Canine vector borne diseases of zoonotic concern in three dog shelters in Peninsular Malaysia: The importance of preventive measures

This study investigated canine vector borne diseases (CVBDs) of zoonotic significance in three major shelters in Peninsular Malaysia in order to highlight the importance of shelter management in diseases prevention. Since crowded housing has the potential to bring vectors and infected dogs into close proximity, the prevalence of CVBDs infection is always higher in sheltered dogs in comparison to pet dogs. Serum was collected from 90 adult dogs (30 from each shelter) from three shelters in different regions of Peninsular Malaysia (Shelter A, B and C). The prevalence of Dirofilaria immitis, Ehrlichia canis, E. ewingii, Anaplasma phagocytophilum, A. platys and Borrelia burgdorferi in dogs residing in three shelters with different management protocols was investigated by using rapid clinical test kits, SNAP® 4Dx® Plus (IDEXX Laboratories, Westbrook, ME). The most common pathogen detected was Ehrlichia spp. (55.6%, 50 out of 90 dogs), followed by Anaplasma spp. (16.7%; 15 out of 90 dogs). Dirofilaria immitis could only be detected in one of the shelters (10.0%; nine out of 90 dogs). No evidence of B. burgdorferi was detected in all three shelters. Forty one out of 90 dogs (45.6%) were infected with at least one pathogen meanwhile 14 out of 90 dogs (15.6%) were infected with more than one pathogen. It is of crucial importance to practice preventive measures during the admission of the new animals into the facilities. Occasional treatment of the dogs (as practiced in Shelter B) was not effective when compared to scheduled preventive measures. Future studies should emphasize the isolation and additional molecular characterization of vector borne pathogens in Peninsular Malaysia. In addition, studies that define the tick species that infest dogs in this region would help to elucidate their role as vectors for disease transmission.

Telephone-delivered individual cognitive behavioural therapy for cancer patients: An equivalence randomised trial

OBJECTIVE

To evaluate Telephone-Delivered Cognitive Behavioural Therapy (T-CBT) compared to CBT face to face treatment as usual (TAU-CBT), in cancer patients with high psychological needs, in terms of mental health and coping.

METHOD

A prospective randomised equivalence trial with Patient Reported Outcome (PRO's), measured pre- and post-therapy including; Hospital Anxiety and Depression Scale (HADS), Mental Adjustment to Cancer Scale: Helpless/Hopeless subscale only (MAC H/H), Checklist of Cancer Concerns (CLCC) and the Cancer Coping Questionnaire (CCQ). A study-specific Service Evaluation Questionnaire (SEQ) was include.

RESULTS

Assessment of change scores, in n = 118 randomised patients referred for psychological care, indicate significant improvements (P < 0.01 or greater) for both therapy groups pre- and post-therapy in HADS anxiety, depression and total scores and cancer concerns (CLCC). Overall, for the groups combined, there is a significant shift towards reduction of CCQ stress (P = 0.028) and worry (P = 0.003) post-therapy when compared to baseline levels. Median number of therapy sessions was four. For cancer coping (CCQ) and for Mental Adjustment to Cancer (MAC) there were significant change scores only for Positive Focus and Helpless/hopeless scores respectively, in the TAU-CBT group. Although equivalence was not observed, the data demonstrate that T-CBT was non-inferior to TAU-CBT.

CONCLUSIONS

Delivery of CBT to patients with clinician identified high need can be offered according to patient choice without loss of mental health benefit. Both TAU-CBT and T-CBT are effective at reducing mental health problems on the specific outcome measures.

In vitro larvicidal effects of ethanolic extract of Curcuma longa Linn. on Haemonchus larval stage

Aim:

Gastrointestinal helminthosis is a global problem in small ruminant production. Most parasites have developed resistance to commonly available anthelminthic compounds, and there is currently an increasing need for new compounds with more efficacies. This study evaluated the in vitro effects of ethanolic extract of Curcuma longa (EECL) as a biological nematicide against third stage Haemonchus larvae (L3) isolated from sheep.

Materials and Methods:

Haemonchus L3 were cultured and harvested from the feces of naturally infected sheep. EECL was prepared and three concentrations; 50, 100, and 200 mg/mL were tested for their efficacies on Haemonchus L3. Levamisole at concentration 1.5 and 3 mg/mL were used as positive controls.

Results:

EECL showed anthelmintic activity in a dose-dependent manner with 78% worm mortality within 24 h of exposure at the highest dose rate of 200 mg/mL. There was a 100% worm mortality rate after 2 h of levamisole (3 mg/mL) admisntration. However, there was a comparable larvicidal effect between when levamisole (1.5 mg/mL) and EECL (200 mg) were administered.

Conclusion:

The study shows that EECL does exhibit good anthelmintic properties at 200 mg/mL which is comparable with levamisole at 1.5 mg/mL.

Long-term outcome of HER2 positive metastatic breast cancer patients treated with first-line trastuzumab

BACKGROUND

Trastuzumab has changed the natural history of metastatic HER2 positive breast cancer. Some patients remain well and in remission for many years. There is currently no established duration after which trastuzumab in the advanced setting can be safely discontinued. This study aims to evaluate long-term efficacy and cardiac safety of trastuzumab when used as first-line treatment for patients with metastatic HER2 positive breast cancer.

PATIENT AND METHODS

We retrospectively identified 215 patients with HER2 positive, locally advanced or metastatic breast cancer who commenced first line trastuzumab-containing therapy for metastatic disease between 2001 and 2010 at The Royal Marsden Hospital.

RESULTS

The median progression free survival for all patients was 12 months (95%CI: 10.3-14.6 months); 103 (48%) patients remained in remission beyond one year, 59 (27%) beyond two years and 25 (12%) beyond five years. The median overall survival was 2.6 years (95% confidence interval (CI): 2.2-3.3). The objective response rate (ORR) was 65% with 17 (8%) complete responses and 120 (57%) partial responses. Trastuzumab was well tolerated. Twenty eight (13%) patients recorded any grade of left ventricular dysfunction. There was no significant difference in cardiac toxicity between those patients on less than or more than one year of trastuzumab.

CONCLUSION

Trastuzumab is associated with long-term remissions in a significant proportion of patients with metastatic HER2 positive disease when used in the first-line advanced setting.

Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder

BACKGROUND

Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy.

METHODS

Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (± biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model.

RESULTS

Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P < 0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4-127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature.

CONCLUSIONS

Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.

Breast cancer brain metastases - A 12 year review of treatment outcomes

BACKGROUND

Breast cancer (BC) is the 2nd commonest cause of brain metastases (BM). This retrospective review investigates the applicability of prognostic scores and highlights different outcomes for patients with HER2 positive compared to triple negative (TN) subtypes.

METHODS

Two hundred and seventy four patients received whole brain radiotherapy for BC BM (01/2000-12/2011). The primary objective was to determine factors influencing overall survival (OS). All information relevant to primary BC, disease recurrence, treatment, outcome and cause of death (either neurological (NP) or systemic progression (SP)) were collected. Univariate (UV) and multivariate (MV) Cox regression analysis were used.

RESULTS

One hundred and forty four patients (53%) were ER positive, 104 (38%) HER2 positive and 57 (21%) TN. Median age at BM was 53 (27-81) years and median OS from BM diagnosis 7.3 (5.7-8.9) months. On MV analysis, Her2 status, RPA score, surgery, stereotactic radiotherapy, and absence of TN disease were independent prognostic factor for OS. NP was the cause of death in 69.2% of HER2 positive patients and 17.3% had SP. Of the TN patients, 29.8% had NP and 54.4% SP (p < 0.001).

CONCLUSION

A consistent OS advantage is noted for HER2 positive BM cases and inclusion of BC subtype in the breast GPA score should improve the prognostic factors' sensitivity. The unique presentations, response to treatment and causes of death for HER2 positive patients means more aggressive focal therapy should be considered and studied in the context of clinical trials. For TN BM patients with poor performance status, best supportive care may be appropriate.

Clinical management of dietary induced urolithiasis associated with balanoposthitis in a Boer goat

A Boer-Kajang cross male goat was presented to the Veterinary Hospital, University Malaysia Kelantan with a history of dysuria, hematuria and restlessness. The goat was intensively managed (confined to the pen) and fed with only palm kernel cake for the last three months. Physical examination revealed that the goat was dull, depressed, having an inflamed penis and prepuce with blood stained urine dripping from the penis. The differential diagnoses were obstructive urolithiasis, urinary tract infection and balanoposthitis. Based on the history, clinical signs, physical examination, urinalysis, ultrasonagraphy and feed analysis, the goat was diagnosed with obstructive urolithiasis and balanoposthitis. Treatment was instituted by amputation of the urethral process and retrograde urohydropulsion to relieve the blockade. Sulfadiazine-trimethoprim (Norodine®24) 15mg/kg, I.M; flunixin meglumine 2.2mg/kg, I.M; vitamin B complex 1ml/10kg, I.M and ammonium chloride 300mg/kg orally were administered. The goat responded well to treatment and was recovering well during a follow up visit.