Browse publications by year: 2019

  1. Waiho K, Shi X, Fazhan H, Li S, Zhang Y, Zheng H, et al.
    Front Genet, 2019;10:298.
    PMID: 31024620 DOI: 10.3389/fgene.2019.00298
    Mud crab, Scylla paramamosain is one of the most important crustacean species in global aquaculture. To determine the genetic basis of sex and growth-related traits in S. paramamosain, a high-density genetic linkage map with 16,701 single nucleotide polymorphisms (SNPs) was constructed using SLAF-seq and a full-sib family. The consensus map has 49 linkage groups, spanning 5,996.66 cM with an average marker-interval of 0.81 cM. A total of 516 SNP markers, including 8 female-specific SNPs segregated in two quantitative trait loci (QTLs) for phenotypic sex were located on LG32. The presence of female-specific SNP markers only on female linkage map, their segregation patterns and lower female: male recombination rate strongly suggest the conformation of a ZW/ZZ sex determination system in S. paramamosain. The QTLs of most (90%) growth-related traits were found within a small interval (25.18-33.74 cM) on LG46, highlighting the potential involvement of LG46 in growth. Four markers on LG46 were significantly associated with 10-16 growth-related traits. BW was only associated with marker 3846. Based on the annotation of transcriptome data, 11 and 2 candidate genes were identified within the QTL regions of sex and growth-related traits, respectively. The newly constructed high-density genetic linkage map with sex-specific SNPs, and the identified QTLs of sex- and growth-related traits serve as a valuable genetic resource and solid foundation for marker-assisted selection and genetic improvement of crustaceans.
    MeSH terms: Animals; Chromosome Mapping; Brachyura; Female; Genetic Linkage; Male; Phenotype; Recombination, Genetic; Sex; Aquaculture; Polymorphism, Single Nucleotide; Consensus; Quantitative Trait Loci; Transcriptome
  2. Zaribaf F, Mohammadifard N, Sarrafzadegan N, Karimi G, Gholampour A, Azadbakht L
    J Cardiovasc Thorac Res, 2019;11(1):19-27.
    PMID: 31024668 DOI: 10.15171/jcvtr.2019.04
    Introduction:
    Lipid metabolism is one of the main concerns of cardiovascular disease and atherosclerosis. Little is known about the association between dietary patterns and dyslipidemia. Therefore, the present study aimed to determine such association among Iranian adults.
    Methods:
    This cross-sectional study was conducted on 1433 Iranian adults in Isfahan Healthy Heart Program (IHHP). Usual dietary intakes were assessed with the use of a 48 items food frequency questionnaire (FFQ). Factor analysis was used to identify dietary patterns. Three major dietary patterns were identified: western, semi healthy and healthy fat patterns.
    Results:
    After adjustment, subjects in the upper quartiles of western dietary pattern were more likely to have high total cholesterol concentrations than those in the first quartile (odds ratio [OR]: 2.07; 95% CI: 1.25-3.42). Individuals with greater adherence to western dietary pattern had greater odds of having high low-density lipoprotein-cholesterol (LDL-C) levels compared with those in the lowest quartiles (2.53; 1.45-4.40).
    Conclusion:
    Semi healthy dietary pattern was not associated with cardiovascular disease (CVD) risk factors. Same trend was observed for healthy fat dietary pattern. Significant association was found between western dietary pattern and dyslipidemia among Iranian adults.
    MeSH terms: Adult; Cardiovascular Diseases; Cholesterol; Cross-Sectional Studies; Dietary Fats; Factor Analysis, Statistical; Health Promotion; Humans; Iran; Lipoproteins, LDL; Surveys and Questionnaires; Risk Factors; Odds Ratio; Dyslipidemias; Atherosclerosis; Lipid Metabolism; Diet, Western
  3. Umar Imam M, Ismail M, George A, Chinnappan SM, Yusof A
    Food Sci Nutr, 2019 Apr;7(4):1482-1493.
    PMID: 31024722 DOI: 10.1002/fsn3.988
    Clinacanthus nutans (Burm. f.) Lindau (C. nutans) has been reported to lower blood glucose level; however, evidence on its efficacy in lowering diabetic complications is limited. The antidiabetic properties of C. nutans aqueous leaf extract on serum metabolic indices, sorbitol production, and aldose reductase enzyme activities in the kidneys, lens, and sciatic nerve of type II diabetic (T2D) rats were evaluated. All rats except normal control rats were fed with a high-fat diet for 8 weeks to induce obesity and subsequently injected with 35 mg/kg streptozotocin to induce type II diabetes. Aqueous leaf extract of C. nutans (100 and 200 mg kg-1 day-1) and quercetin (10 mg kg-1 day-1) were fed orally for 4 weeks. Diabetic rats administered with C. nutans at 100, 200 mg kg-1 day-1 and quercetin had significantly (p 
  4. Al-Saari N, Amada E, Matsumura Y, Tanaka M, Mino S, Sawabe T
    PeerJ, 2019;7:e6769.
    PMID: 31024772 DOI: 10.7717/peerj.6769
    Biohydrogen is one of the most suitable clean energy sources for sustaining a fossil fuel independent society. The use of both land and ocean bioresources as feedstocks show great potential in maximizing biohydrogen production, but sodium ion is one of the main obstacles in efficient bacterial biohydrogen production. Vibrio tritonius strain AM2 can perform efficient hydrogen production with a molar yield of 1.7 mol H2/mol mannitol, which corresponds to 85% theoretical molar yield of H2 production, under saline conditions. With a view to maximizing the hydrogen production using marine biomass, it is important to accumulate knowledge on the effects of salts on the hydrogen production kinetics. Here, we show the kinetics in batch hydrogen production of V. tritonius strain AM2 to investigate the response to various NaCl concentrations. The modified Han-Levenspiel model reveals that salt inhibition in hydrogen production using V. tritonius starts precisely at the point where 10.2 g/L of NaCl is added, and is critically inhibited at 46 g/L. NaCl concentration greatly affects the substrate consumption which in turn affects both growth and hydrogen production. The NaCl-dependent behavior of fermentative hydrogen production of V. tritonius compared to that of Escherichia coli JCM 1649 reveals the marine-adapted fermentative hydrogen production system in V. tritonius. V. tritonius AM2 is capable of producing hydrogen from seaweed carbohydrate under a wide range of NaCl concentrations (5 to 46 g/L). The optimal salt concentration producing the highest levels of hydrogen, optimal substrate consumption and highest molar hydrogen yield is at 10 g/L NaCl (1.0% (w/v)).
    MeSH terms: Energy-Generating Resources; Escherichia coli; Fermentation; Fossil Fuels; Hydrogen; Kinetics; Mannitol; Molar; Oceans and Seas; Seaweed; Sodium; Sodium Chloride; Vibrio; Sodium Chloride, Dietary; Biomass
  5. Mazlan MZ, Chong SE, Salmuna Ayub ZN, Mohamad NAN
    IDCases, 2019;16:e00520.
    PMID: 31024798 DOI: 10.1016/j.idcr.2019.e00520
    Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section.
    MeSH terms: Anesthesia, General; Anesthesia, Spinal; Anti-Infective Agents, Local; Cesarean Section; Chlorhexidine; Female; Meningitis; Pregnancy; Punctures; Subarachnoid Space; Tinea Versicolor; Parturition; Anesthetists
  6. Dong AN, Ahemad N, Pan Y, Palanisamy UD, Yiap BC, Ong CE
    Naunyn Schmiedebergs Arch Pharmacol, 2019 08;392(8):1015-1029.
    PMID: 31025144 DOI: 10.1007/s00210-019-01651-0
    One major source of inter-individual variability in drug pharmacokinetics is genetic polymorphism of the cytochrome P450 (CYP) genes. This study aimed to elucidate the enzyme kinetic and molecular basis for altered activity in three major alleles of CYP2D6, namely CYP2D6*2, CYP2D6*10 and CYP2D6*17. The E. coli-expressed allelic variants were examined using substrate (venlafaxine and 3-cyano-7-ethoxycoumarin[CEC]) and inhibitor (quinidine, fluoxetine, paroxetine, terbinafine) probes in enzyme assays as well as molecular docking. The kinetics data indicated that R296C and S486T mutations in CYP2D6*2 have caused enhanced ligand binding (enhanced intrinsic clearance for venlafaxine and reduced IC50 for quinidine, paroxetine and terbinafine), suggesting morphological changes within the active site cavity that favoured ligand docking and binding. Mutations in CYP2D6*10 and CYP2D6*17 tended to cause deleterious effect on catalysis, with reduced clearance for venlafaxine and CEC. Molecular docking indicated that P34S and T107I, the unique mutations in the alleles, have negatively impacted activity by affecting ligand access and binding due to alteration of the substrate access channel and active site morphology. IC50 values however were quite variable for quinidine, fluoxetine and terbinafine, and a general decrease in IC50 was observed for paroxetine, suggesting ligand-specific altered susceptibility to inhibition in the alleles. This study indicates that CYP2D6 allele selectivity for ligands was not solely governed by changes in the active site architecture induced by the mutations, but that the intrinsic properties of the substrates and inhibitors also played vital role.
    MeSH terms: Venlafaxine Hydrochloride/pharmacokinetics; Alleles; Amino Acid Sequence; Catalysis; Escherichia coli; Humans; Isoenzymes; Models, Molecular; Mutation; Polymorphism, Genetic; Proline/genetics; Threonine/genetics; Genetic Variation; Mutagenesis, Site-Directed; Cytochrome P-450 CYP2D6/genetics*; Cytochrome P-450 CYP2D6/metabolism; Cytochrome P-450 CYP2D6/chemistry; Molecular Docking Simulation; Cytochrome P-450 CYP2D6 Inhibitors/pharmacology*
  7. Choong SS, Mimi Armiladiana M, Ruhil HH, Peng TL
    J Med Primatol, 2019 08;48(4):207-210.
    PMID: 31025372 DOI: 10.1111/jmp.12416
    BACKGROUND: Coconut is an important commodity in Kelantan, and pig-tailed macaques (Macaca nemestrina) have been traditionally used for coconut-plucking for over a century. Most of these animals were sourced from the wild population, and the parasitic status of these macaques is unknown, plus the impacts caused by these parasites are usually underestimated by the owners.

    METHODS: A total of 30 macaques were sampled for blood, faeces and hair plucks to detect parasite.

    RESULTS: Out of 21 faecal samples examined, 11 (52%) were determined positive for one or more gastrointestinal parasites, namely Trichostrongylus spp., Strongyloides spp., Anatrichosoma spp., Capillaria spp., Trichuris spp. and Paramphisotomum spp. Filaria was detected in one (3%) of the blood samples. For ectoparasites, only lice, Pedicinus sp., were found in 9 (30%) macaques.

    CONCLUSIONS: It is imperative that the parasitic status of these animals be determined so that necessary actions and preventive measures can be implemented to prevent zoonotic transmissions.

    MeSH terms: Animals; Blood/parasitology; Ectoparasitic Infestations/epidemiology; Ectoparasitic Infestations/parasitology; Ectoparasitic Infestations/veterinary*; Feces/parasitology; Hair/parasitology; Intestinal Diseases, Parasitic/epidemiology; Intestinal Diseases, Parasitic/parasitology; Intestinal Diseases, Parasitic/veterinary*; Macaca nemestrina*; Malaysia/epidemiology; Monkey Diseases/epidemiology*; Monkey Diseases/parasitology; Prevalence
  8. Behrouzi F, Ma'aram A
    Int J Health Plann Manage, 2019 Oct;34(4):1364-1376.
    PMID: 31025447 DOI: 10.1002/hpm.2799
    Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty-four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on "feasibility" and "relevance" criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately.
  9. Moorchung N
    Malays J Pathol, 2019 Apr;41(1):1-5.
    PMID: 31025631
    The term "Lock In" as applied to Science and Technology refers to a technology which has been utilised for a certain amount of time and it has been determined that the technology is viable and cost effective. An analysis of the technological advancements in pathology over a period of time shows that the newer technologies in contrast to the older technologies are reaching a state of "Technological Lock In" much faster. Three different discoveries, the development of the autopsy as a research tool, the discovery of the microscope and immunohistochemistry illustrate how rapidly "Technological Lock In" is being achieved with the passage of time. Three probable scenarios are possible because of this rapid "Technological Lock In". Technology may continue to progress at the same pace (an ideal scenario), may plateau until pathologists accept and absorb new technologies or thirdly, develop very rapidly so that the technology may never reach pathology practice. What will the future be? How will technology influence the principles and practices of Pathology? Only time will tell.
    MeSH terms: Autopsy; Immunohistochemistry; Microscopy; Probability; Research; Technology; Pathologists
  10. Mohmad Sallih N, Subbiah I, Ali A, Jackson N
    Malays J Pathol, 2019 Apr;41(1):7-13.
    PMID: 31025632
    INTRODUCTION: Plasma D-dimer levels rise progressively during pregnancy, so one cannot apply normal reference ranges, or the usual cut-off value (500ng/mL), for the exclusion of venous thromboembolism (VTE), in pregnant women. This study was carried out in pregnant Malaysian women in order to build applicable reference ranges for D-dimer.

    MATERIALS AND METHODS: A cross-sectional study was conducted to measure D-dimer in healthy pregnant women, and a non-pregnant control group, using the quantitative HaemosIL D-dimer HS500 assay. Reference ranges were derived using CLSI 'Robust' methods, and differences between group medians were tested using the Kruskal-Wallis and Mann-Whitney U tests.

    RESULTS: Plasma D-dimer levels were measured in 92 pregnant women (distributed across the three trimesters)and 31 control women. The medians (and reference ranges) in ng/mL were: control 265 (<799); first trimester 481 (<1070); second trimester 1073 (357-1748); 3rd trimester 1533 (771-2410). There were significant differences between the D-dimer levels of each group and each of the other groups (P<0.001).

    CONCLUSIONS: Reference ranges for D-dimer in pregnant Malaysian women have been establised by this study. Whether these ranges can be used to determine cut-off levels for the exclusion of VTE at different stages of pregnancy is doubtful, as the levels rise continuously through pregnancy, and some very high outlying values occur in apparently normal near-term pregnancy.

    MeSH terms: Cross-Sectional Studies; Female; Fibrin Fibrinogen Degradation Products; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Pregnancy Trimesters; Reference Values; Control Groups; Term Birth; Venous Thromboembolism
  11. Sarmadi S, Izadi-Mood N, Sanii S, Motevalli D
    Malays J Pathol, 2019 Apr;41(1):15-24.
    PMID: 31025633
    INTRODUCTION: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability.

    MATERIALS AND METHODS: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement.

    RESULTS: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial).

    CONCLUSION: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. "hydropic change" and "trophoblastic proliferation".

    MeSH terms: Abortion, Spontaneous; Abortion, Induced; Eosine Yellowish-(YS); Female; Hematoxylin; Humans; Hydatidiform Mole; Pregnancy; Trophoblasts; Uterine Neoplasms; Observer Variation; Cell Proliferation; Pathologists
  12. Vântu A, Ghertescu D, Fiscă C, Mărginean A, Hutanu A, Gheban D, et al.
    Malays J Pathol, 2019 Apr;41(1):25-32.
    PMID: 31025634
    INTRODUCTION: Experimental models are essential for clarifying the pathogenesis of atherosclerosis in the context of diabetes mellitus (DM). We aimed to evaluate the presence and the magnitude of several factors known to promote atherogenesis, and to assess the potential of a pro-atherogenic environment to stimulate the development of atherosclerotic lesions in a rat model of long-term type 1 DM.

    MATERIALS AND METHODS: Six control and five DM Wistar rats were evaluated. DM was induced at 11 weeks of age using streptozotocin (STZ; 60 mg/kg, intraperitoneal). Animals were monitored up to 38 weeks of age, when plasma glucose, lipid profile, and markers specific for systemic inflammation, endothelial dysfunction, and oxidative stress were measured. The amount of fat within the aortic wall was assessed semiquantitatively using Oil Red O staining.

    RESULTS: Diabetic rats presented significantly higher plasma glucose (p < 0.001), total cholesterol and triglycerides (both p = 0.02), high-sensitivity C-reactive protein (p = 0.01), and vascular endothelial growth factor (p = 0.04) levels, and significantly lower interleukin-10 (p = 0.04), superoxide dismutase (p < 0.01), and glutathione peroxidase (p = 0.01) levels than the control rats. Mild (grade 1) atherosclerotic lesions were observed in the aortic wall of 80% of the diabetic rats and in none of the control rats.

    CONCLUSIONS: This study presents a STZ-induced type 1 DM rat model with one of the longest follow-ups in the literature. In this model, long-term DM created a highly pro-atherogenic environment characterised by hyperglycemia, dyslipidemia, systemic inflammation, endothelial dysfunction, and oxidative stress that resulted in the development of early aortic atherosclerotic lesions.

    MeSH terms: Animals; Aorta; Blood Glucose; C-Reactive Protein; Cholesterol; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Follow-Up Studies; Glutathione Peroxidase; Hyperglycemia; Inflammation; Models, Theoretical; Staining and Labeling; Streptozocin; Superoxide Dismutase; Triglycerides; Interleukin-10; Rats, Wistar; Oxidative Stress; Vascular Endothelial Growth Factor A; Dyslipidemias; Atherosclerosis; Rats
  13. Mohd Nafi SN, Siti Azrin AH, Mat Zin AA, Othman NH, Che Jalil NA
    Malays J Pathol, 2019 Apr;41(1):33-39.
    PMID: 31025635
    INTRODUCTION: Insulin-like growth factor binding protein-related protein 1 (IGFBP-rP1) is an important component of the IGF system that regulates insulin resistance-related to tumour development. The aim of this study is to investigate the expression of IGFBP-rP1 among female cancer patients who are known or not known to have Type 2 Diabetes Mellitus (T2DM).

    MATERIALS AND METHODS: Using a cross-sectional design, cases of ovarian and breast cancer with clinical status of T2DM were selected over a 10-year period in Hospital Universiti Sains Malaysia. Immunohistochemical staining for IGFBP-rP1 was performed on paraffin-embedded tissues and the results were correlated with the patient's demographic and clinicopathological data.

    RESULTS: A total of 152 breast cancer patients were recruited into the current study with 33.5% (51/152) patients were positive T2DM. Most of the breast cancer patients with T2DM were IGFBP-rP1-negative (66.7%, 34/51). The IGFBP-rP1 expression was significantly difference between breast cancer subjects with and without T2DM (p<0.001). There was no significant association of IGFBP-rP1 expression with data on the demographic and clinicopathological profiles of patients with breast cancer. Meanwhile, positive IGFBP-rP1 expression was evident in 44 out of 108 (40.74%) ovarian cancer cases. Among these cases, 36 were T2DM. In contrast to breast cancer cases, IGFBP-rP1 was mostly expressed among ovarian cancer patients with T2DM (66.7%, 24/36, p < 0.001). However, the -positive expression was not significantly associated with any sociodemographic and clinicopathological features of ovarian cancers.

    CONCLUSIONS: Majority of breast cancer patients with T2DM did not express IGFBP-rP1. In contrast, majority of the ovarian cancer patients with T2DM expressed IGFBP-rP1.

    MeSH terms: Breast Neoplasms; Cross-Sectional Studies; Demography; Diabetes Mellitus, Type 2; Female; Humans; Insulin Resistance; Malaysia; Ovarian Neoplasms; Staining and Labeling; Paraffin Embedding; Insulin-Like Growth Factor Binding Proteins
  14. Fish-Low CY, Abubakar S, Othman F, Chee HY
    Malays J Pathol, 2019 Apr;41(1):41-46.
    PMID: 31025636
    INTRODUCTION: Dengue virus (DENV), the causative agent of dengue disease exists in sylvatic and endemic ecotypes. The cell morphological changes and viral morphogenesis of two dengue ecotypes were examined at the ultrastructural level to identify potential similarities and differences in the surrogate model of enzootic host.

    MATERIALS AND METHODS: Vero cells were inoculated with virus at a multiplicity of infection (MOI) of 0.1. Cell cultures were harvested over a time course and processed for transmission electron microscopic imaging.

    RESULTS: The filopodia protrusions on cell periphery preceded virus entry. Additionally, sylvatic DENV infection was found spreading slower than the endemic DENV. Morphogenesis of both dengue ecotypes was alike but at different level of efficiency in the permissive cells.

    CONCLUSIONS: This is the first ultrastructural study on sylvatic DENV and this comparative study revealed the similarities and differences of cellular responses and morphogenesis of two dengue ecotypes in vitro. The study revealed the weaker infectivity of sylvatic DENV in the surrogate model of enzootic host, which supposed to support better replication of enzootic DENV than endemic DENV.

    MeSH terms: Animals; Cell Count; Cercopithecus aethiops; Dengue; Dengue Virus; DNA Replication; Electrons; Morphogenesis; Pseudopodia; Vero Cells; Cell Culture Techniques; Virus Internalization; Ecotype
  15. Faheem NAA, Kwan Z, Yong ASW, Ch'ng CC, Tan KK, Naicker M, et al.
    Malays J Pathol, 2019 Apr;41(1):47-49.
    PMID: 31025637
    Naevus sebaceus is a cutaneous hamartoma with the potential of developing into benign or malignant neoplasms. Syringocystadenoma papilliferum (SCAP) have been reported to originate from naevus sebaceus. SCAP is a rare, benign adnexal skin tumour of apocrine or eccrine type of differentiation which typically presents as a nodule or a plaque on the scalp or face. We report a case of syringocystadenoma papilliferum arising in an undiagnosed pre-existing naevus sebaceus in a 56-year-old female.
    MeSH terms: Female; Hamartoma; Adenoma, Sweat Gland; Scalp; Skin Diseases; Skin Neoplasms
  16. Subramaniam K, Siew SF, Mahmood MS
    Malays J Pathol, 2019 Apr;41(1):51-54.
    PMID: 31025638
    Spontaneous coronary artery dissection is a rare event and commonly associated with pregnancy and female gender. This condition can reduce or completely obstruct the blood flow to the heart, causing a myocardial ischaemia, abnormalities in heart rhythm or sudden death. We present a case of a 28-year-old Indian male with no previous medical illness who complained sudden onset of chest pain prior to his death. Autopsy revealed a left anterior descending coronary artery dissection associated with plaque rupture. The anterior wall of left ventricle showed contraction band necrosis. There was also atheroma present in the right coronary artery which was insignificant. Histologically, dissection was associated with atherosclerosis. There was no evidence of vasculitis. The cause of death was given as coronary artery dissection due to coronary artery atherosclerosis.
    MeSH terms: Autopsy; Cause of Death; Chest Pain; Coronary Artery Disease; Coronary Vessel Anomalies; Death, Sudden; Female; Heart Ventricles; Male; Pregnancy; Vasculitis; Myocardial Ischemia; Atherosclerosis; Plaque, Atherosclerotic
  17. Hassan MZ, Iberahim S, Abdul Rahman WSW, Zulkafli Z, Bahar R, Ramli M, et al.
    Malays J Pathol, 2019 Apr;41(1):55-58.
    PMID: 31025639
    INTRODUCTION: Anti-D alloimmunisation may occur from the blood transfusion or fetomaternal haemorrhage which can lead to haemolytic disease of fetal and newborn (HDFN). The morbidity and mortality of HDFN related to anti-D is significantly reduced after introduction of anti-D prophylaxis and furthermore, anti-D HDFN in RhD negative primigravida is uncommonly seen.

    CASE REPORT: A case of unusual severe HDFN due to anti-D alloimmunisation in undiagnosed RhD negative primigravida Malay woman is reported here. This case illustrates the possibility of an anamnestic response from previous unknown sensitisation event or the development of anti-D in mid trimester. The newborn expired due to hydrops fetalis and severe anaemia. Antenatally, the mother was identified as RhD positive and thus there was no antenatal antibody screening, antepartum anti-D prophylaxis or close fetal monitoring for HDFN.

    DISCUSSION: The thorough antenatal ABO and RhD blood grouping with antibody screening is mandatory as part of prevention and early detection of HDFN especially due to anti-D alloimmunisation. Improper management of RhD negative women might lead to severe HDFN including in primigravida.

    MeSH terms: Blood Grouping and Crossmatching; Blood Transfusion; Erythroblastosis, Fetal; Female; Fetal Monitoring; Fetomaternal Transfusion; Humans; Immunoglobulins; Infant, Newborn; Malaysia; Mothers; Pregnancy; Prenatal Diagnosis; Hydrops Fetalis; Rho(D) Immune Globulin
  18. Yahaya A, Wa Kammal WS, Abd Shukor N, Osman SS
    Malays J Pathol, 2019 Apr;41(1):59-63.
    PMID: 31025640
    Alpha-fetoprotein (AFP)-producing carcinoma which microscopically mimics hepatocellular carcinoma (HCC) is a rare entity known as hepatoid adenocarcinoma (HC). They usually arise in the stomach, while oesophageal origin is only occasionally encountered. This tumour is highly aggressive and is associated with a poor prognosis. They frequently metastasise to the liver, thus giving rise to diagnostic difficulty, especially in cases where simultaneous oesophageal and liver mass are present. We reported a case of oesophageal hepatoid carcinoma with multiple liver metastasis, that was associated with an increased serum AFP. The distinction between HCC and HC is important because HC is more aggressive and has a poorer prognosis with limited therapeutic options. An extensive diagnostic work-up which include a thorough clinical history, radiological investigations (computed tomography or magnetic resonance imaging) as well as tissue biopsy supported by a panel of immunohistochemical markers are necessary to aid in the diagnosis of HC.
    MeSH terms: Adenocarcinoma; alpha-Fetoproteins; Biopsy; Carcinoma, Hepatocellular; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Stomach; Tomography, X-Ray Computed
  19. Ahmad Affandi K, Abd Shukor N, Mohamed Rose I, Raja Ali RA, Masir N
    Malays J Pathol, 2019 Apr;41(1):65-69.
    PMID: 31025641
    INTRODUCTION: Coeliac disease enteropathy is associated with an increased risk of lymphomas. Enteropathy-associated T-cell lymphoma is the principal malignancy related to coeliac disease. However, studies have shown that other types of lymphoma such as diffuse large B-cell lymphoma may also be associated with coeliac disease.

    CASE REPORT: We report a 54-year-old Caucasian man who presented with chronic diarrhoea and weight loss. He was diagnosed with coeliac disease based on positive serology results and duodenal, jejunal, and ileal biopsies that showed villous atrophy. Despite adherence to a gluten-free diet, there was no clinical remission and enteropathy-associated T cell lymphoma was suspected. Repeated endoscopic biopsy showed persistent mucosal disease but no evidence of lymphoma. Several weeks later he presented with a perforated jejunum. Histology of the resected jejunum showed diffuse infiltration of submucosa and muscularis propria by malignant lymphoid cells sparing the mucosa. The cells expressed CD20, CD79α, CD10 and BCL6 and ki67 of 80%, consistent with diffuse large B-cell lymphoma.

    DISCUSSION: It is suspected that the undetected lymphoma may have contributed to the persistent malabsorption syndrome rendering the patient unresponsive to treatment. Despite thorough clinical and endoscopic evaluation and multiple biopsies, histologic diagnosis of DLBCL was only confirmed following resection of the perforated jejunum.

  20. Tan GC, Sallapan S, Haworth K, Finlay J, Boue DR, Pierson CR
    Malays J Pathol, 2019 Apr;41(1):71-73.
    PMID: 31025642
    INTRODUCTION: Intratumoral calcification is a feature that is more often observed in pineal parenchymal tumour than germinoma. We describe a 13-year-old male with pineal region germinoma demonstrating extensive intratumoral calcification.

    CASE REPORT: He presented with worsening headache that was associated with fatigue, nausea and vomiting. Radiologic examination revealed a multilobular mass in the pineal region with internal calcifications. Biopsy showed a pure germinoma with unusually extensive calcification.

    DISCUSSION: Although a diagnosis may be suggested with a careful evaluation of imaging, there is no pathognomonic pattern. Thus, histologic verification is necessary for most pineal region masses.

    MeSH terms: Biopsy; Headache; Male; Nausea; Pineal Gland; Pinealoma; Vomiting; Germinoma
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