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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.