinal symptoms in Malaysia.

An observational study was carried out to establish the existence of intestinal microsporidiosis among patients with and without gastrointestinal symptoms in Hospital Universiti Kebangsaan Malaysia, Malaysia. A total of 893 faecal specimens from hospitalized patients were examined for microsporidia using a modification of the usual Gram-chromotrope stain technique. One hundred and sixteen (13.0%) patients were positive for microsporidia: 84 (72.4%), 27 (23.3%) and 5 (4.3%) were low, moderate and high excreters of microsporidia spores, respectively. Of the 91 patients with available medical records, microsporidiosis was commonly observed in children aged 0-6 years (26.4%) and adults aged >or=31 years (57.2%). About one-third of this infection was observed in immunocompetent individuals. Among the immunosuppressive group, microsporidia were observed to be more prevalent in patients with haematological malignancy or a combination of malignancy and diabetes mellitus. About 74% of the patients who had microsporidia in their faeces had gastrointestinal symptoms, which could be related to infections or induced by immunosuppressive therapy. The role of microsporidia in causing gastrointestinal symptoms in this population is as yet unclear.

Heated palm oil causes rise in blood pressure and cardiac changes in heart muscle in experimental rats.

BACKGROUND: Palm oil used worldwide contains considerable amounts of antioxidants, namely, vitamin E and carotenes. The purpose of the study was to observe the effect of heated palm oil on blood pressure and observe the cardiac histological changes in rats. METHODS: Forty male Sprague Dawley rats were divided equally into four groups and given treatment as follows: (i) basal diet (control group); (ii) basal diet fortified with 15% weight/weight (w/w) fresh palm oil (FPO); (iii) basal diet fortified with 15% w/w palm oil heated five times (5HPO); (iv) basal diet fortified with 15% w/w palm oil heated ten times (10HPO). Treatment duration was 16 weeks. Blood pressure was measured at baseline and at monthly intervals for 4 months using the tail-cuff method. After 16 weeks of study, the rats were killed and the hearts were taken out. The specimens were sectioned longitudinally and stained with hematoxylin and eosin for light microscopy. RESULTS: The FPO group did not show any significant changes in blood pressure and histological study. There was a significant increase (p <0.05) in blood pressure in the 5HPO and 10HPO groups. However, blood pressure in the 10HPO group was higher than in the 5HPO group. Histological sections of the heart showed necrosis in cardiac tissue in the 5HPO and 10HPO groups with the latter group showing more damage. CONCLUSIONS: Fresh palm oil has no deleterious effects on blood pressure and cardiac tissue but prolonged consumption of repeatedly heated palm oil may result in an increase in blood pressure level with necrosis of cardiac tissue.

Prevalence and distribution of soil-transmitted helminthiases among Orang Asli children living in peripheral Selangor, Malaysia.

Soil-transmitted helminthiases are a public health problem in rural communities. A cross-sectional study of the prevalence and distribution of Ascaris lumbricoides, Trichuris trichiura and hookworm was conducted in 281 Orang Asli children (aborigines) aged between 2 and 15 years, from 8 Orang Asli villages in Selangor, Malaysia. All the children were infected with soil-transmitted helminthes, with 26.3% of the children infected either with A. lumbricoides, T. trichiura or hookworm and 72.6% having mixed infection. The overall prevalences of A. lumbricoides, T. trichiura and hookworm were 61.9, 98.2 and 37.0%, respectively. Approximately 19.0, 26.0 and 3.0% of the children had severe infection of ascariasis, trichuriasis and hookworm infection, respectively. The prevalences and mean egg per gram (epg) counts for A. lumbricoides and T. trichiura were not significantly dependent on age, therefore age-dependent convexity was not seen in this study. However, the results of this study reveal an age-dependent prevalence and mean epg count in children with hookworm infection. We conclude that ascariasis, trichuriasis and hookworm infection are still prevalent and therefore a public health concern in Orang Asli communities. Severe ascariasis and trichuriasis may lead to other health and medical problems.

Giardiasis as a predictor of childhood malnutrition in Orang Asli children in Malaysia.

A cross-sectional study to examine the association of giardiasis with protein-energy malnutrition, vitamin A deficiency and iron deficiency anaemia was conducted among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2-15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and faecal samples. The results showed that 24.9% of the children were infected with Giardia duodenalis, while 56.5, 61.3 and 15.1% had significant underweight, stunting and wasting, respectively. Giardiasis was statistically identified as a strong predictor of significant wasting in this study population.