Malaysian Journal of Pathology最新文献

Introduction: Fatal falls from heights rank as the second leading cause of unnatural deaths, following road traffic accidents. Victims exhibit distinct injury patterns influenced by multiple factors. Therefore, this study aimed to assess the pattern of fatal injuries resulting from falls from height in medicolegal autopsies.

Materials and methods: We reviewed 340 autopsies records conducted at the Universiti Kebangsaan Malaysia Medical Centre for ten years from 2010 to 2019. Statistical analysis was performed on socio-demographic data, cause and manner of death, fall height, primary impact, toxicological analysis, and psychiatric illness.

Results: A total of 340 cases comprising 246 males and 94 females, representing 175 Chinese, 106 non-Malaysians, 28 Malays, 27 Indians, and two Bumiputeras Sabahan/Sarawakian. Their ages ranged from 5 months to 86 years old. The findings revealed that most deceased were males aged between 19 and 40. The primary locations of falls were reported within the home (77.9%) and workplace (16.8%). In cases of falls from significant heights, multiple injuries were the leading cause of death (71.4%), with 68.3% of these incidents classified as suicides. Head injuries were prevalent in falls from lower elevations (42.3%), particularly in accidental scenarios (34.9%). In 80% of cases, toxicological analysis yielded negative results, with alcohol being the most frequently detected substance (30.9%).

Conclusions: This study revealed that most injuries were linked to suicide. Hence, it is crucial to implement preventive measures to raise awareness among the public and mitigate similar incidents in the future.

Introduction: The formation of multinucleated giant cells (MGCs), is known to occur during chronic inflammations. However, the molecular mechanisms and cell signalling pathways by which they adhere are largely unknown. Most studies concerning the development of MGCs involve the stimulation of isolated monocytes or macrophages with infectious pathogens. However, such in vitro studies are limited, and the resulting MGCs do not accurately mimic MGC observed in vivo. In this report, we discuss an observation of the emergence of MGCs derived from umbilical cord blood in a modified methylcellulose culture.

Materials and methods: A 10-day colony-forming unit (CFU) assay (methylcellulose culture) using umbilical cord blood mononuclear cells resulted in the emergence of adherent epithelioid-like clusters.

Results: During the latter stages of the culture timeline, monocytic-like cells were observed to emerge from within these adherent clusters, alongside the formation of large MGCs exhibiting their characteristic morphology of multiple nuclei.

Conclusions: This observation could serve as a reference for cell culture studies and may present an alternative model of monocytic-lineage cell development, involving an intermediary stage rather than the conventional linear haematopoietic hierarchy of blood cell differentiation.

Introduction: Leptospirosis is an emerging infectious disease exemplified by frequent outbreaks worldwide with more than one million cases and 50,000 deaths annually. A high number of cases have been reported in Southeast Asia, including Malaysia. This study aims to identify the relationship between climatic patterns and leptospirosis cases in Malaysia from 2013 to 2021.

Materials and methods: The climatic data comprising temperature, humidity, and rainfall from 2013 to 2021 were obtained from the Malaysian Meteorological Department. Data was collected from five states in Malaysia: Kelantan, Perak, Selangor, Negeri Sembilan, and Sarawak. A Spearman correlation test was used to determine the relationship between the climatic pattern and Leptospirosis cases.

Results: In general, Leptospirosis cases fluctuated, with a maximum number of 8291 cases in 2015 and the lowest number being 1761 cases in 2021. The rainfall (mm) exhibited a fluctuating pattern from 2013 to 2021, with the highest total rainfall of 1938.5 mm in 2017. Temperature patterns varied from 2013 to 2021 with the highest temperature recorded was 27.60 degrees Celsius (°C) in 2016. The humidity increased steadily from 2017 to 2021, with the highest humidity recorded at 83.7% in 2020. A significant relationship was identified between the rainfall (mm) and Leptospirosis cases (p<0.05).

Conclusion: The findings imply that the amount of rainfall has a significant relationship with leptospirosis cases and the highest cases of leptospirosis of 8291 cases, occurred in the year 2015 with a temperature of 27.3°C, a humidity of 82.4 %, and a total rainfall of 1559.1mm.

Introduction: Delta storage pool disease (δ-SPD) is a platelet function disorder due to the decreased number and contents of dense granules causing bleeding symptoms. Diagnosis of δ-SPD is a complex procedure due to the variability of test results in platelet aggregometry and also it requires specialised tests. Electron microscopy (EM) is a promising tool to help in the diagnosis of this disorder. We report here a rare case of δ-SPD confirmed by EM.

Case report: A 42-year-old lady presented with prolonged bleeding history from a leech bite for 3 days. She also has a history of bleeding of variable severity for more than 20 years. On presentation, blood was oozing from the bite mark on her right wrist and there were multiple small bruises over her lower limbs. Full blood count, peripheral blood smear, coagulation profile, factor VIII assay, factor IX assay, von Willebrand Factor antigen and activity, bleeding time, and clot retraction test were normal. Platelet aggregation tests showed poor aggregation with ADP with a lag phase >60 seconds with arachidonic acid. There was poor ATP release reaction with ADP and arachidonic acid suggesting a storage defect. Subsequently, the EM of the platelets was performed and showed reduced dense granules indicating delta storage pool deficiency (δ-SPD). She was counselled about her diet and medication which seems to control her symptoms.

Conclusions: This case report highlights rare δ-SPD confirmed by EM. Diagnosis of this disorder is crucial in managing the patient. Highly specialised tests including platelet aggregometry, EM and molecular analysis are helpful in diagnosing this rare SPD.

Invasive neonatal Group B streptococcal (GBS) disease is a globally recognised serious condition. Its most devastating impact is during perinatal and postnatal periods. Epidemiological studies from high-income countries (HICs) showed that maternal rectovaginal GBS colonisation is the leading cause. It was estimated that world-wide, there were 20 million pregnant women with rectovaginal GBS colonisation which has caused 46,200 stillbirths, 40,500 cases of invasive maternal diseases, and 231,800 cases of early-onset and 162,200 cases of late-onset sepsis in neonates/infants. Among neonates/infants who have recovered from the disease, 37,100 suffered neurodevelopmental impairment. The current preventive measures in HICs consist of universal screening for maternal rectovaginal GBS colonisation at 35- to 37-week gestation, followed by intrapartum antibiotic prophylaxis for positive cases. This has prevented more than 80% of early-onset GBS disease. In Malaysian public hospitals, only targeted screening for maternal GBS colonisation was practiced in high-risk women with previous perinatal GBS infection/disease. We do not have national data on a) maternal GBS rectovaginal colonisation rates, b) stillbirths caused by GBS infections, c) preterm birth associated with maternal GBS colonisation, and d) neurodevelopmental impairment following invasive neonatal GBS disease. We only have national data of neonatal GBS sepsis which showed high morbidity and mortality. To reduce invasive neonatal GBS disease in Malaysia, we need national data on the prevalence of maternal GBS rectovaginal colonisation, its associated risk with stillbirths, and GBS-associated preterm births to help improve current preventive strategies to reduce invasive GBS disease during the perinatal and postnatal periods.

In Malaysia, tuberculosis remains a public health problem despite initiatives in disease control and prevention. This review explores the timeline of pulmonary tuberculosis (PTB) in Malaysia, epidemiology, management and outlook of the disease in the country. PTB was first reported in Malaya in the early 20th century and caused high morbidity and mortality. With the establishment of the National TB Control Programme in 1961 and chest clinics in every state general hospital, mortality was successfully reduced. Nonetheless, PTB incidence rate increased steadily after 2011, and Malaysia is currently an endemic country for the disease. Diagnosis for PTB is performed according to the Ministry of Health's Clinical Practice Guidelines which include chest X-ray, sputum culture and antibiotic susceptibility testing. Patients are treated according to WHO guidelines. While the country has seen a 0.02% decrease in drug-resistant cases in recent years; two cases of extensively drug-resistant tuberculosis have been reported. All major Mycobacterium tuberculosis lineages (Indo-Oceanic; East-Asian (including Beijing), East-African-Indian and Euro-American) have been reported in the country. The Beijing family of strains were found to have a higher prevalence in Peninsular Malaysia compared with Sabah and Sarawak, suggesting divergence of pathogen evolution between the two locations. Most antibiotic-resistant strains were found to harbour mutations in rpoB, katG, embB and pncA. Increasing usage of molecular platforms and artificial intelligence in diagnostics, apps and alert systems for better surveillance, and implementation of universal coverage in terms of treatment will be important for the country to achieve a tuberculosis-free status in 2035.

Metastasis of breast carcinoma to the oral cavity is extremely rare as compared to metastasis to the lung and liver. The non-specific presentation of metastatic lesions clinically and radiographically also pose a diagnostic challenge. We present an interesting case of metastatic carcinoma to the right mandible which was provisionally diagnosed as a benign lesion of the alveolar ridge.