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Inflamatory pseudotumor of the bladder: a histopathological diagnostic challenge from its malignant variant

Muhammad Akbar, Praveen, S., Christopher, H.C.K., Goh, E.H., Swaminathan, Zulkifli, M.Z.

Journal of Surgical Academia, 2012;2(1):46-49.
MyJurnal

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology
Transfusion-dependent thalassaemics: a practical approach

George E, George R, Duraisamy G, Ilina I, Swaminathan M, Thien T, et al.

Family Practitioner, 1986;9:35-37.
Fulltext Duodenal leiomyosarcoma: a report of a rare and aggressive tumour

Ho YN, Leong YP, Sakijan AS, Swaminathan M, Sarvananthan K

Singapore Med J, 1992 Jun;33(3):297-8.
PMID: 1631594

A 45-year-old Malay lady who presented with intermittent abdominal pain and a left hypochondrial mass was found to have a 10 x 8 x 5 cm duodenal tumour without local invasion at laparotomy. En bloc resection of the tumour with adequate margin of clearance was done and histopathological diagnosis of low grade leiomyosarcoma was made. Fourteen months later, she returned with multiple metastases in the liver and needed palliative chemotherapy for pain relief. Duodenal leiomyosarcomata are very rare tumour. Their prognostic indicators include biological grading, tumour size and presence of metastases. Recognition of its high malignant potential calls for close surveillance calls even after apparent curative surgery.
Fulltext Villoglandular papillary adenocarcinoma of the uterine cervix with lymph node metastasis - a case report and review of the literature

Geok, Chin Tan, Mohd Sidik Shiran, Manickam Swaminathan, Ali Siti Aishah, M.D., Poo, Ling Ong, Mohd Dali Ahmad Zailani Hatta

Medicine & Health, 2006;1(1):85-90.
MyJurnal

Villoglandular papillary adenocarcinoma was first described by Young and Scully in 1989 as a distinct entity with the histological features of exophytic growth proliferation, villous and papillary architecture and mild to moderate nuclear atypia. We report one case of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix with lymph node metastasis and reviewed the clinicopathological features of six other cases reported in the literature. Our patient is the seventh similar reported cases. They ranged in age from 29 to 54 (mean, 41) years. Five had lymphovascular invasion. All except our patient were treated with radical hysterectomy and radiotherapy. She was followed-up for 7 months and unfortunately died due to chest infection.
Histologic, histomorphometric, and cone-beam computerized tomography analyses of calcium sulfate and platelet-rich plasma in socket preservation: a pilot study

Cheah CW, Vaithilingam RD, Siar CH, Swaminathan D, Hornbuckle GC

Implant Dent, 2014 Oct;23(5):593-601.
PMID: 25192162 DOI: 10.1097/ID.0000000000000148

To assess dimensional changes and histologic/histomorphometric aspects of grafted sockets using either calcium sulfate-platelet-rich plasma (CS-PRP) or CS alone in socket preservation procedure.
Fulltext Effects of nonsurgical periodontal therapy on clinical response, microbiological profile, and glycemic control in Malaysian subjects with type 1 diabetes

Buzinin SM, Alabsi AM, Tan AT, Vincent-Chong VK, Swaminathan D

ScientificWorldJournal, 2014;2014:232535.
PMID: 25147841 DOI: 10.1155/2014/232535

The association between diabetes mellitus and chronic periodontal disease has long been established. Most of the researches linking these two very common chronic diseases were based on type 2 diabetes mellitus and chronic periodontal disease. However, this study was conducted to investigate the association between type 1 diabetes and chronic periodontal disease in Malaysian subjects. Forty-one Malaysian subjects, of which 20 subjects were type 1 diabetics and with chronic periodontal disease (test group) and 21 subjects with only chronic periodontal disease (control group), were included in the study. Periodontal parameters and plaque samples for microbiological evaluation were done at baseline, 2 and 3 months after nonsurgical periodontal therapy. Blood samples were taken from only the test group and evaluated for HbA1c at baseline and 3 months after periodontal therapy. There were no statistically significant difference in periodontal parameters between groups (P>0.05) and no significant improvement in the level of HbA1c in the test group. Microbiological studies indicated that there were significant reductions in the levels of the tested pathogens in both groups. The results of our study were similar to the findings of several other studies that had been done previously.
Fulltext Flavonoids with M1 muscarinic acetylcholine receptor binding activity

Swaminathan M, Chee CF, Chin SP, Buckle MJ, Rahman NA, Doughty SW, et al.

Molecules, 2014 Jun 27;19(7):8933-48.
PMID: 24979399 DOI: 10.3390/molecules19078933

Muscarinic acetylcholine receptor-active compounds have potential for the treatment of Alzheimer's disease. In this study, a series of natural and synthetic flavones and flavonols was assayed in vitro for their ability to inhibit radioligand binding at human cloned M1 muscarinic receptors. Several compounds were found to possess competitive binding affinity (Ki=40-110 µM), comparable to that of acetylcholine (Ki=59 µM). Despite the fact that these compounds lack a positively-charged ammonium group under physiological conditions, molecular modelling studies suggested that they bind to the orthosteric site of the receptor, mainly through non-polar interactions.
Peri-implant soft tissue integration of immediately loaded implants in the posterior macaque mandible: a histomorphometric study

Siar CH, Toh CG, Romanos G, Swaminathan D, Ong AH, Yaacob H, et al.

J. Periodontol., 2003 May;74(5):571-8.
PMID: 12816287

Today, one critical goal in implant placement is the achievement of optimal soft tissue integration. Reports thus far have demonstrated successful soft tissue preservation in delayed loaded implants placed in anterior jaws. The aim of this study was to histomorphometrically examine the soft tissues around immediately loaded implants placed in the macaque posterior mandible.
Fulltext The influence of socioeconomic and demographic variables on willingness to donate cadaveric human organs in Malaysia

Rasiah R, Manikam R, Chandarsekaran SK, Thangiah G, Puspharajan S, Swaminathan D

Medicine (Baltimore), 2014 Nov;93(23):e126.
PMID: 25415665 DOI: 10.1097/MD.0000000000000126

The growing shortage in human organs has raised serious concerns. To address this problem, we examine in this article the association between demographic and socioeconomic factors, and respondents' willingness to donate cadaveric organs using a large survey of Malaysian adults aged 18 years and above.A convenience sampling method was used to extract information from a total of 10,350 participants from Metropolitan Kuala Lumpur over the period of April 2, 2013 to February 29, 2014. In addition to analyzing the data using incidence of willingness to donate by demographic and socioeconomic factors, we carried out logistic regression analysis to estimate the odds ratio of respondents' willingness to become cadaveric organ donors controlling for age.About less than a third of the participants pledged to donate their organs upon death with women (35.6%) showing a higher incidence compared with men (33.2%). The Chinese (35.7%) and Malays (35.0%) pledged to contribute more than the Indians (31.6%) and the logistic regressions show that Malays (adjusted odds ration [OR] = 1.18) and Chinese (adjusted OR = 1.21) are more likely to donate than Indians (reference group). The results by religion were significant among Muslims and Hindus but not Buddhists. The likelihood of Muslims donating was the lowest (adjusted OR = 0.26). Income was also highly significant but the relationship with willingness to donate was negative. Against tertiary education, all other occupations were significant. However, the respondents with primary education enjoyed the highest adjusted OR (5.46) whereas that of secondary (0.48) and higher secondary (0.83) education was low. Among occupations (against supervisory, clerical, and direct workers), it was significant only among the unemployed and managers with adjusted OR of 1.50 and 1.58, respectively.Sex, education, ethnicity, religion, and income are important demographic and socioeconomic influences on the likelihood of Malaysians willing to become cadaveric organ donors. The Malaysian evidence suggests that awareness programs should be targeted at men, Muslims, Hindus, Malays, and the rich more than the others.
Intrauterine Gardnerella vaginalis Infection Results in Fetal Growth Restriction and Alveolar Septal Hypertrophy in a Rabbit Model

Cheah FC, Lai CH, Tan GC, Swaminathan A, Wong KK, Wong YP, et al.

Front Pediatr, 2020;8:593802.
PMID: 33553066 DOI: 10.3389/fped.2020.593802

Background:Gardnerella vaginalis (GV) is most frequently associated with bacterial vaginosis and is the second most common etiology causing intrauterine infection after Ureaplasma urealyticum. Intrauterine GV infection adversely affects pregnancy outcomes, resulting in preterm birth, fetal growth restriction, and neonatal pneumonia. The knowledge of how GV exerts its effects is limited. We developed an in vivo animal model to study its effects on fetal development. Materials and Methods: A survival mini-laparotomy was conducted on New Zealand rabbits on gestational day 21 (28 weeks of human pregnancy). In each dam, fetuses in the right uterine horn received intra-amniotic 0.5 × 102 colony-forming units of GV injections each, while their littermate controls in the left horn received sterile saline injections. A second laparotomy was performed seven days later. Assessment of the fetal pups, histopathology of the placenta and histomorphometric examination of the fetal lung tissues was done. Results: Three dams with a combined total of 12 fetuses were exposed to intra-amniotic GV, and 9 fetuses were unexposed. The weights of fetuses, placenta, and fetal lung were significantly lower in the GV group than the saline-inoculated control group [mean gross weight, GV (19.8 ± 3.8 g) vs. control (27.9 ± 1.7 g), p < 0.001; mean placenta weight, GV (5.5 ± 1.0 g) vs. control (6.5 ± 0.7 g), p = 0.027; mean fetal lung weight, GV (0.59 ± 0.11 g) vs. control (0.91 ± 0.08 g), p = 0.002. There was a two-fold increase in the multinucleated syncytiotrophoblasts in the placenta of the GV group than their littermate controls (82.9 ± 14.9 vs. 41.6 ± 13.4, p < 0.001). The mean alveolar septae of GV fetuses was significantly thicker than the control (14.8 ± 2.8 μm vs. 12.4 ± 3.8 μm, p = 0.007). Correspondingly, the proliferative index in the interalveolar septum was 1.8-fold higher in the GV group than controls (24.9 ± 6.6% vs. 14.2 ± 2.9%, p = 0.011). The number of alveoli and alveolar surface area did not vary between groups. Discussion: Low-dose intra-amniotic GV injection induces fetal growth restriction, increased placental multinucleated syncytiotrophoblasts and fetal lung re-modeling characterized by alveolar septal hypertrophy with cellular proliferative changes. Conclusion: This intra-amniotic model could be utilized in future studies to elucidate the acute and chronic effects of GV intrauterine infections.
Fulltext Maternal and umbilical cord blood polymorphonuclear leukocytes showed moderate oxidative burst at phagocytosis of Gardnerella vaginalis

Swaminathan A, Abd Aziz NH, Ayub NA, Wong KK, Cheah FC

BMC Res Notes, 2021 Nov 22;14(1):420.
PMID: 34809696 DOI: 10.1186/s13104-021-05842-y

OBJECTIVE: Pregnant women with bacterial vaginosis due to Gardnerella vaginalis (GV) infection presents with a wide-ranging disease symptomatology. We speculate this may be due to interaction that varies between host immune response and the pathogen. We studied the oxidative burst in polymorphonuclear leukocytes (PMNL)s from maternal blood (MB) and cord blood (CB) upon phagocytosis of GV and compared against E. coli and Group B Streptococcus (GBS).
RESULTS: The PHAGOBURST™ assay detects fluorescence from oxidized dihydrorhodamine during oxidative burst. The average percentage of PMNL showing oxidative burst was almost two-fold greater with GBS (99.5%) and E. coli (98.2%) than GV (56.9%) (p
Reassortment and evolutionary dynamics of tilapia lake virus genomic segments

Verma DK, Sood N, Paria A, Swaminathan TR, Mohan CV, Rajendran KV, et al.

Virus Res, 2021 Nov 12;308:198625.
PMID: 34780882 DOI: 10.1016/j.virusres.2021.198625

The tilapia lake virus (TiLV), a highly infectious negative-sense single-stranded segmented RNA virus, has caused several outbreaks worldwide since its first report from Israel in 2014, and continues to pose a major threat to the global tilapia industry. Despite its economic importance, little is known about the underlying mechanisms in the genomic evolution of this highly infectious viral pathogen. Using phylogenomic approaches to the genome sequences of TiLV isolates from various geographic regions, we report on the pervasive role of reassortment, selection, and mutation in TiLV evolution. Our findings provided the evidence of genome-wide reassortment in this newly discovered RNA virus. The rate of non-synonymous (dN) to synonymous (dS) substitutions was less than one (dN/dS = 0.076 to 0.692), indicating that each genomic segment has been subjected to purifying selection. Concurrently, the rate of nucleotide substitution for each genomic segment was in the order of 1-3 × 10-3 nucleotide substitutions per site per year, which is comparable to the rate of other RNA viruses. Collectively, in line with the results of the previous studies, our results demonstrated that reassortment is the dominant force in the evolution and emergence of this highly infectious segmented RNA virus.
Letter: Addressing Neurosurgery Research and Data Access Gaps in War-Inflicted Nations

Adebusoye FT, Awuah WA, Swaminathan N, Ghosh S, Wellington J, Abdul-Rahman T, et al.

Neurosurgery, 2023 Aug 01;93(2):e30-e31.
PMID: 37192472 DOI: 10.1227/neu.0000000000002527
Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity

Fisher D, Michaels J, Hase R, Zhang J, Kataria S, Sim B, et al.

J Antimicrob Chemother, 2017 04 01;72(4):1221-1226.
PMID: 28077673 DOI: 10.1093/jac/dkw551

Objectives: Healthcare facilities internationally have grown outpatient parenteral antibiotic administration services for the last few decades. The literature contains publications from dozens of countries describing systematized processes with specialist oversight and their levels of service provision and outcomes. Such descriptions are absent in the majority of Asian countries. We sought to elucidate the extent and nature of outpatient parenteral antibiotic therapy (OPAT) in Asia and to consider the ramifications and opportunities for improvement.
Methods: Utilizing colleagues and their personal networks, we surveyed healthcare facilities across 17 countries in Asia to ascertain the current means (if any) of providing OPAT. In that survey we also sought to explore the capacity and interest of these facilities in developing systematized OPAT services.
Results: Responses were received from 171 different healthcare facilities from 17 countries. Most (97/171, 57%) stated that they administer outpatient parenteral antibiotics, but only 5 of 162 facilities (3%) outside of Singapore described comprehensive services with specialist oversight.
Conclusions: There is very likely a large unrecognized problem of unchecked outpatient parenteral antibiotic administration in Asia. Developing comprehensive and systematized OPAT in Asia is needed as a priority in an environment in which the infectious diseases community is demanding broad stewardship approaches. There are nonetheless challenges in establishing and sustaining OPAT programmes. Local champions and leverage off identified local incentives and needs are key to regional advancement.
Study site: unclear (convenient sample from contacts of investigators)
Note: Questionnaire available here:
https://academic.oup.com/jac/article/72/4/1221/2888431#supplementary-data
Fulltext Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries

Parikh P, Semba R, Manary M, Swaminathan S, Udomkesmalee E, Bos R, et al.

Matern Child Nutr, 2022 Jan;18(1):e13264.
PMID: 34467645 DOI: 10.1111/mcn.13264

Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low- and middle-income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)-sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low-quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient-dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.
Threatening the Global AIDS Response - Obstacles to PEPFAR's Reauthorization

Abdool Karim SS, Barre-Sinoussi F, Varmus HE, Serwadda D, Bukusi E, M'boup S, et al.

N Engl J Med, 2023 Sep 28;389(13):1159-1161.
PMID: 37694893 DOI: 10.1056/NEJMp2310330
Fulltext Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review

Swaminathan N, Awuah WA, Bharadwaj HR, Roy S, Ferreira T, Adebusoye FT, et al.

Health Sci Rep, 2024 May;7(5):e2075.
PMID: 38690005 DOI: 10.1002/hsr2.2075

BACKGROUND AND AIMS: Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates.
METHODS: A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries.
RESULTS: The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing.
CONCLUSION: The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.
An unexpected case of primary peritoneal carcinoma

Nur-Syahrina R, Siti-Aishah MA, Swaminathan M, Ng PH, Ismail S, Syazarina SO, et al.

Clin Ter, 2010;161(3):261-3.
PMID: 20589359

Primary peritoneal carcinoma (PPC) is a rare tumor that is histologically and immunohistochemically indistinguishable from epithelial ovarian carcinoma. The diagnosis is usually made after excluding gross ovarian involvement or the ovarian involvement is only confined to the surface. A 68-year-old lady presented with right iliac fossa pain and increasing CA125. The CT scan showed bilateral pelvic adnexal masses with peritoneal deposits within the right side of abdomen. She was initially diagnosed as carcinomatosis peritonei from the omental cake removed after exploratory surgery. She was managed as advanced ovarian tumor with peritoneal metastasis and was then administered six cycles of chemotherapy. Surgical intervention included debulking surgery consisting of total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy and also with right hemicolectomy. The histopathological findings were of primary peritoneal serous carcinoma with only minimal involvement of the serosal surface of the right ovarian capsule. No microscopic invasion into underlying ovarian cortex and stroma was observed. Multiple tumor deposits were also seen over the right paratubal and paraovarian tissue, both parametrium as well as serosal surface of the terminal ileum and periappendicular tissue. Immunohistochemically, the malignant cells were positive to CA125, focally positive to CK7 and negative to CD20 and Calretinin. PPC is one of important differential diagnosis which needs to be considered in cases of advanced ovarian tumor, although the former can only be ascertained after excluding the ovarian involvement microscopically.
Non-secretory multiple myeloma with diagnostic challenges

Hamidah NH, Azma RZ, Ezalia E, Das S, Umar NA, Swaminathan M, et al.

Clin Ter, 2010;161(5):445-8.
PMID: 20949241

Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM). In NSMM, no monoclonal gammopathy can be detected in serum or urine by conventional techniques, making the diagnosis more difficult. We describe a 71-year-old man who had been diagnosed and treated for granulocytic sarcoma one year prior to his recent problems of progressive low-back pain of two months duration. Skeletal X-rays showed diffuse osteolytic lesions with multiple pathological fractures but there was no monoclonal gammopathy in the serum or urine. The biopsy of the lytic lesion on the upper part of the femur showed infiltration by abnormal plasma cells. A diagnosis of NSMM was made and he was treated with chemotherapy. The early diagnostic difficulty and the challenges faced regarding the case are discussed.
Start-up, performance and optimization of a compost biofilter treating gas-phase mixture of benzene and toluene

Rene ER, Kar S, Krishnan J, Pakshirajan K, López ME, Murthy DV, et al.

Bioresour Technol, 2015 Aug;190:529-35.
PMID: 25827361 DOI: 10.1016/j.biortech.2015.03.049

The performance of a compost biofilter inoculated with mixed microbial consortium was optimized for treating a gas-phase mixture of benzene and toluene. The biofilter was acclimated to these VOCs for a period of ∼18d. The effects of concentration and flow rate on the removal efficiency (RE) and elimination capacity (EC) were investigated by varying the inlet concentration of benzene (0.12-0.95g/m(3)), toluene (0.14-1.48g/m(3)) and gas-flow rate (0.024-0.072m(3)/h). At comparable loading rates, benzene removal in the mixture was reduced in the range of 6.6-41% in comparison with the individual benzene degradation. Toluene removal in mixture was even more affected as observed from the reductions in REs, ranging from 18.4% to 76%. The results were statistically interpreted by performing an analysis of variance (ANOVA) to elucidate the main and interaction effects.

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