Cutaneous larva migrans in Hospital Kuala Lumpur, Malaysia: rate of correct diagnosis made by the referring primary care doctors

A retrospective study was undertaken to determine the clinical features of cutaneous larva migrans (CLM) seen in the Department of Dermatology, Hospital Kuala Lumpur (Kuala Lumpur, Malaysia) and to assess the rate of correct diagnosis made by the referring primary care doctors. Clinical records of all 31 patients with CLM seen between January 2006 and June 2010 were retrieved. The majority of patients were male. The mean age was 32.2 years. Pruritus was reported in 83.9% of cases and serpiginous tracts in 100%. The mean lesion count was 4.4 and the mean duration of disease before presentation was 3.1 weeks. The majority of skin lesions were on the buttock and lower extremities. Only 45.2% of patients had the correct diagnosis made by the referring primary care doctors. Older age of patients and lower number of lesions were associated with a higher rate of correct diagnosis. The low rate of correct diagnosis made by the referring primary care doctors to the dermatologists in this study warrants the need for education of not only primary care doctors but also future primary care providers, consisting of medical students, house officers and junior medical officers.     

Feasibility of case-control and test-negative designs to evaluate dengue vaccine effectiveness in Malaysia

BackgroundThe world’s first dengue vaccine [Dengvaxia; Sanofi Pasteur] was licensed in 2015 and others are in development. Real-world evaluations of dengue vaccines will therefore soon be needed. We assessed feasibility of case control (CC) and test-negative (TN) design studies for dengue vaccine effectiveness by measuring associations between socio-demographic risk factors, and hospitalized dengue outcomes, in Malaysia.MethodsFollowing ethical approval, we conducted hospital-based dengue surveillance for one year in three referral hospitals. Suspected cases aged 9–25 years underwent dengue virological confirmation by RT-PCR and/or NS1 Ag ELISA at a central laboratory. Two age- and geography-matched hospitalized non-dengue case-controls were recruited for a traditional CC study. Suspected cases testing negative were test-negative controls. Socio-demographic, risk factor and routine laboratory data were collected. Logistic regression models were used to estimate associations between confirmed dengue and risk factors.ResultsWe recruited 327 subjects; 155 were suspected of dengue. The planned sample size was not met. 124 (80%) of suspected cases were dengue-confirmed; seven were assessed as severe. Three had missing RT-PCR results; the study recruited 28 test-negative controls. Only 172 matched controls could be recruited; 90 cases were matched with ≥1 controls. Characteristics of cases and controls were mostly similar. By CC design, two variables were significant risk factors for hospitalized dengue: recent household dengue contact (OR: 54, 95% CI: 7.3–397) and recent neighbourhood insecticidal fogging (OR: 2.1; 95% CI: 1.3–3.6). In the TN design, no risk factors were identified. In comparison with gold-standard diagnostics, routine tests performed poorly.ConclusionsThe CC design may be more appropriate than the TN design for hospitalized dengue vaccine effectiveness studies. Selection bias in case control selection could be minimized by protocol changes more easily than increasing TN design control numbers, because early-stage dengue diagnosis in endemic countries is highly specific. MREC study approval: (39)KKM/NIHSEC/P16-1334.     

Intra-Operative Frozen Sections for Ovarian Tumors – A Tertiary Center Experience

Background: Accuracy of diagnosis with intra-operative frozen sections is extremely important in the evaluation of ovarian tumors so that appropriate surgical procedures can be selected. Study design: All patients who with intra-operative frozen sections for ovarian masses in a tertiary center over nine years from June 2008 until April 2017 were reviewed. Frozen section diagnosis and final histopathological reports were compared. Main outcome measures: Sensitivity, specificity, positive and negative predictive values of intra-operative frozen section as compared to final histopathological results for ovarian tumors. Results: A total of 92 cases were recruited for final evaluation. The frozen section diagnoses were comparable with the final histopathological reports in 83.7% of cases. The sensitivity, specificity, positive predictive value and negative predictive value for benign and malignant ovarian tumors were 95.6%, 85.1%, 86.0% and 95.2% and 69.2%, 100%, 100% and 89.2% respectively. For borderline ovarian tumors, the sensitivity and specificity were 76.2% and 88.7%, respectively; the positive predictive value was 66.7% and the negative predictive value was 92.7%. Conclusion: The accuracy of intra-operative frozen section diagnoses for ovarian tumors is high and this approach remains a reliable option in assessing ovarian masses intra-operatively.     

Perceived Risk of Developing Cancer in a Suburban Community in Malaysia

Objective: To determine the perceived risk of developing cancer in a suburban community in Malaysia. Methods:A cross sectional study using a simple random sampling was conducted among residents aged 18 years old and above(n=520) who had never been diagnosed with cancer, in selected households in a suburban area of Pahang state inMalaysia. The study instruments were a validated questionnaire on risk perception, an automatic blood pressure monitor,a weighing scale and a measuring tape. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 andthe p value was taken at p they were at risk cancer, whilst the perceived severity was 41.3 percent. Multivariable analysis showed a significantassociation only for a family history of cancer (adjusted OR of 4.80; 95% CI = 1.45-15.82) (p=0.010) among thispopulation. Conclusion: The perceived risk of developing cancer in the selected suburban community of Pahang state inMalaysia is low as compared to that for other non-communicable diseases in this country, whilst the perceived severitywas higher than for other diseases. Thus, considering the importance of correct perceptions for behavioral changes,more health education and promotion is needed to make the community better aware of the actual threat of cancer.     

Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia

Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programmewith the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in additionto cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history ofHPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genitalwarts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the MalaysianMinistry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumedto have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine priceparity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustnessof the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewerCC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discountedtotal costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. Inone-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for bothvaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening,was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.     

Breast Reconstruction After Mastectomy: A Survey of Surgeons’ and Patients’ Perceptions

Background

Breast reconstruction after mastectomy is important in breast cancer care.

Localization of neurons supplying the temporalis muscle in the rat and monkey.

Following injection of horseradish peroxidase (HRP) solution into the rat and monkey temporalis muscle, a similar pattern of nuclear representation was found in the motor trigeminal nucleus. Labelled neurons were seen throughout the rostro-caudal extent of the ipsilateral motor trigeminal nucleus, in its dorsal, intermediate and ventral portions and its dorsomedial, ventromedial and ventrolateral corners. In addition to the motor trigeminal nucleus labelled neurons were also found in the ipsilateral trigeminal ganglion and mesencephalic trigeminal nucleus. The results were discussed.