Spectrum of Thyroid Lesions in Hospital Universiti Sains Malaysia Over 11-Years and A Review of Thyroid Cancers in Malaysia

Introduction: Endemic goitre is a major concern in many nations including Malaysia. Seven states in thecountry have been identified by Ministry of Health of Malaysia to have high incidence of goitre and one of theseis Kelantan. Methods: This is a retrospective study over an 11-year period from 1994 to 2004 on all thyroidspecimens submitted to the Pathology Department, Hospital Universiti Sains Malaysia (HUSM), in Kelantan.Epidemiological data were retrieved from the patients’ records and pathology findings from the pathologyreports. Results: During this period, Department of Pathology HUSM received a total of 1,486 thyroid specimens.The female to male ratio was 6:1 and the median age was 40.0 years. The duration of goitre ranged from one to15 years. Histopathological examination showed 71.9 percent were non-neoplastic and 28.1 percent neoplasticlesions. The hospital-based incidence of nodular hyperplasia was 9.9 per 100,000 admitted patients per year.The hospital-based incidence of all types of malignant thyroid cancers was 3.5 per 100,000. The most commonmalignancy was papillary carcinoma (76.6 percent). The majority of the cancers (59.5 percent) occurred in abackground of nodular hyperplasia. Thyroid cancers made up 4.9 percent of all cancers seen in HUSM.Conclusion: This study suggests that malignant thyroid lesions arising from multi-nodular goitre are high in apopulation living in an iodine-deficiency area.     

Histopathological Findings for Cervical Lesions in Malaysian Women

Objective: The objective of this study was to determine the histopathological features and cell morphologyof various cervical lesions observed among Malaysian women. Methodology: A retrospective study was conductedto evaluate 77 cervical cases collected from the histopathology laboratory of Ipoh hospital from 1st January,2005, to 31st December, 2006. Results: Cervical intraepithelial neoplasia (CIN) was found in 33 (42%) cases,CIN III accounting for 27%, and CIN I, CIN II and CIN II-III 5% each. The highest rate for CIN cases was43% in the 41-50 year age group and the lowest rate was 6% in the group aged 61-70 years . Non-keratinizingand metastatic squamous cell carcinomas (SCCs) accounted for 16% and 13%, respectively, the combinationbeing second in majority (29%), followed by adenocarcinoma (17%). The histopathological results showed CINI to be characterized by mild papillary projections of the epithelium with some degree of nuclear enlargement,pleomorphism, mild koilocytosis, bionucleated cells and a low nucleo-cytoplasmic ratio. CIN II demonstratedtypical squamous epithelium with disorganization of the lower part of the epithelium accompanied by nuclearhyperchromatism, an increased nucleo-cytoplasmic ratio, and scanty mitotic figures. CIN III was characterizedby pleomorphic nuclei, atypical cells with mitotic figures, nucleo-cytoplasmic ratio, anisokaryosis andhyperchromasia. Conclusion: Lesions related to cervical cancer showed tumor progression correlating withhistopathological changes in cell morphology.     

Eight Year Survival among Breast Cancer Malaysian Women from University Kebangsaan Malaysia Medical Centre

Survival after diagnosis of cancer is one of the major outcome measurements and a key criterion for assessingquality of cancer control related to both the preventive and the therapeutic level. The purpose of this study wasto determine the 8-year survival time in Malaysia based on socio-demographic and clinical characteristics. Aretrospective study of 472 Malaysian women with breast cancer from the Medical Record Department at UniversitiKebangsaan Malaysia Medical Centre (UKMMC) was therefore performed with survival analysis carried outusing the Kaplan-Meier with log-rank test for univariate analysis and Cox-regression for multivariate analysis.Women who had cancer or family history of cancer had a longer 8-year survival time (p = 0.008) compared withothers who did not have such a history. Tamoxifen use, positive oestrogen receptor status, and race were prognosticindicators for 8-year survival time (p = 0.036, p = 0.018, p = 0.053, respectively) in univariate analysis. Multivariateanalysis showed that being Malays and having no family history of cancer were independent prognostic factorsfor shorter survival time (p = 0.008, p = 0.012, respectively). In conclusion, being Chinese and having a familyhistory of cancer are predictors of longer survival among the Malaysian breast cancer women.     

Facilitators and Barriers to Implementing Healthy School Canteen Intervention among Malaysian Adolescents: A Qualitative Study

This study evaluated implementing a school-based intervention to promote healthier dietary habits in the school environment among Malaysian adolescents using qualitative methods. This qualitative study was conducted in four secondary schools in Perak and Selangor (two urban and two rural schools) that received the intervention (either training or training and food subsidy). A total of eight focus groups (68 students aged 15 years old) and 16 in-depth interviews were conducted with canteen operators, school convenience shop operators, school teachers and school principals in each school. Thematic analysis was used to analyse the qualitative data to identify suitable themes. We found several initiatives and changes by the schools’ stakeholders to change to a healthy school canteen programme. The stakeholders also noticed the students’ food preferences that influence healthy food intake in canteens and convenience shops. The food vendors and school administrators also found that subsidising healthy meals might encourage healthy eating. Among barriers to implementing healthy school initiatives were the student’s perception of healthy food and their eating habits, which also affect the food vendors’ profit if they want to implement a healthy canteen. The school-based intervention has the potential to promotes healthier eating among school adolescents. Continuous training and monitoring of canteen operators and convenience shops are needed, including building partnerships and educating the students on healthy eating to cultivate healthy eating habits.     

Survival analysis of malaysian women with breast cancer: results from the university of malaya medical centre

Background: Breast cancer is the commonest cancer amongst Malaysian women but local survival data are scarce. The present study was therefore conducted to assess overall survival and prognostic factors in Malaysian breast cancer patients. Methods: The research sample was a prospective cohort of 413 patients diagnosed with breast cancer in the University of Malaya Medical Centre between 1993 to 1997. Survival data were obtained from the National Registry of Birth and Deaths in December 2000. The clinico-pathological variables studied were age, ethnic group, stage, tumour size, lymph node status, oestrogen receptor status and grade. The data were analysed utilizing Splus statistical software. The important prognostic factors were identified by fitting the Cox's proportional hazard model to the data set. Survival probabilities were estimated using the Kaplan-Meier method and differences were compared by the log-rank test. Results: The overall 5-year survival was 59.1%. The Cox's proportional hazard model identified stage, lymph node status, size and grade as factors that correlated with prognosis. Age was not a significant prognostic factor. The Cox regression model by stepwise selection showed stage, nodal status and grade of tumour to be independent prognostic factors, whereas ethnicity, age and ER status were not. Interpretation: The overall survival in our centre was low. Recognizing factors that affect prognosis of breast cancer patients in Malaysia may improve delivery of health care to at-risk groups by strategizing interventions as survival depends on early detection and effective treatment.     

马来西亚西部眼球摘除术和眼内容摘除术的手术适应证及其变化趋势

目的:通过研究近30a马来西亚西部地区眼球摘除术和眼内容物摘除术的数据统计和手术适应证,观察其近30a的动态变化趋势.方法:通过回顾研究20a(1985/2004)在马来亚大学医学中心接受眼球摘除术和眼球内容摘除术病例资料,对患者的年龄、性别、种族及其手术适应证进行分析.结果:在全部160名患者中,85例单眼行眼球摘除术,75例单眼行眼内容摘除术,患者平均36.4岁(6mo～90岁).全眼球炎(26.9%)和视网膜母细胞瘤(18.8%)是眼球摘除术和眼球内容摘除术共同的病因,72.0%因眼部感染行眼球摘除术,51.8%因眼部肿瘤行眼内容摘除术.与30a前的统计数据相比较,我们医院近30a的眼球摘除率显著降低,因青光眼和眼创伤疾病导致眼球摘除的数量显著减少,而因感染和疼痛性盲眼导致的眼球摘除数量则有显著增加.结论:全眼球炎和眼内肿瘤是眼球摘除术的主要手术适应证,尽管现在在我国需要行眼球摘除术的病例数量较以前有显著降低,但手术适应证比例的变化提示我们,在马来群岛眼部的护理仍需要很大的改进.     

Genetic diversity of avian haemosporidians in Malaysia: Cytochrome b lineages of the genera Plasmodium and Haemoproteus (Haemosporida) from Selangor

The knowledge of the diversity of haemosporidian parasites is of primary importance as their representatives include agents of bird malaria. We investigated the occurrence of Haemoproteus spp. and Plasmodium spp. in bird populations from a single locality in the State of Selangor, Peninsular Malaysia, and report on the parasite prevalence of the two genera. A combination of methods (molecular and morphological) was used for detecting these parasites. Seventy-nine bird individuals were caught using mist-nets in July and August 2010 at Gombak Field Station of the University of Malaya, Kuala Lumpur. In total, 23 birds were identified as positive for Haemoproteus or Plasmodium infection and one individual was recognized as carrying mixed infection. The total prevalence of haemosporidians in the collected samples was 30.3%. Infections with parasites of the genus Haemoproteus were predominant compared to those of the genus Plasmodium. In total, 10 new cyt b lineages of Haemoproteus spp. and 3 new cyt b lineages of Plasmodium spp. were recorded in this study. From all recorded haemosporidian lineages (16 in total), 3 were known from previous studies – hCOLL2, hYWT2 and pNILSUN1. Two of them are linked with their corresponding morphospecies – Haemoproteus pallidus (COLL2) and Haemoproteus motacillae (YWT2). The morphological analysis in the present study confirmed the results obtained by the PCR method relative to prevalence, with 25.3% total prevalence of Haemoproteus and Plasmodium parasites. The intensities of infection varied between 0.01% and 19%. Most infections were light, with intensities below 0.1%. The present study is the first molecular survey of the protozoan blood parasites of the order Haemosporida recorded in Malaysia.     

The establishment of in-house neurology driven therapeutic plasma exchange infrastructure in a resource-limited public hospital in Malaysia: Adopting and integrating evidenced-based health care technology through time

There has been an increase in the use of therapeutic plasma exchange (TPE) in immune-mediated neurological disorders in recent years. However, accessibility and availability of TPE remains low and costly, especially for a country with limited healthcare funding like Malaysia. With expanding clinical indications in neurological disorders, and increasingly expensive conventional immunomodulatory treatment such as intravenous immunoglobulin and monoclonal antibodies, TPE remains an effective part of first or second-line treatment. In this article, we detailed the historical aspects of the use of TPE in neurological disorders in Malaysia over the last four decades and discussed the challenges behind the establishment of the first in-house neurology-driven TPE service in the country. Local TPE database from a national neurology centre in Kuala Lumpur over the past 20 years was analyzed. We observed a remarkable three folds increase in the use of TPE at our center over the past 10 years (total 131 TPE treatments) compared to a decade prior, with expanding clinical indications predominantly for central nervous system demyelinating disorders. Besides using membrane filtration method, centrifugal technique was adopted, providing new opportunities for other clinical beneficiaries such as a neurologist driven “in-house TPE unit”. However, there were real world challenges, especially having to provide services with limited funding, human resources, and space. In addition, much has to be done to improve accessibility, availability, and sustainability of TPE services at our center and nationwide. Nevertheless, even with limited resources and support, it is possible with concerted efforts to work within the confines of these limitations to establish a safe, successful, and sustainable TPE service.