Phenotype and TCR-gamma gene rearrangements in a Malaysian cohort of T-cell leukaemia/lymphoma cases

T cells undergo a series of complex phenotypic changes before achieving maturation. Discrete stages of T-cell differentiation are simplified to four stages (pro-, pre-, cortical and mature-T cell) and used in the classification of T-cell leukaemia. HLA-DR has been reported to be expressed in immature T-cell acute lymphoblastic leukemia (ALL) and also confer a poorer treatment outcome. Simultaneously, the genotype goes through distinct pattern changes due to rearrangement of T-cell receptor (TCR) genes. TCR gene rearrangement is important in the diagnosis of clonality and used as markers to detect minimal residual disease in lymphoproliferative disorders. We identified a subset within Pro-T and Pre-T cell cases distinguished by the expression of HLA-DR. These subgroups appeared to be more immature as rearrangement of the TCR-gamma gene was either at germline or involved only the first constant region (C1) unlike a more rearranged pattern in the HLA-DR-subgroups. We also observed a higher incidence of mediastinal mass (67%) in the HLA-DR-subgroup in the Pre-T stage. These characteristics may be useful as markers to further refine staging of T-cell ALL and determine prognosis

Erectile dysfunction in male lymphoma survivors in a Southeast Asian country

Introduction: Although erectile dysfunction (ED) is one of known long-term complications among male lymphoma survivors, it is not commonly reported, particularly in Southeast Asia. This study aimed to determine the prevalence of ED in lymphoma survivors in Malaysia and its association with anxiety and depression, and effects on quality of life. Methods: This was a cross-sectional study conducted at a tertiary hospital in Malaysia. Patients were all male lymphoma survivors. The self-administered International Index of Erectile Function questionnaire was used to screen for ED. The Hospital Anxiety and Depression Score questionnaire was used to assess for anxiety and depression, and quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire. Results: Overall, 106 patients were recruited. Mean age was 55.7 years, with 61.3% of patients aged above 50 years. Only 67.0% of patients were sexually active and 81.7% of these reported the presence of ED, with only 4.2% having severe ED. Prevalence of ED among younger patients (age ≤ 50 years old) was 64.5%.The most common reason given by patients who were not sexually active was fatigue. Age was the only factor found to be associated with ED (p < 0.005) and severity of ED increased with age. There was no association between ED and psychological stress or quality of life. Conclusion: Prevalence of ED and absence of sexual activity in lymphoma survivors was high. This should serve as a reminder to the treating clinician to offer early treatment and counselling

Central nervous system intravascular lymphoma in a Malaysian.

Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large cell lymphoma, characterized by intravascular proliferation of B or T lymphocytes within small blood vessels; which may lead to occlusive symptoms, its neurological involvement has been said to be uncommon among Asians. 1 We describe a Malaysian with central nervous system IVL, to demonstrate that IVL is an important differential diagnosis in diffuse brain pathology also among Asians

Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants : a cross-sectional study

Introduction and aim: Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). Methods: This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results: A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069). Conclusion: Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes

The willingness of parents to vaccinate their children younger than 12 years against COVID-19: a cross-sectional study in Malaysia

Background: The initiation of a new drug, for instance, the coronavirus disease 2019 (COVID‑19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID‑19. Methods: An online cross‑sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method. Results: The analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID‑19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32–3.04; P=0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21–1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34–2.26; P < 0.001), parents who had significant contact with COVID‑19 (OR, 1.3; 95% CI, 1.09–1.63; P=0.006), and parents who had been vaccinated against COVID‑19 (OR, 15.4; 95% CI, 9.76–24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine informa‑ tion from physicians (82.3%), and the belief of vaccine was unsafe (79.8%). Conclusions: In this study, nearly three‑quarters of parents were willing to vaccinate their children younger than 12 years against COVID‑19. The parents’ history of COVID‑19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID‑19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine’s benefit

Secondary metabolite gene expression and interplay of bacterial functions in a tropical freshwater cyanobacterial bloom

Cyanobacterial harmful algal blooms (cyanoHABs) appear to be increasing in frequency on a global scale. The Cyanobacteria in blooms can produce toxic secondary metabolites that make freshwater dangerous for drinking and recreation. To characterize microbial activities in a cyanoHAB, transcripts from a eutrophic freshwater reservoir in Singapore were sequenced for six samples collected over one day-night period. Transcripts from the Cyanobacterium Microcystis dominated all samples and were accompanied by at least 533 genera primarily from the Cyanobacteria, Proteobacteria, Bacteroidetes and Actinobacteria. Within the Microcystis population, abundant transcripts were from genes for buoyancy, photosynthesis and synthesis of the toxin microviridin, suggesting that these are necessary for competitive dominance in the Reservoir. During the day, Microcystis transcripts were enriched in photosynthesis and energy metabolism while at night enriched pathways included DNA replication and repair and toxin biosynthesis. Microcystis was the dominant source of transcripts from polyketide and non-ribosomal peptide synthase (PKS and NRPS, respectively) gene clusters. Unexpectedly, expression of all PKS/NRPS gene clusters, including for the toxins microcystin and aeruginosin, occurred throughout the day-night cycle. The most highly expressed PKS/NRPS gene cluster from Microcystis is not associated with any known product. The four most abundant phyla in the reservoir were enriched in different functions, including photosynthesis (Cyanobacteria), breakdown of complex organic molecules (Proteobacteria), glycan metabolism (Bacteroidetes) and breakdown of plant carbohydrates, such as cellobiose (Actinobacteria). These results provide the first estimate of secondary metabolite gene expression, functional partitioning and functional interplay in a freshwater cyanoHAB.Singapore. National Research Foundation (Singapore MIT Alliance for Research and Technology (SMART), Center for Environmental Sensing and Modeling (CENSAM) research program)National Science Foundation (U.S.) (Postdoctoral Research Fellowship in Biology, Grant No. DBI-1202865)National Institute of Environmental Health Sciences (NIEHS Grant P30-ES002109 to the MIT Center for Environmental Health Sciences)MIT International Science and Technology Initiatives (MISTI-Hayashi fund

A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications

BackgroundThere is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research

Serum free light chains: diagnostic and prognostic value in multiple myeloma

Background: Measurement of serum free light chains (FLCs) has recently become available for the diagnosis and monitoring of patients with plasma cell dyscrasias. The aim of this study was to investigate the performance of the serum FLC assay as a tumour marker by comparing FLC concentrations with serum protein electrophoresis (PE) results in the diagnosis of multiple myeloma (MM). In addition, we also evaluated the prognostic value of the baseline serum FLC ratio in patients with MM. Methods: We measured FLC concentrations and calculated the kappa/lambda (κ/λ) FLC ratios for three groups (control, polyclonal gammopathy and MM). Results: The FLC ratio at a cut-off threshold of 2.0 showed higher sensitivity and specificity compared with serum electrophoresis for the diagnosis of MM. We used the median FLC ratio of &#62;57.5 and &#60;0.04 for κ and λ secretors, respectively, for assessing survival. Survival was 30 months in patients with the κ/λ ratio of &#62;57.5 and &#60;0.04 compared to 47 months in patients with the ratio &#60;57.5 and &#62;0.04, indicating that more abnormal serum FLC ratios are associated with poorer survival (p&#60;0.011). Conclusions: Despite the limitations of the assay, the results of our study indicate that the FLC assay in combination with serum PE has an increased sensitivity in the diagnosis of MM. Also, baseline measurement of the κ/λ ratio provides prognostic information in these same patients. Clin Chem Lab Med 2009;47:1101–7.Peer Reviewe

Precision Measurement of {eta} --&gt; {gamma} {gamma} Decay Width via the Primakoff Effect

A precision measurement of the {eta} --&gt; {gamma} {gamma} decay width via the Primakoff effect is underway in Hall D at Jefferson Lab. The decay width will be extracted from measured differential cross sections at forward angles on two light targets, liquid hydrogen and 4He, using a 11.5 GeV tagged photon beam. Results of this experiment will not only potentially resolve a long standing discrepancy between the Primakoff and the collider measurements, but will also reduce the experimental uncertainty by a factor of two on the average value of previous experimental results listed by the Particle Data Group(PDG). It will directly improve all other eta partial decay widths which rely on the accuracy of the eta radiative decay width. The projected 3% precision on the {Gamma}({eta} --&gt; {gamma} {gamma} ) measurement will have a significant impact on the experimental determination of the fundamental parameters in QCD, such as the ratio of light quark masses (m{sub u},m{sub d},m{sub s}) and the {eta} - {eta}&#x27; mixing angle. It will be a sensitive probe for understanding QCD symmetries and the origin and the dynamics of QCD symmetry breaking

The use of mycophenolate mofetil in treating patients with non responding aplastic anemia

Aplastic anemia is a relatively uncommon disease and conventional management options include immunosuppressive drugs and/or haematopoeitic stem cell transplantation. It is now known that the pathogenesis of aplastic anemia is immune mediated. Mycophenolate mofetil is a common immunosuppressive drug now used mainly in prophylaxis of graft rejection in organ transplant and also for prevention/treatment for graft versus host disease in haemtopoeitic stem cell transplantation. It is thought that mycophenolate mofetil may be useful in this group of patients. In this short report, mycophenolate mofetil was tried in 6 patients who had severe aplastic anemia with variable doses for a minimum duration of 9 months. The result has however not been encouraging