Introduction: Chronic lymphocytic leukaemia (CLL) is the most frequent adult leukaemia in the Western world. The clinical presentation varies greatly, from very indolent cases to those with aggressive and fast advancing disease. This variation has significant implications for clinical approaches, therapeutic tactics, and, ultimately, survival durations from diagnosis. Acquired chromosomal aberrations play a key role in CLL aetiology. Due to difficulty to obtain abnormal metaphases for analysis, few methods such as fluorescence in-situ hybridization (FISH) and multiplex ligation-dependent probe assay (MLPA) were employed to detect chromosomal aberration however the methods are limited to specific locus only. Thus, this study is aimed to detect the chromosomal aberrations using DNA microarray platform. Methods: In this retrospective study, DNA archive obtained from 7 CLL patients which collected at diagnosis and subjected to Affymetrix CytoScan® 750K single nucleotide polymorphism (SNP) array following the manufacture procedure. The raw data obtained were analysed using the Chromosome Analysis Suite (ChAS) software (Affymetrix) using annotations of genome version GRCh38 (hg38). Result: Out of 7 patients, 4 of them showing deletion of 13q while 3 of them showing deletion of 14q in various region . Some of the deleted loci were too small (0.42-0.6Mb) to be detected by conventional cytogenetic analysis (CCA). There was also the presence of additional chromosomal aberrations that could be missed by CCA, FISH, or MLPA due to cryptic deletion or duplication that was as small as 0.4MB in size. Conclusion: The present study showed that low resolution chromosomal aberration was able to be detected using DNA microarray platform in comparison to CCA, FISH and MLPA.

Introduction: Cancer patients’ perception on the treatment they received is vital to determine their adherence to cancer treatment, but important data on how this variable affects posttraumatic growth (PTG) experience by cancer patients is lacking. This cross-sectional study aimed to evaluate the degree of PTG among a cohort of head and neck cancer (HNC) survivors who were within first year of diagnosis and determined the association between perception of cancer treatment received (expectation and satisfaction with cancer treatment received and the feeling about the adverse effects) and PTG controlling for socio-demographic and clinical characteristics. Methods: HNC survivors were recruited from two oncology referral centres, and they were administered socio-demographic and clinical characteristics questionnaire, the Malay version of the Cancer Therapy Satisfaction Questionnaire (CTSQ) (to assess the satisfaction, expectation and feeling about the adverse effects of cancer treatment received) and the Malay version of the Posttraumatic Growth Inventory-Short Form (PTGi-SF) (to measure the degree of PTG). Results: A total of 200 HNC survivors participated in the study. The mean total PTGI-SF score was 39.5 (standard deviation [SD] = 9.3). Greater degree of positive expectation of cancer treatment and satisfaction with cancer treatment received significantly contributed to higher level of PTG, whereas feeling about side effects of treatment was not associated with PTG, after controlling for socio-demographic and clinical characteristics. Conclusion: Incorporating psychosocial interventions (such as education on cancer treatment and counselling) into the treatment regimen may facilitate development of PTG and hence, safeguard the mental well-being of HNC patients.

Oral squamous cell carcinoma (OSCC) is the commonest malignant tumour affecting the oral cavity with a poor 5-year disease free survival. We present an octogenarian with a recurrent oral cavity squamous cell carcinoma, treated with salvage mandibulectomy without bony reconstruction. No immediate or intermediate perioperative complications were documented. Subsequent monthly surveillance clinical examination, endoscopy and computed tomography at six months post-operative showed no evidence of residual tumour. Geriatric syndrome, perioperative risk and oncologic stratification are three main cornerstones in evaluating feasibility of oncologic surgery in an elderly patient. A multidisciplinary approach allowed surgical extirpation of OSCC with a good outcome

Introduction: Imatinib mesylate has been widely used as a standard treatment for chronic myeloid leukemia (CML). It acts as a selective competitive inhibitor of the BCR-ABL tyrosine kinase. Despite the excellent efficacy on CML treatment, some patients developed resistance to the treatment. Mutation in the PDGFRA may be one of the factors involved in the mechanism of resistance that affects the response to imatinib. The mutational status of PDGFRA is highly relevant for prognosis and treatment prediction in CML patients. Thus, this study is intended to establish and validate a High Resolution Melting (HRM) analysis for PDGFRA exon 10 c.1432 T>C polymorphism in CML patients. Methods: High resolution melting (HRM) analysis was used to identify the c.1432 T > C polymorphism in PDGFRA exon 10 (n =86; response = 43; resistance = 43). The results from HRM analysis were compared and validated with Sanger sequencing. The association between the polymorphism and treatment response was assessed by statistical analysis using binomial logistic regression analysis. Results: HRM analyses showed two different melt curves. One curve followed the shape of the reference, homozygous wild type (TT) and the other curve showed a different melting profile than the reference with the TC genotype (heterozygous variant). The results revealed that heterozygous variant (TC) genotype showed a high risk of acquiring resistance with an OR of 3.795; 95% CI: 1.502-9.591, with a statistically significant association, p = 0.005. HRM analysis also showed 100% sensitivity and specificity in the detection of PDGFRA exon 10. Conclusion: The HRM analysis of PDGFRA exon 10 c.1432 T>C was successfully established. The exon 10 c.1432 T>C polymorphism shows a higher risk for the development of resistance toward imatinib treatment.

Background: Mortality among tuberculosis patients while on treatment is a public health concern in Malaysia. Exploring the risk factors for tuberculosis mortality is important to evaluate the effectiveness of national tuberculosis control programs and to identify vulnerable patients. This study aimed to estimate the 5-year proportion of mortality among tuberculosis patients on treatment and determine its associated factors in Malaysian setting. Methods: A case-control study was conducted between deceased and survived groups in Terengganu state of Malaysia. All notified cases that fulfilled the inclusion and exclusion criteria from 1st January 2016 until 31st December 2020 were included in the study. Descriptive statistics, simple and multiple logistic regressions were employed for data analysis. Results: There were 3,603 tuberculosis cases notified and 12.4% of total notified patients had died during their course of treatment. Multiple logistic regression revealed older age, working group, prison inmate, positive HIV status, far advanced lesion on chest radiographs and disseminated form of tuberculosis were the significant factors associated with mortality among tuberculosis patients with an adjusted odds ratio (AOR) 1.06 (95%CI: 1.04, 1.07; p<0.001); 0.48 (95%CI: 0.33, 0.68; p<0.001); 0.26 (95%CI: 0.09, 0.79; p=0.017); 12.18 (95%CI: 7.15, 20.75; p<0.001); 3.56 (95%CI: 1.46, 8.64; p=0.005); and 6.95 (95%CI: 2.02, 23.97; p=0.002), respectively. Conclusion About 1 in 10 patients had died during the treatment of tuberculosis in Terengganu attributed to the pinpointed socio-demographic and clinical factors. The identified risk factors were useful in improving the current screening programme and clinical management to avert mortality among vulnerable patients.
Tuberculosis

Self-care is defined as activities performed by individuals, families, and communities to enhance their health, prevent diseases, limit illnesses, and restore health. Previous research has mainly focused on self-care skills of older adults in either institution or residential homes separately but limited studies have compared between both these settings. This study aimed to compare the self-care skills between institutionalised and home dwelling older adults at selected area in Malaysia. A total of 43 participants aged 60 years old and above were recruited in our study; (23 participants were home-dwelled older adults and 19 participants were recruited from institutionalised older adults located in Kuala Lumpur). The Malay Version of Performance Assessment of Self-Care Skills (M-PASS-HOME) 4.0 was used focusing on four main subtests of self-skills; oral hygiene, trimming toenails, house mobility and shower mobility. The differences in self-care skills between institutionalised and home dwelling older adults are statistically significant (p<0.01) in the aspects of independency for all self-care activities. The results of this study revealed that home dwelling older adults group are more independent in self-care activities of oral hygiene, trimming toenails, house mobility and shower mobility compared to institutionalised group.

Introduction: Aberrant expression of E-cadherin has shown to have correlation with advanced disease of prostate cancer. In this study, we evaluated the potential of E-cadherin as a prostate cancer prognostic marker and determined its correlation with patient outcomes. Method: 46 prostate cancer specimens in the form of paraffin-embedded tissue blocks were retrieved from the Histopathology Unit, Department of Pathology, Hospital Kuala Lumpur. The expression patterns of E-cadherin were determined by immunohistochemistry staining. The E-cadherin expression was evaluated and scored as positive (3+) and negative or loss of expression (2+ and 1+). The correlations of E-cadherin expression with patient outcomes which included biochemical failure, disease-free, metastasis and local recurrence were determined. Correlations of E-cadherin expression with the currently used traditional clinicopathological parameters were also evaluated. Results: There were significant correlations between E-cadherin expression with biochemical failure (p=0.005) and local recurrence (p=0.003). However, there were no significant correlations between E-cadherin expression with disease-free (p=0.864) and tumour metastasis (p=0.430). Comparing the correlation of E-cadherin expression with the traditional clinicopathological parameters, there were significant correlations between E-cadherin expression with pathological staging (p=0.001), Gleason score (p=0.004) and perineural invasion (p=0.001). However, there was no significant correlation between E-cadherin expression with positive tumour margin (p=0.320). Conclusion: These results support the potential use of E-cadherin as a prognostic tool for prostate cancer as well as an additional marker along the currently available traditional clinicopathological parameters.

The influx of low skilled migrant workers to Malaysia from low socio-economic countries where gastrointestinal parasitic infections are prevalent has raised concerns about transmission to the local population. Three methods for detection (serology, microscopy and molecular techniques) were utilized to identify Entamoeba infections amongst the targeted cohort and determine risk factors associated with infection. Serological screening of 484 migrant workers from five working sectors in Peninsular Malaysia using IgG4 ELISA based on the rPPDK antigen showed an overall seroprevalence of 7.4% (n = 36; CL95 = 5.3–10.1%) with only one factor statistically associated with seropositivity of anti-amoebic antibodies, i.e. years of residence in Malaysia (χ2 1 = 4.007, p = 0.045). Microscopic examination of 388 faecal samples for protozoan cysts and trophozoites showed a slightly higher prevalence (11.6%; n=45; CL95: 8.4–14.8%). Meanwhile, amplification of the 16S rDNA gene detected two species i.e. Entamoeba dispar (23/388; 5.9%; CL95: 3.6–8.3%) and E. histolytica (11/388; 2.8%; CL95: 1.2–4.5%) and mixed infections with both parasites in only three samples (3/388; 0.8%; CL95: 0.2–2.2%). Entamoeba dispar infection was significantly associated with those employed in food and domestic services (χ2 4 = 12.879, p = 0.012). However, none of the factors affected the prevalence of E. histolytica infection. Despite the low prevalence of E. histolytica in faecal samples of the study cohort, the presence of this pathogenic parasite still poses potential public health risks and calls for tighter control strategies based on better availability of chemotherapeutic treatment and accessibility to appropriate health education.

Rapid detection of Burkholderia pseudomallei, the etiologic agent of melioidosis, allows for timely initiation of appropriate treatment and better clinical outcomes. In the current gold standard, the culture method is time consuming and suffers from low sensitivity. Meanwhile, previously reported molecular assays are fast and sensitive, but their performance on isolates from Malaysia, an endemic region of melioidosis is under reported. This study designed oligonucleotides targeting orf2 of Type III secretion system (TTSS) genes cluster for the detection of Malaysian B. pseudomallei isolates and evaluated the assay on 95 local B. pseudomallei strains, 58 other microorganisms and 71 clinical specimens from patients. The developed assay exclusively detected all tested B. pseudomallei isolates with a detection limit of 20 fg per reaction (equivalent to ~2.5 copies). Subsequent testing on clinical samples showed that the assay detected all confirmed specimens with the growth of B. pseudomallei (n = 10/10). None of the negative specimens had a detectable signal of our TTSS-orf2 assay (n = 0/61). In conclusion, the present study provides crucial preliminary data for a subsequent study and should be considered as a potential alternative to current time-consuming culture method for the detection of B. pseudomallei.

Background: This descriptive study identifies the demographic characteristics and patterns of referral to clinical psychology services, which include types of diagnosis, types of referral and source of referrals in child, adolescent, adult and geriatric cases in Malaysia. Methods: We utilised 2,179 referrals between January and December 2015 from six general hospitals and three mental health institutions that provide clinical psychology services. Results: The percentage of male referrals (60.3%) is higher than that of female referrals (39.7%). Adult cases had the highest percentage of referrals (48.2%). Children (48.8%) and adolescent (28.1%) cases were mainly referred for psychological assessment. Meanwhile, adult cases (74.8%) were mainly referred for psychological intervention. Neurodevelopmental disorders was the diagnosis with the highest percentage of referrals recorded (41.4%), followed by depressive disorders (13.3%) and anxiety disorders (12.7%), and the combination of other disorders. Psychiatrists provided the highest number of referrals (82.2%), which is unsurprising as both fields are closely related. Conclusion: Clinical psychology services within the Ministry of Health (MOH) Malaysia play an important role in mental health care.