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.

United States rural residence is associated with increased acute maternal end-organ injury or mortality after birth: a retrospective multi-state analysis, 2007-2018.

BACKGROUND: Geographic-based healthcare determinants and choice of anesthesia have been shown to be associated with maternal morbidity and mortality. We explored whether differences in maternal outcomes based on maternal residence, and anesthesia type for cesarean and vaginal birth, exist. METHODS: This study was a retrospective multi-state analysis; patient residence was the predictor variable of interest and a composite binary measure of maternal end-organ injury or inpatient mortality was the primary outcome. Our secondary outcomes included a binary measure of anesthesia type for cesarean birth (general vs. neuraxial [NA]) and NA analgesia for vaginal birth (no NA vs. NA). Our predictor variable of interest was patient residency (reference category central metropolitan areas of >1 million population), fringe large metropolitan county, medium metropolitan, small metropolitan, micropolitan, and non-metropolitan or micropolitan county. RESULTS: Women residing in micropolitan (OR 1.17; 95% CI 1.09 to 1.27) and non-metropolitan or micropolitan counties (OR 1.14; 95% CI 1.04 to 1.24) had the highest adjusted increased odds of adverse maternal outcomes. Those residing in suburban, medium, and small metropolitan areas underwent general anesthesia less often during cesarean births than those residing in urban areas. Patients residing in micropolitan rural (OR 2.07; 95% CI 2.02 to 2.12) and non-metropolitan or micropolitan (2.25; 95% CI 2.16 to 2.34) counties underwent vaginal births without NA analgesia more than twice as often as those residing in urban areas. CONCLUSIONS: Rural-urban disparities in maternal end-organ damage and mortality exist and anesthesia choice may play an important role in these disparate outcomes.

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.

Revisiting the Kittel's model of antiferroelectricity: phase diagrams, hysteresis loops and electrocaloric effect.

We revisit the Kittel's model of antiferroelectricity by extending the model to study the phase transitions, hysteresis loop behaviors and electrocaloric effect (ECE) of antiferroelectrics (AFEs). By considering both the first- and second-order AFEs, explicit expressions for the physical and staggered polarizations of AFEs in the stable states are derived. We also obtain the analytical solutions for describing the dielectric susceptibilities of AFEs in the AFE and paraelectric (PE) phases. Coercive fields in AFE are also derived and studied. To verify the usefulness of the Kittel's model of antiferroelectricity, we apply the model to systematically investigate the phase transitions, hysteresis loops and ECEs of PbZrO3(PZO). By adopting appropriate values of the Kittel's parameters for first-order transition, analytical and numerical results are obtained and discussed. Our results show that PZO exhibits a complex temperature (T)-electric field (E) phase diagram, consisting of the AFE, ferroelectrics, ferrielectric, PE and mixed phases. TheT-Ephase diagram is qualitatively agreed with the new AFE model that was derived based on symmetry by Tolédano and Khalyavin (2019Phys. Rev.B99024105). We found that the calculated zero-field dielectric susceptibility is qualitatively and quantitatively agreed with experimental results. We show that the polarizations and dielectric susceptibilities of PZO in heating and cooling deviate from each other, as expected for the first-order materials. Our calculated results also reveal that the ECE in PZO has an electro-heating of ΔT≈ +6.5 °C and an electro-cooling of ΔT≈ -4.0 °C, respectively, which are comparable to the experimental results.

Achalasia cardia: A five-year review in Hospital Tuanku Ja'afar, Seremban.

INTRODUCTION: Achalasia cardia is an oesophageal motility disorder that affects various age groups. This study focused on the epidemiological features of achalasia, its risk factors, treatment modalities offered and the clinical outcomes in a tertiary hospital. MATERIALS AND METHODS: A retrospective search was carried out on all patients with a diagnosis of achalasia cardia in Hospital Tuanku Ja'afar (HTJ), Seremban, Malaysia between 2014 and 2018. Demographic data, patient symptomatology, and definitive management options were determined from the records. Telephone interviews were conducted to evaluate patient satisfaction with the outcome of treatment. RESULTS: There were 30 patients with a newly diagnosed achalasia cardia in that 5-year period, with an equal incidence among men and women. The mean age of presentation was 44.63 ± 18.21 years. Malays formed the largest group. The mean weight and body mass index were 46.8 ± 10.4 kg and 18.0 ± 4.4 kg/m2 respectively. There was a wide range of duration of symptoms at presentation with a mean of 30.11 ± 35.29 months. Almost all patients presented with dysphagia (96.7%) while 70% also noted loss of weight. All patients underwent oesophagogastroduodenoscopy (OGDS) and 26 patients (86.7%) had barium swallow as part of diagnostic workup. A total of 18 patients underwent a laparoscopic Heller myotomy with or without Dor Fundoplication and/or cruroplasty while two patients (6.7%) underwent pneumatic dilatation as first treatment. Iatrogenic mucosal perforations were detected in 8 patients who underwent myotomy and fundoplication and were repaired intraoperatively. Of the patients who underwent myotomy and fundoplication, the mean weight increase was 15.6kg, increasing from 43.0 ± 8.4 kg to 58.6 ± 13.7 kg. All the patients who underwent treatment were satisfied with their treatment outcomes. CONCLUSION: Most patients with achalasia cardia deemed suitable for surgery and counselled accordingly accept surgery resulting in high levels of satisfaction and weight gain in almost all these patients. A small minority who opt for pneumatic dilatation may also achieve satisfactory outcomes comparable to surgery in the short term. Although rare, clinicians should be able to recognise this disease early as early intervention often leads to satisfactory longterm outcomes.

Rich antiferroelectric phase diagram of antiferroelectric-ferroelectric superlattices: internal electric field- and interface induced phase transitions.

We propose a thermodynamic model to the study the antiferroelectric (AFE) phase transitions in antiferroelectric-ferroelectric (AFE-FE) superlattices in which the coupling at the interface between two layers is mediated by local polarizations. Phase diagram of the AFE layer in term of the degree of interfacial effect λ and temperature T involving ferrielectric (FI) and ferroelectric (FE) phases is investigated. These two phases are stabilized by the interfacial effect and internal electric field. AFE thickness L AFE versus T phase diagram is also constructed. Intermediate regions of two-phase coexistence (IM) emerge in the λ-T and L AFE-T phase diagrams, if certain interface properties λ and layer thickness L AFE criteria are met. These IM regions are metastable states, which exist as a transition state between two phases. A tricritical point locates at the boundaries across the FI, IM and FE phases is found in the L AFE-T phase diagram. Competition among the internal electric field due to the electrostatic coupling, the FE ordering arises from the interfacial effect and the antiferroelectric ordering within the AFE layer giving rises to the rich AFE phase diagram.

Knowledge, attitude and factors influencing public willingness towards organ donation among hospital patients and relatives in Negeri Sembilan, Malaysia.

BACKGROUND: Malaysia continues to have a very low cadaveric organ donation rate of 0.48 per million population. The aim of this paper is to assess the attitude, beliefs and knowledge of patients and relatives at three different hospitals in Negeri Sembilan towards organ donation to increase the acceptability of organ transplant. METHODS: A cross-sectional descriptive study with convenient sampling was carried out Hospital Tuanku Ja'afar, Hospital Port Dickson and Hospital Tuanku Ampuan Najihah in Negeri Sembilan, Malaysia. The participants answered a questionnaire regarding the source of their information about organ donation, their knowledge about brain death and willingness to donate. The association between variables was tested using chi-squared test or Fischer's exact test as appropriate. RESULTS: A total of 385 individuals completed the survey of whom 134 (35%) were willing to donate their organs upon death and 25(19%) were registered donors. Higher educational level (41%), age 30 and below (42%) and people who attended organ donation awareness campaigns (60%) were more willing to donate their organs. Correct understanding of brain death was associated with willingness to be an organ donor. The commonest reason cited for unwillingness to donate was opposition from family members. CONCLUSION: Marital status, religion, source of knowledge and occupation are significant factors in willingness to donate organs among Malaysians. Lower age and higher educational level were positive factors towards organ donation. Direct personal contact through awareness campaigns, family and friends has a potential for greater positive impact on organ donation.

Is the incidence of cancer in Malaysia falling?

No abstract provided.

A Review of Adult Obesity Research in Malaysia.

A literature search of articles as detailed in the paper Bibliography of clinical research in Malaysia: methods and brief results, using the MESH terms Obesity; Obesity, Abdominal; and Overweight; covering the years 2000 till 2015 was undertaken and 265 articles were identified. Serial population studies showed that the prevalence of obesity increased rapidly in Malaysia in the last decade of the twentieth century. This follows the rising availability of food per capita which had been begun two to three decades previously. Almost every birth cohort, even up to those in their seventh decade increased in prevalence of overweight and obesity between 1996 and 2006. However, the rise in prevalence in obesity appears to have plateaued after the first decade of the twentieth century. Women are more obese than men and Malays and Indians are more obese than Chinese. The Orang Asli (Aborigines) are the least obese ethnic group in Malaysia but that may change with socioeconomic development. Neither living in rural areas nor having low income protects against obesity. On the contrary, a tertiary education and an income over RM4,000/month is associated with less obesity. Malaysians are generally not physically active enough, in the modes of transportation they use and how they use their leisure time. Other criteria and measures of obesity have been investigated, such as the relevance of abdominal obesity, and the Asian criteria or Body Mass Index (BMI) cut-offs value of 23.0 kg/m2 for overweight and 27.0 kg/m2 for obesity, with the view that the risk of diabetes and other chronic diseases start to increase at lower values in Asians compared to Europeans. Nevertheless the standard World Health Organization (WHO) guidelines for obesity are still most widely used and hence is the best common reference. Guidelines for the management of obesity have been published and projects to combat obesity are being run. However, more effort needs to be invested. Studies on intervention programmes showed that weight loss is not easy to achieve nor maintain. Laboratory research worldwide has uncovered several genetic and biochemical markers associated with obesity. Similar studies in Malaysia have found some biomarkers with an association to obesity in the local population but none of great significance.

A Review of Metabolic Syndrome Research in Malaysia.

Seventy-three articles related to metabolic syndrome were found in a search through databases dedicated to indexing all literature with original data involving the Malaysian population between years 2000 and 2015. Metabolic syndrome affects 25 to 40% of adult population of Malaysia with the risk increasing with age. Obese children are also at risk. Indian ethnicity has the highest rates, followed by Malay and chinese. It was found that socioeconomics determinants such as living in urban areas, unemployment, lower income, lower education level and shift workers had higher prevalence of metabolic syndrome. Metabolic syndrome is associated with other medical conditions like cardiovascular diseases, psychiatric disorders, erectile dysfunction, polycystic ovarian syndrome and colorectal cancer. Several biomarkers have been determined to be relevant to our local population but their usage in clinical setting needs further research. Literature into effectiveness of management of metabolic syndrome in Malaysia is lacking and the results were only modest. there are several diagnostic criteria available for metabolic syndrome internationally and their individual significant to our local population is not clear. It also makes it difficult to compare results between studies using different criteria. Finally, we could not identify any local study to look at the health economic burden of metabolic syndrome locally.

Retention of Knowledge following training of students in Basic Trauma Life Support.

INTRODUCTION: In the course of their undergraduate training at the International Medical University, students receive a Basic Trauma Life Support course. OBJECTIVE: We wanted to test the long-term retention of knowledge (after 16 months) of third year medical students who had received training in Basic Trauma Life Support Method: To assess the retention of knowledge one cohort of students who received the training course were tested again 16 months later using the same 30 question One Best Answer quiz. RESULTS: Seventy-three students who underwent the course sat for the Retention test. The number of students who passed the Retention test was not significantly different from the test taken immediately after the course. The mean scores, 62.5% and 59.5% respectively, were however significantly different. CONCLUSION: Our study involves a relatively long interval between the course and retention of knowledge test shows encouraging results.

Introducing a collection of reviews on major diseases in malaysia.

No abstract available.

A review of colorectal cancer research in malaysia.

105 articles related to colorectal cancer(CRC) were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. 56 articles were selected and reviewed on the basis of clinical relevance and future research implications. Research into the genetic basis for colorectal cancer included studies in germline mutations of known syndromes as well as polymorphisms that conferred individuals a higher odds ratio for developing CRC. Several studies also documented the variety of somatic mutations seen in cases of sporadic CRC in Malaysia. Studies into the knowledge and attitudes of Malaysians regarding CRC revealed poor appreciation of the common symptoms, risk factors and available measures for its early detection. This may explain the observed facts that more Malaysians present with late stage CRC than seen in developed countries. The small amount of data recorded concerning the outcome of treatment also suggests overall survival of Malaysian CRC patients for comparable stage of CRC is lower than achieved in developed countries.

An allergic phenotype and the use of steroid inhalers predict eosinophilic oesophagitis in patients with asthma.

BACKGROUND: Patients with eosinophilic oesophagitis (EoE) commonly have asthma and atopy. AIMS: To determine the predictive factors of EoE in patients with asthma. METHODS: A retrospective analysis of a large database identified 156 asthma patients with EoE and 276 patients without EoE between 2000 and 2010. Clinical and laboratory characteristics were first analyzed in half of each group. Significant differences and modelling were then applied to the other half of each group in a split half analysis. RESULTS: Odds ratios and P-values found to predict the presence of EoE in asthma patients were: allergic vs. non-allergic asthma (4.07, <0.01), food allergies (45, <0.01), allergic rhinitis (2.13, =0.01) and peripheral eosinophilia (4.51, <0.01). The use of inhaled corticosteroids was negatively associated with EoE (0.41, <0.01) for asthma patients and (0.37, P < 0.01) for allergic type asthma patients. EoE patients were also younger (27.4 vs. 41.6 years old, P < 0.01). By logistic regression analysis, allergic asthma, presence of peripheral eosinophilia and use of inhaled steroids remained significant. From these parameters, a 3.5-point scoring system model for EoE in asthma was formed with an ROC = 0.787 on split analysis. CONCLUSIONS: In descending order, peripheral eosinophilia, allergic asthma and allergic rhinitis are associated with EoE in patients with asthma. Steroid inhalers appear to have a protective effect against EoE. An accurate and simple scoring system can be used as a screening tool to predict the presence of EoE in patients with asthma and dysphagia. EoE should be viewed as part of a generalised allergic phenotype rather than isolated oesophageal disease.

Malays in peninsular Malaysia may have the lowest incidence of stomach cancer in the world.

The Malaysian National Cancer Registry (NCR) report for the period 2003-2005 shows an incidence of stomach cancer of 2.2 for Malay, 11.3 for Chinese and 11.9 for Indian males per 100,000 population. Malay (1.3), Chinese (7.2) and Indian (7.2) women have rates lower than men. Malays in Peninsular Malaysia have five times less stomach cancer than Chinese and Indians. This racial difference is more marked than that noted in the Singapore cancer registry. Regional data from Kelantan has an even lower rate for Malays there (1.5 for males and 0.9 for females per 100,000 population). The incidence of Helicobacter pylori infection, a known risk factor for stomach cancer, is low among Malays.