New WHO Research Articles

Mortality and retention after 12 months in a cohort of patients initiated with the new WHO recommendations in Uganda

Mortality and retention after 12 months in a cohort of patients initiated with the new WHO recommendations in Uganda

KAJIAN PERBEDAAN PREVALENSI BALITA KURUS DAN PENDEK MENURUT STANDAR WHO 2005 DIBANDING NCHS: Analisis Data SKRT 2004

THE DIFFERENCE IN THE PREVALENCE OF WASTING AND STUNTING IN CHLIDREN AGE 0-59 MONTHS BY USING NCHS AND NEW WHO ANTHROPOMETRIC STANDARD: Re-analysis of Indonesian Household Health Survey 2004 WHO introduced new Child Growth Standard for children 0 – 60 months of age in the early 2006 based on Multi-Centre Growth Reference Study (MGRS) in 6 countries: Brazil, Ghana, India, Norway, Oman and the United States of America involving healthy children living in healthy environment that provide possibility for them to grow according to their genetic potential. WHO recommended that the standard be used as a new anthropometric reference replacing the existing NCHS-WHO child growth reference. However, some experts demand to evaluate the standard, before Indonesia adopts it in the nutrition program. This paper tries to compare the consequence of adopting new WHO standard to the magnitude of stunting and wasting. The main objective of the paper is to re-analyze the existing anthropometric data on children aged 0-59 months by using both NCHS-WHO reference and new WHO standard on the prevalence of wasting (W/L or W/H) and stunting (H/A). This re-analysis is based on anthropometric data of 3,316 children age below 5 years old from Household Health Survey 2004. Child weight and length/height were converted into z-scores of W/H and H/A by using both NCHS and new WHO Growth Standard, and compared the prevalence of wasting and stunting. The results showed that the prevalence stunting is higher by using new WHO Growth Standard (28.6%) compared to that by using NCHS growth references (24.1%). The difference in the prevalence varied between sex from 4.5-4.7% and across age groups from 1.3-9.2%. Similar results also found for the prevalence of wasting. The prevalence of wasting by using WHO Growth Standard and NCHS growth references was 15.1% and 13.8% respectively. The difference in the prevalence varied between sex from 0.8-2.1% and across age groups which varied fourfold (21.0% and 5.6%) for children age below 6 month old and only 1.7% for children age 48-59 month old. Keywords : anthropometric standard, stunted, wasted, height for age, weight for height

Clinical analysis of 29 cases with neuroendocrine neoplasm in the digestive system

To investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system. Clinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification. There were 19 males and 10 females and the average age was 46.5 years. All the patients had no clinical manifestations of carcinoid syndrome, and they all received surgical treatment. Two cases were gastric neuroendocrine carcinoma(NEC), who received radical total gastrectomy and distal gastric resection respectively. Three cases had neoplasm in the duodenum, including 2 NEC and 1 neuroendocrine tumor(NET), and they all underwent Whipple's procedure. Two cases were small intestine NEC, who received partial small intestine resection. Three cases had neoplasm in the appendix, including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy. One case was ascending colon NEC, who received right hemicolectomy. Eighteen cases had neoplasm in the rectum, including 4 NEC treated with low anterior resection and abdominoperineal resection respectively, and 14 cases of NET underwent low anterior resection, local resection, and endoscopic resection respectively. The 1- and 3- year survival rates of 13 NEC cases were 38.4% and 7.7% respectively. The 5-year survival rate of 16 NET cases was 81.3%. NEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific. Radical resection of NEN is the preferred treatment. The prognosis of NEC is poor, and that of NET is better.

Clinical significance of new classification of gastroenteropancreatic neuroendocrine neoplasms

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a group of tumors derived from diffuse neuroendocrine cells of the digestive system. All GEP-NEN shave potential malignancy. According to the WHO classification (2010), GEP-NENs can be divided into well differentiated neuroendocrine tumor (NET) and poorly differentiated neuroendocrine carcinoma (NEC). GEP-NEN scan be grouped into three grades: G1 , G2 and G3. The new WHO classification unifies the diagnostic terms and avoids the confusion of the nomenclature and classification of GEP-NENs,which is the foundation of clinical treatment and prognostic estimation.

The New WHO Revised Principles and Recommendations on HIV and Infant Feeding - care for the mother, and in resource-limited settings let breastmilk care for the baby

The New WHO Revised Principles and Recommendations on HIV and Infant Feeding - care for the mother, and in resource-limited settings let breastmilk care for the baby

Flow cytometric immunophenotyping of fine-needle aspiration specimens

Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL Key words: Lymphoma; Lymph nodes; Biopsy, needle; Flow cytometry; Immunophenotyping

WHO Updates HIV Treatment Recommendations

Almost simultaneously, the WHO and the U.S. Department of Health and Human Services (DHHS) released updated guidelines for HIV treatment. Both raised the CD4-cell–count threshold for starting treatment, and both refined their preferences for first-line regimens. The new WHO recommendations, outlined below, were published online in three rapid-advice documents, with the full set of guidelines expected in February 2010. (A complete review of the DHHS guidelines, by Dr. Abigail Zuger, is available here.)

Nasal and pharyngeal non-Hodgkin lymphomas and their relationship with Epstein-Barr virus: a report of 158 cases

To study the clinical features, immunophenotypes and the significance of Epstein-Barr virus infection in primary nasal and pharyngeal non-Hodgkin's lymphomas in Shenyang. One hundred and fifty eight cases of primary nasal and pharyngeal non-Hodgkin's lymphomas were included in this study. The samples were stained with haematoxylin and eosin for histological examination. Immunohistochemistry studies were performed using monoclonal antibodies, including CD3 for T-lymphocytes, CD20 for B-lymphocytes, and CD56 and CD57 for NK cells. All cases were reclassified according to the new WHO classification of lymphomas (2001). In situ hybridization detection of EBV-encoded small nuclear RNA (EBER-1) was performed in 99 cases. Overall, 101 (63.9%) of the 158 NHL were extranodal NK/T cell lymphomas (nasal type), 23 (14.6%) were nonspecific peripheral T cell lymphomas and the remaining 34 cases (21.5%) were B cell lymphomas. The primary sites of involvement were the nasal cavity (53.2%, 84/158), the tonsil (24.7%, 39/158) and the pharynx (22.1%, 35/158). Among 99 cases studied by EBER-1 in situ hybridization, a positive detection was seen in 70/71 cases (98.6%) of extranodal NK/T cell lymphoma (nasal type), 8/12 cases (66.7%) of T cell lymphoma, and 7/16 cases (43.8%) of B cell lymphoma. Among primary nasal and pharyngeal NK lymphomas, extranodal NK/T cell lymphoma (nasal type) is the most common type and is strongly associated with EBV infection. The pathological diagnosis of nasal and pharyngeal lymphomas should take considerations of the anatomic sites and immunophenotypical features.

Complex diagnosis of follicular lymphomas

In the Western world the second most common type of non-Hodgkin's lymphomas is follicular lymphoma (FL) comprising 30-35% of all cases. According to the data of the National Cancer Registry and our institute, this ratio is lower in Hungary and is about 15-20%, but the occurrence shows an increasing tendency. Our aim was to survey and revise FLs that had been diagnosed at the National Institute of Oncology between 1990-1995. We studied the diagnostic relevance of histology, immunohistochemistry and the detection of immunoglobulin heavy chain (IgH) and bcl-2 gene rearrangements. We surveyed 53 cases that were previously diagnosed as follicular or centrocytic, centroblastic lymphoma. Following histological re-examination, immunohistochemistry (CD20, CD3, bcl-2, CD10, bcl-6, CD5, p53, cyclin D1 and Ki-67) was performed on each case. We also studied the IgH and bcl-2 (major breakpoint region=MBR) gene rearrangement on paraffin embedded samples with conventional PCR methods. The classification was made according to the new WHO classification. After the revision of the 53 cases we found 37 follicular, 11 diffuse large B-cell, 1 mantle cell and 1 marginal zone lymphomas, 1 nodular lymphocyte predominant Hodgkin's lymphoma and 2 follicular hyperplasias. The grade of the FLs correlated with the expression of different antigens. CD10, bcl-2 expression and the proliferation index with Ki-67 showed good correlation with the grade of FLs. We could detect bcl-2 gene rearrangement in 55% of the FLs. Considering the diagnostic relevance of the different methods we can conclude that histology alone is not sufficient to make a correct diagnosis. Ninety percent of our cases were solvable with the help of immunohistochemistry and in 10% of the cases the diagnosis was partly based on the molecular pathological results.

New WHO Regional Director pledges to do better for Africa.

New WHO Regional Director pledges to do better for Africa.

Who is WHO and what was REAL?

The principles of the new WHO classification of haematopoietic and lymphoid tumours are based on those defined in the Revised European American classification of Lymphoid neoplasms (REAL), published by the International Lymphoma Study Group (ILSG) in 1994. Thus, the new WHO classification may be considered an updated version of the REAL classification rather than of the old WHO classification published in 1976. Disease entities are defined on the basis of morphological, phenotypic, genotypic, and clinical data. The relative impact of these characteristics varies among different diseases and there is "no gold standard". Thus, the strict hierarchy among diagnostic criteria, headed by morphology and followed by immunohistochemistry and genetics, has been discontinued. The WHO classification not only encompasses lymphoid tumours but extends to myeloid, mast cell and histiocytic/dendritic cell malignancies. Neoplasms are primarily stratified according to their tumour cell lineage. For each neoplasm a cell of origin is postulated. The classification of lymphoid malignancies recognises three major categories, B-cell neoplasms, T-/NK-cell neoplasms, and Hodgkin lymphomas. B-cell and T-cell lymphomas are further divided into precursor neoplasms and mature neoplasms, the latter being subdivided according to their clinical manifestation into disseminated/leukaemic, extranodal and nodal malignancies. In contrast to previous classifications, the neoplasms are grouped neither according to their histological grade (Kiel classification) nor according to their clinical aggressiveness (International Working Formulation). However, the histological grade is considered a prognostic factor which enters into the description of each disease entity. Hodgkin's disease, now more appropriately termed Hodgkin lymphoma, comprises nodular lymphocyte-predominant Hodgkin lymphoma and classical Hodgkin lymphomas of nodular sclerosis, mixed cellularity, lymphocyte-depleted and lymphocyte-rich subtype. For practical purposes this minireview disregards the description of myeloid, macrophage/histiocytic, dendritic cell and mast cell disorders. Furthermore, the present paper is restricted to those lymphoid tumours that are not already identically described in the REAL classification, in order to focus on what is really new in the WHO classification.

Book Reviews

Books Reviewed in this Article: NEW WHO PUBLICATION Oral Health Unit (ed.): Common oral diseases ‐ Prevention and emergency care. COST‐BENEFIT ANALYSES Doessel, D. P.: Cost‐benefit analysis and water fluoridation: an Australian study.