B-cell lymphoma research in Malaysia - A narrative review.

Lymphomas are a diverse group of malignant proliferations that arise as discrete tissue masses. The most widely accepted taxonomy for lymphoma is the World Health Organization classification of tumours of haematopoietic and lymphoid tissues, the 5th edition of which was released in June 2022. Most (85% to 90%) lymphoid neoplasms are of B cell origin. Mature B-cell neoplasms are a heterogeneous group of malignancies with similar disease courses and treatment paradigms. This review focuses on the various mature B-cell lymphomas in Malaysia, including Hodgkin lymphoma. A literature search was performed in various bibliographic databases. A total of 64 papers were included in this review. We found 15 papers on Hodgkin lymphoma, 14 on follicular lymphoma, 12 on Burkitt lymphoma, 5 on mucosa-associated lymphoid tissue (MALT) lymphoma, 4 on plasmablastic lymphoma, 3 on mantle cell lymphoma, 1 each on primary mediastinal large B-cell lymphoma, B-lymphoblastic lymphoma, and 3 on other unspecified B-cell lymphomas. The site, age, distribution, prognostic markers, and the various subclassification of B cell lymphomas were studied from these papers. Prognostic genetic markers in B-cell lymphomas include C-MYC, BCL2 and BCL6 as they are the most prevalent mutations in this condition. Anecdotal outcomes range from rapid fatality to unexplained spontaneous remission. This review adds to the existing literature on lymphoma in Malaysia by compiling the evidence that may lead to further research on the diagnosis and treatment of lymphoma in Malaysia and worldwide.

Diffuse large B-cell lymphoma research in Malaysia: A review.

Lymphomas are prevalent worldwide and a common malignancy reported in Malaysia. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of B-cell lymphomas accounting for 54% to 65% of all B-cell lymphomas and 39% to 57% of all malignant lymphomas. However, DLBCL comprises a heterogeneous group of diseases with different clinical presentations, biology and response to treatment. Recent advances in understanding the genetic landscape and molecular features of DLBCL have identified high-risk subsets with poor outcomes to chemo-immunotherapy that are actively being studied in various clinical trials. C-MYC is a proto-oncogene located in chromosome 8q24. 10 to 15 % of patients with newly diagnosed DLBCL have an underlying rearrangement of the MYC oncogene, resulting in dysregulated cellular survival and proliferation. Approximately half of these cases also carry a rearrangement of the anti-apoptotic proto-oncogene BCL2 and/or its transcription repressor BCL6. Over 20 case reports of DLBCL cases with notable features in Malaysia have found in the literature, in addition to a few extensive case series and included in this review. R-CHOP remains the mainstay of therapy and can help achieve control of long-term disease in nearly 90% of patients presenting with limited-stage and in up to 60% of those presenting with advanced stages. This review captures all 52 studies that reported DLBCL in Malaysia and summarises the essential aspects, including prevalence, subtype, prognostic markers clinical features in presentation and limited outcomes of cases when available.

Integrated yoga and naturopathy on cardiovascular functions and mental health in a patient with COVID-19: A case report.

A 43-year-old-married male diagnosed with coronavirus disease 2019 (COVID-19) in July 2020. His symptoms as described by him began with cough and sore throat, breathlessness, generalized body weakness, irritability, stress, and mood swing for a period of one week. He was admitted in our District COVID Care Center (DCCC) located in Tamil Nadu, India. He underwent Integrated Yoga and Naturopathy (IYN) [i.e., Conventional medicine + yoga and naturopathy] for two weeks. The results showed negative Reverse Transcription Polymerase Chain Reaction (RT-PCR) test for COVID-19, improvement in cardiovascular functions (i.e., a reduction in systolic and diastolic blood pressures, pulse rate, mean arterial pressure, rate pressure product, and double product) and mental health (i.e., a reduction in depression, anxiety, and stress levels). The results suggest that IYN might improve cardiovascular and mental health of patients with COVID-19 in addition to positive to negative conversion of RT-PCR. However, further studies are required to warrant these results.

Effect of long-term yoga training on autonomic function among the healthy adults.

Background: Autonomic dysfunction is one of the major complications in noncommunicable diseases, and there are studies to prove yoga practice improves cardiac autonomic function. So, this present study was done to compare the autonomic functions among yoga practitioners and nonyoga practitioners. Methods: This cross-sectional comparative study was initiated among 68 healthy volunteers of both sexes, after recruiting them based on inclusion and exclusion criteria in the age group of 17-30 yrs. The autonomic reactivity tests like resting heart rate, response of heart rate to standing, Valsalva maneuver, and response of heart rate to deep breathing, response of BP to standing, and sustained hand-grip were done. Results: In the autonomic reactivity test, resting heart rate (80.92 ± 11.76 vs 69.24 ± 10.64) and sustained handgrip (16.30 ± 4.53 vs 10.20 ± 3.67) significantly decreased (P < 0.05) in the participants of the yoga group compared to control group. Deep breathing test, Valsalva maneuver, 30:15 ratio in lying to standing, and BP response to standing test did not show any significant difference between the groups (P > 0.05). Conclusion: The present study revealed diminished sympathetic activity and improved parasympathetic activity among the regular yoga practicing participants. It can be practiced regularly to reduce stress and prevent lifestyle-associated disorders in the future.

Hydrogeochemical assessment of groundwater quality and suitability for irrigation in the coastal part of Cuddalore district, Tamil Nadu, India.

A study was undertaken to identify in the irrigational suitability of groundwater in the cuddalore district (coastal part), Tamil Nadu, India. An entire study, 132 shallow and deep groundwater samples was gathered during Pre monsoon period (PRM) year of 2017 and post monsoon (POM) period samples collected year of 2018. Rock water interaction, silicate weathering and domestic waste are dominant sources for the water quality in the study area. The groundwater classification and irrigational suitability of groundwater were performed for both seasons. From the results of Chloro-Alkaline Indices (CAI I), and Chloro-Alkaline Indices (CAI II), during both seasons and classes, the direct ions exchange processes are predominant when compare with reverse ions exchange processes. The r1 and r2 results represents that most of the samples found as saline sources as Na+ - SO42- facies and performing with Deep Meteoric Percolation (DMP) than shallow meteoric percolation During PRM season, r1 represents 65 (98%) samples for Na+ - SO42- facies and 1 (2%) sample represents Na+ - HCO3- facies and during POM season, r1 represents 63 (95%) samples for Na+ - SO42- facies and 3 (5%) samples represent Na+ - HCO3- facies respectively. Irrigation water quality parameters like and satisfied the analysed water's irrigation suitability. However, according to MAR parameters, 5% of water samples were unsuitable for irrigation in PRM based on KR parameters, 41% of samples collected in the PRM season only were unsuitable for irrigation. The Wilcox diagram showed that 35% of water samples are suitable for irrigation. Sodium Adsorption Ratio (SAR), Soluble Sodium Percentage (SSP), Magnesium Adsorption Ratio (MAR), Permeability Index (PI), Potential Salinity (PS), and Total Dissolved Solids (TDS) are indicating the irrigational appropriateness of the groundwater samples, which is more suitable in post monsoon season compare to pre monsoon due to enrichment of Na+ by seawater intrusion and other processes. During POM season, the most number of groundwater samples are representing excellent to good categories might be due to an effective rainfall recharge by the monsoonal rain in the study area. The parameters indicated the introduction of geogenic and anthropogenic pollutions. The coastal community's knowledge is crucial to the long conservation of coastal water resources.

The burden of COVID-19 infection in a rural Tamil Nadu community.

BACKGROUND: There have been over 30 million cases of COVID-19 in India and over 430,000 deaths. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu. METHODS: The study was undertaken in a population of approximately 130,000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients-testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals. RESULTS: There were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0%) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 - 38.98). Our estimated infection-to-case ratio was 31.7. CONCLUSIONS: A simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It's vital these lower income, rural populations aren't overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

Yoga and Naturopathy intervention for reducing anxiety and depression of Covid-19 patients - A pilot study.

BACKGROUND: Coronavirus disease 2019 (Covid-19) infection has caused a prominent psychological and mental havoc among the patients. Till now, there is paucity in literature for the management of psychological problems among patients with Covid-19. So we aimed in our study to assess the effect of Yoga and Naturopathy intervention on anxiety and depression of Covid-19 patients. METHODS: This quasi experimental study was conducted among 130 Covid-19 positive patients admitted in a tertiary care hospital. Yoga and Naturopathic intervention was given for 60 min a day for two weeks. Hospital anxiety depression scale (HADS) and Corona anxiety scale (CAS) was used to assess the generalized anxiety and depression among the patients. RESULTS: Average age of the patients participated was 44 with the range from 36 to 53 years. Among them 85 were male and 45 were female. Of all 130 patients, 33% had symptoms of borderline depression, 9.2% had severe depression, 40% had borderline anxiety and 12.3% had severe anxiety. In CAS, 59 patients (45.38%) reported Covid-19 related dysfunctional anxiety. All the patients showed a significant reduction in the HADS- anxiety (P < 0.01), HADS-depression (p < 0.01) and CAS (p < 0.01) score after the intervention. CONCLUSION: The present study showed significant reduction of anxiety and depression level among the Covid-19 patients. These interventions can be added to the conventional care for better mental and physical wellbeing of the patients after validating the findings with justified study design.

Stress in Parents of Children With Genetically Determined Leukoencephalopathies: A Pilot Study.

Genetically determined leukoencephalopathies comprise a group of rare inherited white matter disorders. The majority are progressive diseases resulting in early death. We performed a cross-sectional pilot study including 55 parents from 36 families to assess the level of stress experienced by parents of patients with genetically determined leukoencephalopathies, aged 1 month to 12 years. Thirty-four mothers and 21 fathers completed the Parenting Stress Index-4th Edition. One demographic questionnaire was completed per family. Detailed clinical data was gathered on all patients. Statistical analysis was performed with total stress percentile score as the primary outcome. Mothers and fathers had significantly higher stress levels compared with the normative sample; 20% of parents had high levels of stress whereas 11% had clinically significant levels of stress. Mothers and fathers had comparable total stress percentile scores. We identified pediatric behavioral difficulties and gross motor function to be factors influencing stress in mothers. Our study is the first to examine parental stress in this population and highlights the need for parental support early in the disease course. In this pilot study, we demonstrated that using the Parenting Stress Index-4th Edition to assess stress levels in parents of patients with genetically determined leukoencephalopathies is feasible, leads to valuable and actionable results, and should be used in larger, prospective studies.

Prioritization of the micro-watersheds through morphometric analysis in the Vasishta Sub Basin of the Vellar River, Tamil Nadu using ASTER Digital Elevation Model (DEM) data.

The dataset for this article includes morphological analysis of the level to which groundwater potential of the Vasishta River, Salem and Perambalur districts of Tamil Nadu. The method for the computation of morphometric parameters using data Digital Elevation Model (DEM) of the Vasishta River, is also prepared using SRTM (Shuttle Radar Topographic Mission) 90 m resolution data Morphometric parameter linear, aerial and relief limits, such as a bifurcation ratio (Rb), Drainage density (Dd) Stream Frequency (Fs) Elongation ratio (Re), Length of overland flow (Lg), Relief ratio, ruggedness number (Rn) and Slope (sb) of Vasishta Sub Basin (VSB). The relief ratio indicates that the discharge should be considered high priority given to the following micro-watersheds numbers 9,1,15,11 and 10. This data could be very useful to help with sustainable groundwater planning in any similar basins.

Drainage morphometric analysis of the Nagavathi watershed, Cauvery river basin in Dharmapuri district, Tamil Nadu, India using SRTM data and GIS.

A drainage morphometric analysis of Nagavathi watershed in Dharmapuri district has been chosen for the present study. Geospatial tools, such as remote sensing and GIS, are utilized for the extraction of watershed and its drainage networks. The Shuttle Radar Topographic Mission (SRTM) data have been used for drainage morphometric analysis and evaluating various morphometric parameters Linear aspect, Aerial aspect Relief aspect. The morphometric parameters of Nagavathi watershed have been analyzed and evaluated by pioneer methods, such as Horton and Strahler. The bifurcation ratio varies from 0.8 to 43.1. The elongation ratio of Microwatersheds varies from 0.13 to 0.43, indicates Microwatersheds fall under elongated pattern. This study would help the local people to utilize the resources for planning rainwater harvesting and watershed management.

A novel mutation in LAMC3 associated with generalized polymicrogyria of the cortex and epilepsy.

Occipital cortical malformation is a rare neurodevelopmental disorder characterized by pachygyria and polymicrogyria of the occipital lobes as well as global developmental delays and seizures. This condition is due to biallelic, loss-of-function mutations in LAMC3 and has been reported in four unrelated families to date. We report an individual with global delays, seizures, and polymicrogyria that extends beyond the occipital lobes and includes the frontal, parietal, temporal, and occipital lobes. Next-generation sequencing identified a homozygous nonsense mutation in LAMC3: c.3190C>T (p.Gln1064*). This finding extends the cortical phenotype associated with LAMC3 mutations.

Comparison of shear bond strength of self-etching fluoride releasing adhesives with and without pumice prophylaxis.

CONTEXT: Despite the advances in orthodontic material and treatment mechanics, the placement of fixed appliances increases the risk of enamel demineralization. The development of fluoride release adhesives has attracted considerable interests because the combined use of antimicrobials and fluoride enhances the cariostatic effect. AIM: To compare the shear bond strength (SBS) of fluoride release adhesives with established orthodontic adhesives and assess failure mode using adhesive remnant index (ARI). SETTINGS AND DESIGN: The present study included 80 maxillary premolars which were randomly divided into four groups (n = 20) and were further subdivided into two subgroups A - Pumice prophylaxis (PP) and subgroup B - No PP (n = 10). MATERIALS AND METHODS: Stainless steel brackets were bonded with Transbond XT, Transbond plus (TP) color change adhesive, Light Bond, and Clearfil protect bond. After debonding, the ARI was used to assess the mode of bracket failure. STATISTICAL ANALYSIS: The data were analyzed using two-way analysis of variance, Post-hoc Tukey Honest significant differences test, and Chi-square test. RESULTS: The mean SBS of Group 4 was comparably higher regardless of PP. Brackets bonded with TP showed a comparable SBS to conventional Transbond XT. The ARI scores were predominately 2. CONCLUSIONS: Fluoride releasing adhesives combined with antibacterial monomer can play a vital role in reducing white spot lesions by enhancing the cariostatic effect especially in noncompliant\medically compromised patients.

Mitochondrial DNA haplogroups and mutations in children with acquired central demyelination.

OBJECTIVE: We investigated mitochondrial DNA (mtDNA) variants in children with a first episode of acquired demyelinating syndromes (PD-ADS) of the CNS and their relationship to disease phenotype, including subsequent diagnosis of multiple sclerosis (MS). METHODS: This exploratory analysis included the initial 213 children with PD-ADS in the prospective Canadian Pediatric Demyelinating Study and 166 matched healthy sibling controls from the Canadian Autism Genome Project. A total of 31 single nucleotide polymorphisms (SNPs) were analyzed, including haplogroup-defining SNPs and mtDNA variants previously reported to be associated with MS. RESULTS: Primary Leber hereditary optic neuropathy (LHON) mutations and other known pathogenic mtDNA mutations were absent in both patients with pediatric acquired demyelinating syndromes and controls. The 13708A haplogroup J-associated variant, previously linked to adult MS, was more frequent among subjects with PD-ADS (13.0%) compared to controls (6.2%; odds ratio [OR] 2.27; 95% confidence interval [CI] 1.06 to 4.83) and haplogroup M was associated with an earlier age at onset of PD-ADS (-1.74 years; 95% CI -3.33 to -0.07). In contrast, the haplogroup cluster UKJT, as well as 3 other SNPs, were each associated with a lower risk of PD-ADS. A total of 33 subjects with PD-ADS were diagnosed with MS during a mean follow-up period of 3.11 ± 1.14 (SD) years. No single SNP was associated with the risk of subsequent diagnosis of MS. However, haplogroup H was associated with an increased risk of MS (OR 2.60; 95% CI 1.21 to 5.55). CONCLUSION: These data suggest an association between mtDNA variants and the risk of PD-ADS and of a subsequent MS diagnosis. Replication of these findings in an independent population of subjects with PD-ADS is required.

Treatment of an adult patient with a periodontally compromised skeletal Class II malocclusion.

This article describes the treatment of an adult female with periodontally induced bone loss, excessive gingival display when smiling, vertical maxillary excess, a convex profile, a traumatic deep overbite, and severe lip incompetence. The therapy included four steps: (1) periodontal flap surgery and root planing with regular follow-ups; (2) leveling and aligning of the maxillary and mandibular arch with closure of all spaces, the extraction of mandibular first premolars, and retraction of the mandibular incisors; (3) LeFort I two-segment osteotomy with removal of the second premolars and a 5-mm impaction to reduce the excessive gingival display and permit autorotation of the mandible to decrease the facial convexity. To close the extraction space, the posterior segment was set 4 mm anteriorly and the anterior segment 3 mm posteriorly; and (4) postsurgical orthodontics for finishing and detailing. The treatment lasted 36 months; improved facial esthetics significantly; and resulted in a normal occlusion, overjet, and overbite.

Surface-enhanced resonance Raman scattering and density functional calculations of hemicyanine adsorbed on colloidal silver surface.

Resonance Raman (RR) and surface-enhanced resonance Raman scattering (SERRS) of 4'-(N,N'-dimethylaminostyryl)-4-propylpyridinium bromide (hemicyanine, HC dye) in acetonitrile solution and on a colloidal silver surface have been investigated. The structure of the dye in the ground (S0) and excited (S1) electronic states was optimized using density functional calculations along with the B3LYP and the configuration interaction with the singlet excitation (CIS) methods, respectively, using the 6-31G basis set. The vibrational frequencies of the molecule were computed at the optimized geometry and compared with the observed Raman bands. A complete normal-mode analysis has been carried out because it is essential for the accurate assignment of the vibrational spectra. From the observed enhancement along various in-plane and out-of-plane vibrations in the SERRS spectrum and from theoretical calculations, it has been inferred that the interaction with the silver surface occurs via the nitrogen lone pair of the pyridyl or the dimethylamino group of the molecule with a tilted orientation. The observed red-shifts in the SERRS spectrum along various vibrations indicate strong interaction (chemisorption) of the HC dye with the silver surface. This is also supported by the presence of a Ag-N stretching vibration at 241 cm(-1). The effect of the dye concentration on the orientation of the molecule is also discussed.

A case of Lemierre's syndrome presenting with multiple pulmonary abscesses associated with a tension hydropneumothorax resulting in a mediastinal shift.

INTRODUCTION: We report a case of Lemierre's syndrome. CLINICAL PICTURE: A previously healthy 36-year-old woman presented with a 2- to 3-month history of fever, cough, dyspnoea and sore throat, which had worsened in the week prior to presentation. Computed tomography of the thorax showed multiple bilateral cavitating lesions and a right-sided hydropneumothorax with mediastinal shift. Blood cultures grew Fusobacterium and Bacteroides species. TREATMENT: Broad-spectrum antibiotics were commenced, a chest drain was inserted, and the patient was transferred to the intensive care unit due to worsening respiratory failure. OUTCOME: Despite intensive supportive care with broad-spectrum antibiotics, aggressive fluid resuscitation and high-dose inotropic support, the patient developed acute renal failure, disseminated intravascular coagulation and intractable shock, and succumbed 8 days later. CONCLUSIONS: Although this condition is uncommon, it should be considered in the differential diagnosis of patients with pulmonary cavitating lesions, especially in the context of fever and rigors preceded by a sore throat.