Malaysian Journal of Pathology最新文献

Introduction: COVID-19 diagnosis relies on the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) genome or antigen. Antibodies have limited use for diagnosis but contribute to serological studies and epidemiologic analysis. We aimed to elucidate anti-N and anti-S antibody responses among patients with PCR-positive and indeterminate results, and/or those with rapid molecular test-positive results.

Materials and methods: 267 serum samples from 199 patients were collected from April 2020 until November 2021. The timing of serum sampling was determined from the diagnostic testing date. Anti-N and anti-S were tested using the ECLIA platform. The patients' COVID-19 clinical categories were retrieved from an online system, and data were analysed using SPSS, version 28.

Results: 82.4% of patients' PCR were positive, while 17.6% were indeterminate. Overall sero-reactivity rate for anti-N and anti-S is 54.3% and 65.3%, respectively. The sero-reactivity rate and level of anti-S antibodies peaked at day 9 to 14 post-PCR but declined after day 15. Anti-N has significantly higher sero-reactivity rate (p<0.001) in the PCR-positive group. Anti-S sero-reactivity rate was significantly higher in mild COVID-19 infections (p=0.027).

Conclusion: In a cohort with the majority belonging to the pre-vaccination period during the COVID-19 pandemic, sero-reactivity of the SARS-CoV-2 antibodies were highest from week two following laboratory diagnosis. Currently, the clinical utility of SARS-CoV-2 antibody testing is limited due to the current endemicity of the virus as well as the vaccinated population. Further research could explore how viral evolution and immunisation impact antibody responses and the detection of the various antibodies.

Introduction: Cytomegalovirus (CMV) is an opportunistic pathogen that causes various end-organ diseases. In HIV patients, it is linked to unfavourable progression even in the era of anti-retroviral therapy (ART). Cases of CMV drug resistance may worsen the situation. This study aimed to determine the prevalence of CMV-HIV co-infection, its associated factors and genotypic detection of ganciclovir-resistant CMV.

Materials and methods: The clinical and laboratory data of 358 HIV patients clinically suspected of CMV infections from December 2018 to December 2020 in Sungai Buloh Hospital, Selangor, Malaysia, were retrospectively analysed. Forty samples were tested for ganciclovir-resistant UL97 mutations (M460I and M460V) using a high-resolution melting curve (HRM) and Sanger sequence analysis.

Results: The prevalence of CMV infection among HIV patients, detected in plasma, cerebrospinal fluids, vitreous fluids and tissue specimens by CMV PCR, was 60.3% (216/358). Pneumonitis (100/216, 46.3%) and gastrointestinal diseases (65/216, 30.1%) were the predominant clinical presentations of CMV-HIV co-infection, followed by retinitis 5.6% (12/216). The majority of HIV patients (84.6%) who succumbed to death were co-infected with CMV. There were significant associations (p<0.05) between ART status, HIV viral load and CD4 cell count with CMV infection when tested individually. In multivariate analysis, CD4 cell count showed significant association, where decreased CD4 cell count increases the likelihood of CMV infection. No ganciclovir-resistant mutations were detected.

Conclusion: Despite the high prevalence of CMV infection, the absence of ganciclovir-resistant strain is a good indication. However, the possibility of drug resistance by other gene mutations in different codons cannot be ruled out using this HRM method.

Digital Twin (DT) technology, originally conceptualised in engineering, has recently emerged as a transformative paradigm in healthcare, promising to redefine the generation, interpretation, and application of biomedical evidence. DTs enable real-time simulation, prediction, and optimisation of clinical outcomes. The review aims to elucidate how DTs may enhance methodological efficiency, ethical standards, and strategic innovation in biomedical science, while addressing their epistemological and regulatory challenges. A DT is a dynamic, data-driven virtual replica of a biological entity or clinical process, continuously updated through real-time data to simulate, predict, and optimise outcomes. Originating in engineering, DTs are now entering healthcare as enablers of predictive, preventive, and precision medicine. Supported by Internet of Things (IoT) technologies, cloud computing, and machine learning, DTs integrate heterogeneous data-genomic, physiological, behavioural, and environmental-into adaptive models capable of mirroring and anticipating patient trajectories. In clinical research, they enable synthetic control arms and in silico trials, reducing recruitment barriers, improving statistical power, and addressing ethical issues associated with placebo use. The recent qualification of DT-based methodologies such as PROCOVA™ by the EMA and FDA confirms their growing scientific and regulatory credibility. DTs are redefining Medical Affairs, strengthening its role as a bridge between data science and clinical practice. They enable patient-level insights and personalised scientific communication, transforming Medical Affairs into a predictive, data-driven discipline that supports evidence-based and patient-centered decisions.

No abstract available.

Introduction: Globally, non-albicans Candida (NAC) species have emerged as a notable cause of both healthcare-associated and opportunistic infections. Compared with Candida albicans, NAC species are more likely to cause infections fraught with antifungal resistance issues and higher mortality rates. The objectives of this study were to identify the various Candida species causing candidaemia in a Malaysian general hospital and to ascertain their antifungal susceptibility profiles.

Materials and methods: This 15-month cross-sectional study involved the peripheral blood of patients diagnosed with candidaemia. Conclusive species identification was achieved through matrix-assisted laser desorption ionisation-time-of-flight mass spectrometry (MALDI-TOF MS) while antifungal susceptibility was performed using the colourimetric broth microdilution method.

Results: A total of 118 non-duplicate Candida isolates were analysed during the study period. Out of this total, 47 (39.8%) were C. albicans, 25 (21.2%) were Candida parapsilosis complex, 24 (20.3%) were Candida tropicalis, 19 (16.1%) were Nakaseomyces glabratus and three (2.6%) were Pichia kudriavzevii. Collectively, the NAC species outnumbered C. albicans (60.2% vs. 39.8%). The overall minimal inhibitory concentration at which ≥90% of isolates were inhibited (MIC90) for NAC species was 32 µg/mL for fluconazole, 1 µg/mL for amphotericin B and between 1 to 2 µg/mL for the echinocandins.

Conclusion: Despite C. albicans being the single most frequently isolated species from patients with candidaemia, more than half of candidaemia cases in our centre were caused by NAC species. Generally, although these NAC species were not fluconazole-susceptible, amphotericin B and echinocandins may still be utilised against them.

Introduction: Odontogenic keratocyst (OKC) is among the commonest odontogenic cysts known for its local invasiveness and high recurrence rate following treatment. The study on OKC among the Malaysian population is limited in recent years. The aim of this study is to evaluate the latest demographic and clinicopathological profile of OKC cases in the Faculty of Dentistry, Universiti Malaya (UM).

Materials and methods: The demographic and clinicopathological data of 147 OKC cases were extracted from the archive of the institution from 2003 to 2022. Descriptive statistics, Pearson Chi-square test and Fisher's Exact Test were employed for the statistical analysis.

Results: OKC affected younger age groups with peak incidence in the third decade of life followed by the second decade of life. An almost equal distribution among males and females was observed. Predominance of OKC was seen within the Chinese ethnicity. The mandible was the commonest site of occurrence. Recurrence was observed in 11.1% of the cases where most of them were treated by enucleation only. Majority of the cysts were predominantly lined by parakeratinized stratified squamous epithelium (94.6%) with corrugated surface (89.8%). Presence of epithelial island (16.3%), satellite cyst (15.6%), dystrophic calcification (10%) and atypia (7.5%) were also observed. Significant association (p<0.05) were seen in syndromic OKC involving both jaws, multilocular radiolucency in mandible and presence of satellite cysts in OKC involving both jaws.

Conclusion: This study provides the latest demographic and clinicopathological profiles of OKC from this institution. This data could add value for current chairside assessment and treatment planning of OKC.

This consensus aims to develop a standardised guideline for human epidermal growth factor-2 (HER2) immunohistochemistry interpretation and reporting in Malaysia to support optimal therapeutic decision-making and research compatibility. An expert committee comprising pathologists and oncologists from public, private, and academic institutions convened to review existing international recommendations and taking into the consideration of local healthcare resource variations. The committee aims to harmonise reporting terminology in the reporting of HER2 testing, with emphasis on HER2-low and HER2-ultralow categories. A standardised HER2 reporting is crucial to ensure Malaysian patients benefit equitably from emerging HER2-targeted therapies. We hope this guideline could prepare the national pathology community in leading the evolving landscape of breast cancer management.

Breast cancer is still one of the most important health burdens worldwide, with incidence and mortality rates increasing, especially in Asia and Africa. As conventional therapeutic approaches, including endocrine therapy, chemotherapy, surgery, and radiotherapy, have developed, their limitations were gradually identified from systemic toxicity to therapeutic resistance. Nanomedicine has emerged as a revolutionary approach where nanotechnology is exploited for precise drug delivery, improving bioavailability while reducing adverse effects. The passive and active targeting mechanisms are involved in the nanoparticle-based drug delivery systems (DDS), which enhance the therapeutic outcomes. Passive accumulation of nanoparticles in tumours is facilitated by the enhanced permeability and retention (EPR) effect, while active targeting is enhanced by the use of ligand-functionalised nanocarriers. Stimuli-responsive nanomedicines further optimise drug release, with triggers from the tumour microenvironment, including pH and reactive oxygen species. Furthermore, nanomedicine has been playing an important role in overcoming radio-resistance and improving immunotherapy efficacy. Nanomedicine, though very promising, has its problems: high expenditure for research and development, legislative barriers, and public scepticism. Overcoming these issues requires resolving nanotoxicity and making the processes capable of large-scale manufacturing. Because cancer nanomedicine is well on its course toward precision medicine, interdisciplinarity at work, and strong policy support should be seen for the fullest deployment of this concept in the treatment of breast cancer.

Sclerosing variant of pancreatic neuroendocrine tumour is a subtype of pancreatic neuroendocrine tumours with abundant fibrous stroma. Sclerosing variant of pancreatic neuroendocrine tumours clinically and radiologically mimic ductal carcinoma and have been reported to have a possible poor prognosis. Here, we describe a case of the sclerosing variant of pancreatic neuroendocrine tumour with mucin lake formation. In the current case, the duct component was intimately incorporated into the neuroendocrine tumour nests; these observations together with the invasive proliferation required differentiation from mixed neuroendocrine-non-neuroendocrine neoplasm and ductulo-insular variant of pancreatic neuroendocrine tumours. Detailed observation clarified that the ducts in the tumour were entrapped in normal pancreatic ducts. Moreover, the current case was a pseudoglandular variant of pancreatic neuroendocrine tumours. The tumour cells produced a small amount of mucin, degenerated, and shed to form mucin lakes. This is a unique and peculiar morphology of pancreatic neuroendocrine tumours and is reported here as a notable case.