Category Archives: Articles

Cancer is the second leading cause of death worldwide which is responsible for an estimated 9.6 million deaths in 2018.¹

Breast cancer ranks as the second most common cancer and the fifth most common cause of deaths due to cancer globally.^{2, 3, 4, 5} In Malaysia, this disease has accounted for 34.1% of all cancer among the females.⁶        

Breast cancer can occur at different parts of the breast like the lobules, ducts and connective tissue. The lobules are the milk producing gland, the ducts are tubes that allow milk to reach the nipple and the connective tissue which consists of fibrous and fatty tissues surrounds and keeps everything together. Breast cancers most commonly occur in the ducts or lobules.^{4, 7}    

Different people experience different symptoms of breast cancer and some does not experience any signs and symptoms at all.⁸ Some of the warning symptoms are changes in the shape or size of breasts, presence of lump in the breasts or underarm areas, changes in nipples (appearance of nipples, pointing direction or presence of any clear or blood discharge), swelling of part of the breast, dimpling or irritation on the breasts skin area, redness, rash or eczema on breasts skin and nipples area, continuous pain in any area of breast, nipples or axilas.^{4, 8, 9, 10, 11}

Breast cancer risk increases with age and a majority of those diagnosed are post-menopausal. Other factors that increases the risk of breast cancer include being a female, inherited genetic mutation, first pregnancy at a later age, low parity, early menarche, late menopause, having dense breast, being overweight or obese in post-menopausal women, physically inactive, previous history of radiotherapy to the breasts and drinking alcohol.^{9, 12}

Breast cancer screening examines a vast number of asymptomatic individuals to identify positive cancer cases and to prevent deaths due to breast cancer by detecting the cancer at an early stage when treatment will be more effective. The cancer can be controlled by early detection through routine self-breast exams, mammographic screening, reducing prevalence of known risk factors and improved treatment.^{4, 5, 9}

 

At Pantai Premier Pathology, we provide screening tests for Breast Cancer. Here are some tests related to breast cancer offered by Pantai Premier Pathology:

Breast CA Screening Test	Prognosis
1.      BRCA Heredity Germline Testing	1.      Immunohistochemistry Testing 2.      HER2 Fish Testing 3.      BRCA1 & 2 Testing (Somatic & Germline) 4.      PIK3CA Testing for hormonal positive, HER2 negative

 

For more information on the tests provided, please contact us at +603-42809115 (Customer Service) or email us at info@premierpathology.com.my.

 

 

References:

1. Cancer. (2018, September 12). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cancer
2. Liu, F. C., Lin, H. T., Kuo, C. F., See, L. C., Chiou, M. J., & Yu, H. P. (2017). Epidemiology and survival outcome of breast cancer in a nationwide study. Oncotarget, 8(10), 16939–16950. https://doi.org/10.18632/oncotarget.15207
3. Moodley, J., Cairncross, L., Naiker, T., & Constant, D. (2018). From symptom discovery to treatment-women’s pathways to breast cancer care: a cross-sectional study. BMC cancer, 18(1), 312.
4. Winters, S., Martin, C., Murphy, D., & Shokar, N. K. (2017). Breast cancer epidemiology, prevention, and screening. In Progress in molecular biology and translational science (Vol. 151, pp. 1-32). Academic Press.
5. Torre, L. A., Siegel, R. L., Ward, E. M., & Jemal, A. (2016). Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiology and Prevention Biomarkers, 25(1), 16-27.
6. National Cancer Registry Department. (2019). MALAYSIA NATIONAL CANCER REGISTRY REPORT (MNCR) 2012-2016. Retrieved from https://drive.google.com/file/d/1BuPWrb05N2Jez6sEP8VM5r6JtJtlPN5W/view
7. What is Breast Cancer? (n.d.). Centers for Disease Control and Prevention. Retrieved September 25, 2020, from https://www.cdc.gov/cancer/breast/basic_info/what-is-breast-cancer.htm
8. What are the Symptoms of Breast Cancer? (n.d.). Centers for Disease Control and Prevention. Retrieved September 25, 2020, from https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm
9. Harmer, V. (2016). Signs and symptoms of breast cancer: The practice nurse role. Practice Nursing, 27(8), 377-382.
10. Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: a review. Jama, 321(3), 288-300.
11. Morrow, M. (2004). Physical examination of the breast. Diseases of the Breast, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 29-32.
12. What Are the Risk Factors for Breast Cancer? (n.d.). Centers for Disease Control and Prevention. Retrieved September 25, 2020, from https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

Atherosclerosis is a chronic inflammatory disease caused by build-up of plaque inside the arteries.^{1, 2, 3}  This disease is a major contributor of cardiovascular diseases (CVDs) and has an increasing prevalence globally each year.^{2, 3, 4} 

The chronic build-up of plaque (fatty deposits) in the artery wall causes blood vessel thickening and arterial stenosis (narrowing of artery wall). The narrowing within the artery channel will result in blood flow restriction, thereby, leading to tissue hypoxia.^{5, 6, 7, 8}

Immune activation was identified in the atherosclerotic plaque where inflammatory cells are attracted within the arterial wall and into the atherosclerotic plaque, hence, promoting the progression of atherosclerotic lesions.^{2, 6, 7, 8}

 

Signs & Symptoms

Atherosclerosis usually does not manifest any signs and symptoms until an artery is severely narrowed or blocked. Many people will only get to know they have the disease when a medical emergency such as a heart attack, unstable angina pectoris or stroke occurs.^{9, 10}

Some individuals may have signs and symptoms of the disease which depends on which arteries are affected.¹¹

 

Risk Factors

Atherosclerosis is a slow and complex disease which may develop in childhood and progress as a person ages.^{5, 11}

Some common factors that cause damage to the inner lining of the arteries which will lead to atherosclerosis to take place are smoking, high blood pressure, being overweight or obese, oxidative stress (reactive oxygen species), high blood cholesterol, high blood glucose levels, family history and lack of physical activities.^{5, 11, 12, 13}

 

Diagnosis

A medical practitioner will diagnose atherosclerosis based on the patient’s medical and family histories, physical examination and test results.^{5, 14}

 

Blood Tests

A blood test is done to measure the levels of certain fats, cholesterol, glucose and proteins (biomarkers) in the blood. Abnormal levels of these parameters may be a sign that a person is at an increased risk of developing atherosclerosis.^{5, 14}

 

Electrocardiogram (ECG)

An ECG is a simple and painless test that detects and records the electrical activity of the heart. The test can detect signs of a previous or current heart attack.^{5, 14}

 

Echocardiography

An echocardiography test shows the size and shape of the heart and how well the heart chambers and valves are functioning. The test can also identify poor blood flow areas of the heart, areas of heart muscles that are not contracting normally and previous injury to heart muscle due to poor blood flow.^{5, 14}

 

Exercise Stress Testing

During a stress test, the patient is required to exercise and make the heart work hard and beat fast while the heart tests are performed. Arteries that are narrowed due to plaque build up do not supply adequate amounts of oxygen-rich blood to the heart, hence, a stress test indicates possible symptoms of a coronary artery disease.^{5, 14}

 

Angiography

An angiography test is done to observe the inside of the arteries by using dye and special x-rays. This test can show whether the arteries are blocked by a plaque and how severe is the blockage.^{5, 14}

 

Computer Tomography (CT) Scan

A CT scan can show if an artery is hardening or narrowing.  The test can also indicate when there is calcium build up in the walls of the coronary arteries which is an early sign of a coronary artery disease.⁵

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Screening for asymptomatic atherosclerosis is important for an early diagnosis as an efficient strategy to control risk factors and prevent or delay atherosclerosis and its related diseases. It is also crucial to identify patients that require long-term surveillance, medication or surgery.^{5, 15, 16}

At Pantai Premier Pathology, we provide screening tests for Heart Disease. For more information on the tests provided, please contact us at +603-42809115 (Customer Service) or email us at info@premierpathology.com.my.

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References:

1. Wolf, D., & Ley, K. (2019). Immunity and inflammation in atherosclerosis. Circulation research, 124(2), 315-327.
2. Gregersen, I., & Halvorsen, B. (2018). Inflammatory Mechanisms in Atherosclerosis [E-book]. In Atherosclerosis. Licensee IntechOpen. https://doi.org/10.5772/intechopen.72222
3. Taleb, S. (2016). Inflammation in atherosclerosis. Archives of cardiovascular diseases, 109(12), 708-715.
4. Cardiovascular Diseases (CVDs). (2017, May 17). World Health Organization. https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
5. Atherosclerosis. (2017, April 30). American Heart Association. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis
6. Wolf, D., & Ley, K. (2019). Immunity and inflammation in atherosclerosis. Circulation research, 124(2), 315-327.
7.  Libby, P., Ridker, P. M., & Maseri, A. (2002). Inflammation and atherosclerosis. Circulation, 105(9), 1135-1143.
8. Tuttolomondo, A., Di Raimondo, D., Pecoraro, R., Arnao, V., Pinto, A., & Licata, G. (2012). Atherosclerosis as an inflammatory disease. Current pharmaceutical design, 18(28), 4266-4288.
9. Boamponsem, A. G., & Boamponsem, L. K. (2011). The role of inflammation in atherosclerosis. AASRFC. ISSN, 978610, 194-207.
10. McCurdy, L. E., Winterbottom, K. E., Mehta, S. S., & Roberts, J. R. (2010). Using nature and outdoor activity to improve children’s health. Current problems in pediatric and adolescent health care, 40(5), 102-117.
11. Atherosclerosis. (n.d.). National Heart, Lung and Blood Institute. Retrieved August 26, 2020, from https://www.nhlbi.nih.gov/health-topics/atherosclerosis
12. Wang, L., Ai, D., & Zhang, N. (2017). Exercise Benefits Coronary Heart Disease. Advances in experimental medicine and biology, 1000, 3–7. https://doi.org/10.1007/978-981-10-4304-8_1
13. Crowther, M. A. (2005). Pathogenesis of atherosclerosis. ASH Education Program Book, 2005(1), 436-441.
14. Seong, A. C., & John, C. K. M. (2016). A review of coronary artery disease research in Malaysia. Med J Malaysia, 71(Supplement 1), 46.
15. Woo, S. Y., Joh, J. H., Han, S. A., & Park, H. C. (2017). Prevalence and risk factors for atherosclerotic carotid stenosis and plaque: A population-based screening study. Medicine, 96(4), e5999. https://doi.org/10.1097/MD.0000000000005999
16. Macedo, L. E. T. D. (2017). Cholesterol and prevention of atherosclerotic events: limits of a new frontier. Revista de saude publica, 51, 2.

Food Allergy

Food allergy is a  serious public health issue with an increasing prevalence that affects both the children and adults.¹ It occurs when the body has a specific and reproducible immune response to certain foods which can be severe and life-threatening (anaphylaxis).² This disease is also associated with an increased morbidity, affecting the daily quality of life.³    

 

Symptoms   

The symptoms and severity of a food allergy reaction can be different between individuals and for one person over time.²

Around 15% of young children and 3% of adults in Malaysia have developed allergy symptoms during their early childhood.^{4, 5} Food allergy reactions usually include the three main systems which are the digestive system, skin and respiratory system.⁶ The most common symptoms are allergic rhinitis, diarrhea, eczema and asthma, whereas, less common manifestations are infantile colic, chronic diarrhea, reflux of stomach contents, failure to thrive in children and anaphylaxis.^{4, 6} In some individuals, allergic reactions to food are mild but some may experience severe reactions that can result in death.⁶

 

Causes

An individual is more likely to develop food allergy when someone in the family has allergies (genetic disposition) or when certain foods trigger the allergic reactions. Among the common foods that often induce allergic reactions are eggs, legumes, nuts, seafood, shellfish, milk, soy, cereals (wheat, oats, barley, corn), fruits (apple, bananas, kiwi, avocado, papaya, etc.) and vegetables (potato, carrot, celery, etc.).^{2, 6}

 

Diagnostic Tool

The most common diagnostic tests to evaluate IgE- mediated food allergy are skin prick test (SPT) or blood test specific IgE to allergens. ^{7, 8}

 

The table below summarises the comparison between blood test which measures specific IgE to allergens and skin prick test.

Table 1: Summary of differences between Blood Test (Specific IgE Test) and Skin Prick Test (SPT)⁹

 

At Pantai Premier Pathology, we provide Single Allergen Testing and Multiple Allergen Testing to test for Allergy. For more information on the tests provided, please contact us at +603-42809115 (Customer Service) or email us at info@premierpathology.com.my.

 

 

References:

1. Panel, N. S. E. (2010). Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. Journal of Allergy and Clinical Immunology, 126(6), S1-S58.
2. Food Allergies. (n.d.). Centers for Disease Control and Prevention. Retrieved July 27, 2020, from https://www.cdc.gov/healthyschools/foodallergies/
3. Sampson, H. A., Aceves, S., Bock, S. A., James, J., Jones, S., Lang, D., … & Randolph, C. (2014). Food allergy: a practice parameter update—2014. Journal of Allergy and Clinical Immunology, 134(5), 1016-1025. 
4. Yadav, D. M. (2009b). Food allergy in infants and children. Allergy Center Malaysia. http://www.allergycentre.com.my/infants.html
5. Yadav, D. M. (2009a). Food allergy in adults. Allergy Center Malaysia. http://www.allergycentre.com.my/adults.html
6.  Lim Nyok Ling, D. D., & Lim Sern Chin, D. (n.d.). Food Allergy. MyHEALTH. Retrieved July 27, 2020, from http://www.myhealth.gov.my/en/food-allergy-2/
7. Abrams, E. M., & Sicherer, S. H. (2016). Diagnosis and management of food allergy. Cmaj, 188(15), 1087-1093.
8. Boyce, J. A., Assa’ad, A., Burks, A. W., Jones, S. M., Sampson, H. A., Wood, R. A., Plaut, M., Cooper, S. F., Fenton, M. J., Arshad, S. H., Bahna, S. L., Beck, L. A., Byrd-Bredbenner, C., Camargo, C. A., Jr, Eichenfield, L., Furuta, G. T., Hanifin, J. M., Jones, C., Kraft, M., Levy, B. D., … NIAID-Sponsored Expert Panel (2010). Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. The Journal of allergy and clinical immunology, 126(6), 1105–1118. https://doi.org/10.1016/j.jaci.2010.10.008
9. Ansotegui, I. J., Melioli, G., Canonica, G. W., Caraballo, L., Villa, E., Ebisawa, M., … & Sánchez, O. L. (2020). IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organization Journal, 13(2), 100080.

Tuberculosis (TB) is categorized as one of the top infectious killers worldwide, despite being a preventable and curable disease, due to the devastating health, social and economic impact it poses.^{1, 2}

Each year, 10 million people are getting infected with TB, with 1.5 million deaths recorded in 2018.^{1, 2} Around 57% of which infected are men, 32% are women and 11% are children who are 15 years old and below. The SouthEast Asia region has been reported to have the highest distribution of TB cases.³

TB is also the leading cause of death in people with HIV, with 251,000 deaths reported and one of the main contributors to antimicrobial resistance with 484,000 individuals who fell ill with drug-resistant TB in 2018.^{1, 2}

Mycobacterium tuberculosis is a bacteria that is responsible for TB infection by affecting the lungs.^{2, 4} TB is spread through airborne transmission when a person with the disease coughs, sneezes or spits and another individual needs to only inhale a few germs from the infected droplets to become infected.⁴

Most TB cases are reported to progress from latent TB infection (LTBI) rather than local transmission, especially in those whose immune systems are weakened. Hence, the transmission of the infectious TB can be prevented through prompt case finding and treatment of LTBI as a crucial strategy to achieve the elimination of TB.^{4, 5, 6}

 

 

Reference:

1. World Tuberculosis Day 2020. (n.d.). World Health Organization. Retrieved July 22, 2020, from https://www.who.int/campaigns/world-tb-day/world-tb-day-2020
2. Tuberculosis. (n.d.). World Health Organization. Retrieved July 22, 2020, from https://www.who.int/health-topics/tuberculosis#tab=tab_1
3. World Health Organization. (2019). TB Report (1.1) [Mobile App]. Play Store. https://apps.apple.com/my/app/tb-report/id1483112411
4. Latent TB Infection and TB Disease. (2016). Centers for Disease Control and Prevention. https://www.cdc.gov/tb/topic/basics/tbinfectiondisease.htm
5. Lönnroth, K., Migliori, G. B., Abubakar, I., D’Ambrosio, L., De Vries, G., Diel, R., … & Ochoa, E. R. G. (2015). Towards tuberculosis elimination: an action framework for low-incidence countries. European Respiratory Journal, 45(4), 928-952.
6. Dobler, C. C., Martin, A., & Marks, G. B. (2015). Benefit of treatment of latent tuberculosis infection in individual patients. European Respiratory Journal, 46(5), 1397-1406.

Hepatitis is a group of infectious diseases that affects 325 million people worldwide. Hepatitis C alone has been estimated to infect around 71 million people globally with either acute or chronic infection. Most individuals that have chronic infection will develop cirrhosis or liver cancer.^{2, 3, 5, 6} In 2016, WHO estimated that approximately 399,000 people have died from hepatitis C, mostly from cirrhosis and primary liver cancer (hepatocellular carcinoma).¹

 

What is Hepatitis C?

Hepatitis C infection occurs due to the inflammation of the liver caused by hepatitis C virus.³

 

What are the symptoms of Hepatitis C?

Individuals infected with hepatitis C are usually unaware that they are infected as it occurs with minimal to no clinical symptoms and are non-specific in most cases.⁷

When symptoms are present, they include extreme fatigue, jaundice, vomiting, dark urine, pale-coloured stool, loss of appetite and abdominal pain.¹

 

What causes Hepatitis C?

Hepatitis holds a great concern due to the burden of death it causes and its potential of causing an outbreak and epidemic spread.

Hepatitis C is mainly transmitted through parenteral contact with contaminated blood such as from infected mother to child at birth, through sharing medical equipment (i.e. needle and syringe) and personal items (i.e. razor and toothbrush) and less frequently through unprotected blood-to-blood sexual contact with an infected person.^{1, 3, 5, 6, 7, 8}

 

Who gets Hepatitis C?

Individuals at risk of hepatitis C are those in the healthcare profession, having multiple sexual partners and intravenous drug abusers.^{1, 8}

Most cases are due to unknown origin which means an individual does not need to be included in a high-risk group in order to be infected with a hepatitis virus.

 

How is Hepatitis C diagnosed?

Since hepatitis C infection is usually asymptomatic, very few individuals are diagnosed and may have developed chronic hepatitis C infection which can lead to serious health problems including secondary to serious liver damage. Hence, it is important for an individual to do early screening to prevent the advancement of the disease.^{1, 3}

Hepatitis C infection is diagnosed by testing for anti-hepatitis C virus antibodies with a serological test which identifies individuals that have been infected with the virus.

After an individual has been diagnosed with hepatitis C virus infection, an assessment of the degree of liver damage (fibrosis or cirrhosis) will be made through liver biopsy.¹

The degree of liver damage is done to be used as a guide for making decisions for the management and treatment of the disease.¹

 

In conclusion, hepatitis C infection is preventable, treatable and curable. Most individuals affected either lack prevention, testing or treatment.¹ Hence, early screening and detection is an important step to prevent the progression to chronic infection (cirrhosis or liver cancer) and to reduce liver-related morbidity and mortality.⁶

 

Source:

1. Hepatitis C. (2017, July 9). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
2. World Hepatitis Day 2019. (n.d.-a). World Health Organization. Retrieved July 24, 2020, from https://www.who.int/campaigns/world-hepatitis-day/2019
3. What is Viral Hepatitis? (n.d.). Centers for Disease Control and Prevention. Retrieved July 24, 2020, from https://www.cdc.gov/hepatitis/abc/index.htm
4. World Hepatitis Day — July 28th. (n.d.). Centers for Disease Control and Prevention. Retrieved July 24, 2020, from https://www.cdc.gov/hepatitis/awareness/worldhepday.htm
5. (İskender, G., Mert, D., Çeken, S., Bahçecitapar, M., Yenigün, A., & Ertek, M. (2020). Hepatitis C screening and referral for further investigation and treatment in a tertiary care hospital. The Journal of Infection in Developing Countries, 14(06), 642-646.
6. Guss, D., Sherigar, J., Rosen, P., & Mohanty, S. R. (2018). Diagnosis and management of hepatitis C infection in primary care settings. Journal of general internal medicine, 33(4), 551-557.
7. Mohd Suan, M. A., Said, S. M., Lim, P. Y., Azman, A. Z. F., & Abu Hassan, M. R. (2019). Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case–control study. PloS one, 14(10), e0224459.
8. Ghany, M. G., Strader, D. B., Thomas, D. L., & Seeff, L. B. (2009). Diagnosis, management, and treatment of hepatitis C: an update. Hepatology, 49(4), 1335-1374.